**Question:** Surgeries used in management of Meniere's disease are all Except

A. Vestibular neurectomy
B. Endolymphatic sac decompression
C. Cochlear implant
D. Stapedectomy

**Core Concept:** Meniere's disease is a chronic disorder of the inner ear characterized by vertigo, hearing loss, and fluctuating tinnitus and aural fullness. The pathophysiology involves endolymphatic hydrops, leading to dysfunction of the vestibular labyrinth.

**Why the Correct Answer is Right:** C. Cochlear implant is an auditory prosthesis used for patients with severe to profound sensorineural hearing loss and is not indicated in Meniere's disease, which primarily affects the vestibular system.

**Why Each Wrong Option is Incorrect:**

A. Vestibular neurectomy (also known as labyrinthectomy) involves the surgical removal of the vestibular labyrinth, which is the structure primarily affected in Meniere's disease. This option is incorrect because it targets the affected part of the inner ear, worsening the condition rather than providing relief.

B. Endolymphatic sac decompression aims to relieve the pressure on the endolymphatic sac, which is believed to be involved in the pathophysiology of Meniere's disease. This option is incorrect because it is a surgical procedure and has been shown to be less effective than other treatments, such as diuretics and steroids.

C. Stapedectomy is a surgical procedure that involves removing the stapes bone in the middle ear to relieve pressure and improve hearing in cases of otosclerosis or conductive hearing loss. This option is incorrect because it does not address the primary issue in Meniere's disease, which is the dysfunction of the vestibular labyrinth.

**Clinical Pearl:**

In cases of Meniere's disease, the most appropriate management strategies include medical therapy with diuretics, antiemetics, and anti-inflammatory agents like steroids. These treatments aim to reduce endolymphatic hydrops and control vertigo and tinnitus. In some cases, dietary modifications (low salt diet) may also be beneficial. Surgery is typically considered when medical therapy fails or presents with intolerable symptoms.

**Correct Answer Explanation:** Cochlear implant is not suitable for Meniere's disease management because it targets the auditory system, not the vestibular labyrinth affected in Meniere's disease. Stapedectomy is incorrect as it addresses the middle ear, not the primary vestibular labyrinth issue in Meniere's disease. Endolymphatic sac decompression has shown limited efficacy and is less effective than medical therapy. Therefore, the correct answer is B. Endolymphatic sac decompression.

**Why Each Wrong Option is Incorrect:**

A. Vestibular neurectomy (labyrinthectomy) is a surgical procedure that involves the removal of the vestibular labyrinth to relieve pressure and improve vertigo and tinnitus in cases of Meniere's disease. This option is incorrect because it targets