Results are reported for 40 patients with disabling vestibular symptoms, treated with endolymphatic sac surgery (ELS), gentamicin injections in the middle ear, or vestibular neurectomy by the middle fossa approach. If ELS failed, an additional treatment with a second ELS procedure or gentamicin instillations was performed. If the gentamicin treatment failed, the patients were treated with a second series of gentamicin instillations or vestibular neurectomy or both. The results in relieving the patients of their vertigo were found to be almost the same with each of the treatment modalities: approximately 82% of the patients in each group reported total or substantial relief of vestibular symptoms, whereas the rate of complications differed between the groups. After ELS, one patient had a possible complication in that she became deaf 10 days after surgery. After gentamicin injections, 12 of the 14 patients with preoperatively measurable hearing had significantly decreased hearing, but no other complications were reported. After vestibular neurectomy, five of 11 patients had complications in the form of hearing loss, infections, or transient facial paralysis. No effect on tinnitus was seen after any of the methods. When evaluating the outcome after the final surgical treatment of the 40 patients, it was found that 38 patients (95%) reported total or substantial relief of vestibular symptoms. A future policy for surgical treatment of vertigo is discussed.