[The surgery of the endolymphatic sac: a conservative or destructive procedure?]

A detailed analysis of different aspects relative to endolymphatic sac surgery employed as conservative surgical treatment in Menière's disease is presented. The presumed basic principles for this type of surgery, which have led several otologists to adopt this procedure in the therapeutical protocol followed in Menière's disease, are discussed along with the good symptomatological results obtained. Particular emphasis is put on the multiple functions which have been attributed to the endolymphatic sac in the functional dynamics of the entire inner ear environment. Among these functions, relevance is given to the secretory activity, which is presumed to be triggered by endolymphatic dysbarisms, which implies that macromolecules that are able to interact with fluid metabolism (glycosaminoglycans) might flow into the luminal endolymphatic space, a phenomenon which may well open new perspectives for the pathogenesis and treatment of Menière's disease. On the grounds of these premises, the conservative aspect of endolymphatic sac surgery, along with its mechanism of action, is reassessed.