Overview

Most inner-ear balance system (vestibular) disorders can be managed well with the passage of time, vestibular rehabilitation, and/or medication. However, when all other treatments have been exhausted and quality of life is severely impaired, surgery may be the only remaining choice for a small minority of patients.

Surgery for vestibular disorders continues to decline. With ongoing improvements in diagnostic tools, exploratory surgery is now rare. Medications that target the inner ear have replaced some surgeries.

Several types of operations are available depending on the cause of the dizziness. Not all procedures are options for every patient. Some can only be offered in severe situations.

With the exception of acoustic neuromas and some advanced cholesteatomas, vestibular disorders are lifestyle threatening rather than life threatening. You and your otolaryngologist (ENT) or neuro-otologist will need to decide whether a medical or surgical approach is best for you. This is a matter of carefully weighing the pros and cons of each choice. Factors include:

• severity of the disorder
• potential impact on hearing
• age
• general health

Successful procedures depend on an accurate diagnosis as well as choosing a procedure that meets your needs.

Types of ear surgeries for inner ear dizziness

Surgical procedures for inner ear dizziness are either restorative or destructive. The aim of restorative surgery is to rehabilitate or restore the function of the inner ear balance system. The aim of destructive surgery is to stop input from the inner ear balance system of the operated ear to the brain. Destructive procedures are usually successful at controlling dizziness, however hearing loss is a high risk.

Surgical procedures vary by disorder. Surgery for disorders affecting the inner ear and vestibular nerve are described on our pages about the disorder:

• acoustic neuroma
• benign paroxysmal position vertigo (BPPV)
• cholesteatoma
• Ménières disease
• otosclerosis
• perilymph fistula
• secondary endolymphatic hydrops (SEH)
• semicircular canal dehiscence (SCD)

General recommendations after ear surgery

Ask your surgeon when you can return to work or driving after surgery. This varies from days to weeks based on the severity of your dizziness/imbalance, your job and the type of surgery.

Muffled hearing ("stuffiness") can follow ear surgery. It usually improves slowly as your body absorbs the healing fluids.

Ask your surgeon if vestibular rehabilitation or occupational therapy may help you return to daily activities, work, or sports and leisure activities.

Risks and complications of surgery for dizziness

Surgical risks vary depending on the invasiveness of the procedure as well as the patient’s age and health. Most inner ear operations require a general anesthetic and an incision behind the ear after shaving away some hair.  Any surgery in or around the ear can put at risk many of the structures in this area. Surgery done next to the brain adds extra risk to life, the brain, and the surrounding nerves.

Risks and complications typically include:

• Hearing loss
  Further hearing impairment in the operated ear may follow many procedures. Perforation of the eardrum can cause some hearing loss.
• Tinnitus
  Tinnitus (ringing in the ears) usually stays the same as before surgery. If hearing is worse after surgery, tinnitus may likewise be more noticeable. Sometimes tinnitus can be improved with rehabilitation programs and specific strategies.
• Taste disturbance and mouth dryness
  Taste disturbances (dysgeusia) and mouth dryness (xerostomia - zeer-o-STOE-me-uh) are not uncommon for a few weeks after surgery. In some cases, this disturbance lasts longer or is permanent.
• Weakness of the face muscles
  The facial nerve travels through the ear bone close to the hearing and balance nerves. Temporary weakness of one side of the face is an uncommon complication after ear surgery. It may happen as the result of the surgery, an abnormality, or swelling of the nerve.
  Permanent paralysis of the face is rare. Should it happen, however, eye complications could develop. These require treatment by an eye specialist (for eye health) and a physiotherapist (for treatment of the facial muscle weakness).
  It is very important to seek guidance on facial retraining exercises. Over-using them can lead to permanent problems with how your facial muscles coordinate and move.
• Spinal fluid leak
  Some operations for dizziness result in a temporary leak of spinal fluid (fluid surrounding the brain). This leak is always closed before the end of the surgery. Sometimes, however, the leak reopens and further surgery may be needed.
• Infection
  Infection rarely happens after inner ear dizziness surgery. Should it develop, however, it could lead to meningitis (an infection in the spinal fluid) and might require intravenous (IV) antibiotics. Fortunately, this complication is rare.
• Hematoma
  A hematoma (collection of blood under the skin incision) develops in a very small number of cases. It may prolong hospitalization and healing. Another operation to remove the clot may be necessary.
• Imbalance, dizziness, and blurred vision
  Certain medical and surgical procedures can cause permanent destruction of the inner ear vestibular function on both sides (bilateral vestiblopathy). This may lead to chronic dizziness, blurred vision, and imbalance.  This is usually improved with vestibular rehabilitation, however the imbalance and dizziness may be permanent. This is especially challenging when both ears are affected by a disorder. Ask your surgeon if these symptoms are expected to be temporary or permanent and if vestibular rehabilitation might improve your recovery.

Sources

Balance & Dizziness Canada Society. A discussion of dizziness and balance disorders. Rev. 2012.

Chan YM, Mattox DE. (2014). Surgical management of vestibular disorders. In Vestibular rehabilitation (4^th edition) (pp 285-295). Philadelphia, PA: FA Davis.

Volkenstein S, Dazert S. Recent surgical options for vestibular vertigo. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2017; 16” Doc01. Available from: https://bit.ly/2NJsnDe