Meniere's disease is a disease of the inner ear characterized by a triad of 
symptoms: vestibular symptoms, auditory symptoms, and pressure. The pathologic 
correlate of Meniere's disease is endolymphatic hydrops and the etiopathogenesis 
involves a deficiency in the absorption of endolymph. The pathophysiology of the 
symptoms is still disputed: membranous ruptures, pressure and mechanical 
displacement of the end organs, or obstruction followed by an abrupt clearance 
of the endolymphatic duct. The course of the disease may be progressive or 
nonprogressive and, in addition to the typical presentation of Meniere's 
disease, two variations of the disorder have been identified: cochlear Meniere's 
disease, and vestibular Meniere's disease. It can be further broken into two 
subsets: Meniere's syndrome, with a known and well-established cause, and 
Meniere's disease, in which the cause seems to be idiopathic. It is likely that 
there are racial (genetic) as well as environmental factors that influence 
differences in incidence among countries and among various sections of 
countries. The disease is much more common in adults, with an average age of 
onset in the fourth decade, the symptoms beginning usually between ages 20 and 
60 years. Meniere's disease is (grossly) equally common in each sex, and right 
and left ears are affected with fairly equal frequency. The diagnosis of 
Meniere's disease is by exclusion, and a careful history is the most important 
guide to a correct diagnosis. Its medical treatment is largely empiric. Surgery 
can be considered when, even after medical therapy, the disease progresses and 
the symptoms become intractable. Surgery may be either conservative or 
destructive. Bilaterality must be considered when deciding the best surgical 
option for a patient with Meniere's disease. It is the authors' opinion that 
endolymphatic sac surgery is an extension of conservative treatment.