Purpose <p>To explore the long-term vestibular and audiometric results of the patients with Meniere’s disease (MD) who underwent endolymphatic duct blockage (EDB), endolymphatic sac drainage (EDD) and endolymphatic sac decompression (ESD).</p> Methods <p>A total of 51 MD patients receiving EDB (<i>n</i> = 24), EDD (<i>n</i> = 15) and ESD (<i>n</i> = 12) were enrolled for evaluation of their vertigo control, hearing threshold, caloric test, and video head impulse test (vHIT) results with 4-year follow-up.</p> Results <p>The recurrence rate of vertigo attacks ratio was significantly higher in ESD compared to the EDB (<i>P</i> = 0.012) and EDD (<i>P</i> = 0.037) groups. Both EDB and EDD showed a significantly lower vertigo recurrence rate (VRR) than ESD (<i>P</i> = 0.040 and <i>P</i> = 0.047, respectively) from 0 to 24 months; yet EDB showed a significantly lower VRR than EDD (<i>P</i> = 0.044) and ESD (<i>P</i> = 0.010) in 25 to 48 months postoperatively. Compared with preoperative measurements, the postoperative average hearing thresholds and mean caloric canal paresis value tended to decrease in EDB but increase in ESD with no statistically significant difference, while hearing and caloric canal paresis value increased significantly in EDD (<i>p</i> = 0.001). A comparison of preoperative and postoperative prevalence of abnormal vHIT test showed no significant differences in EDB and ESD, but a significant difference in EDD (<i>p</i> = 0.017).</p> Conclusion <p>Both EDB and EDD were more effective than ESD in controlling vertigo spells. In contrast to the relatively poor preservation of hearing and vestibular function in ESD, EDB could better preserve hearing and vestibular function, while in patients who underwent EDD, both hearing and vestibular impairments could be detected in long-term follow-up.</p> Level of evidence <p>4.</p>