■ OBJECTIVES: We first published our institutions series of EMS procedures in 1998. Since that time the popularity of transtympanic round window medicinal perfusion has grown. Management of patients with medically refactory endolymphatic hydrops remains controversial with significant numbers of neurotologists continuing to perform EMS surgery according to survey data. This review constitutes a review of our clinical experience and reflects our contemporary management algorithm.

■ METHODS: Retrospective case review 1612 patients referred with a diagnosis of Meniere’s disease to a tertiary referral center.

■ RESULTS: Of 1612 patients referred, 486 underwent EMS surgery. Employing the Arenberg anatomic classification system at a minimum of 5 years follow-up: vertigo was controlled in patients with a Type I sac 72%, Type II, 90%, and Type III 81%

■ CONCLUSIONS: EMS remains a conservative viable option for long term control of vertigo in Meniere’s patients refactory to conventional medical management.