In those Meniere's patients who are refractory to medical management, endolymphatic sac surgery can be offered in an attempt to decompress the hydropic condition. Wide bony decompression of the endolymphatic sac has been found to control vertigo in over 70% of selected cases. The technique of bony decompression is described as well as recent modifications. This surgical alternative, with a history of a low complication rate, is currently offered early in the course of Meniere's disease as an attempt to reduce or eliminate vertigo and stabilize hearing. In those Meniere's patients who are refractory to medical management, endolymphatic sac surgery can be offered in an attempt to decompress the hydropic condition. Wide bony decompression of the endolymphatic sac has been found to control vertigo in over 70% of selected cases. The technique of bony decompression is described as well as recent modifications. This surgical alternative, with a history of a low complication rate, is currently offered early in the course of Meniere's disease as an attempt to reduce or eliminate vertigo and stabilize hearing.