Pathology of Ménière's disease as it relates to the sac and tack procedures.

The rationale for endolymphatic sac and tack operations is to prevent the further accumulation of endolymph, the former by draining endolymph into extralabyrinthine tissues and the latter by shunting endolymph into the perilymphatic space. While the basic concepts are reasonable enough, the probability of achieving these objectives seems remote. There appears to be adequate clinical evidence, however, to show that these procedures are of therapeutic value in selected cases. It is tempting to speculate that these surgical insults to the labyrinth, with the associated inflammatory and biochemical changes, alter the function of cells which control fluid physiology and thus improve the symptoms of Ménière's disease.