Surgical treatment of otogenic vertigo.

Abstract

Objective: To provide a comprehensive review of surgical strategies for vestibular dysfunction-induced vertigo (VDIV), including indications, contraindications, and comparative efficacy analyses of mainstream procedures, and to critically evaluate contemporary controversies and emerging directions based on recent advancements.

Background: Vestibular dysfunction-induced vertigo (VDIV), a balance disorder caused by inner ear pathology, significantly impacts patients' quality of life and often requires surgical intervention when conservative treatments fail. While pharmacological management and vestibular rehabilitation alleviate symptoms in most cases, approximately 10-20% of patients progress to refractory VDIV due to failed conservative treatment, necessitating surgical intervention.

Methods: This article provides a comprehensive review of surgical strategies for VDIV, including indications, contraindications, and comparative efficacy analyses of mainstream procedures (e.g., endolymphatic sac decompression, semicircular canal occlusion, vestibular neurectomy).

Results: Current evidence suggests that ESD offers symptom control in 62.1%-80.36% of patients with minimal invasiveness, while transcanal semicircular canal plugging (TSCP) achieves higher success rates (96.7%-100%) at the cost of potential hearing loss. For patients in the advanced stage of the disease, combined surgical procedures (such as ESD+TSCP) can achieve a balance between vertigo control (100%) and hearing preservation (with a hearing loss rate of 33.3%).  CONCLUSION: The selection of surgical methods should be based on a comprehensive consideration of the patient's specific condition, including the severity of vertigo, hearing level, and overall health status. Future research should focus on exploring more effective and less invasive surgical techniques to improve the prognosis of patients. Additionally, in-depth studies on the long-term outcomes and quality of life of patients after different surgical procedures are necessary to provide more scientific and reliable evidence for clinical decision making.