Surgical treatment of otological vertigo and dizziness

Many of the peripheral vertiginous syndromes have a good prognosis and the treatment is generally conservative; surgical therapy, which may also offer important benefits in selected cases, is to be considered the last of the therapeutic steps, it's must be proposed only after the failure of physical, pharmacological and rehabilitative therapies. Historically, the vertigo surgery has shown good potential if undertaken to stabilize fluctuating and/or progressive unilateral vestibular lesions responsible for recurrent vertiginous crises which not responding to multiple treatments; in these cases, the central compensation will not be possible until the vestibular dysfunction is stabilized and the surgical option it's should be consider for hydropic diseases of the inner ear, Meniere's disease, semicircular canal dehiscence syndrome, perilymphatic fistulas and some resistant forms of benign paroxysmal positional vertigo. The possibility of surgical/rehabilitation therapy has recently been introduced for patients with a complete bilateral vestibular deficit through the use of vestibular implants. These devices, designed following the same concept of the cochlear implant, consist of motion sensors fixed to the patient's head and an electronic components (processor and stimulator) which translate the motion information received into electrical signals transmitted to the brain via implanted electrodes. Actually the projects are limited to restoring the function of the VOR (Vestibular Ocolomotor Reflex), the studies on the restoration of otolithic function have not yet been endorsed on humans. In this chapter, in addition to addressing the principles underlying the surgical strategies in the management of the vertiginous patient, a general description of the technical aspects of each procedure will be provided in order to know its indications, potential, limits, and contraindications: the results depends not only on the correct etiological and site diagnosis, from the knowledge of invasiveness and possible risks due to the intervention; only knowing individual general factors (hearing function, age, general conditions..), it will be possible to propose the most suitable procedure for the individual case.