Surgical treatment of Ménière’s disease is typically reserved for patients with persistent dizziness symptoms that do not respond to conservative medical therapies such as a low-sodium diet, diuretics, and intratympanic injections. Multiple surgical options exist, and clinical recommendations should be based on hearing status and the severity of symptoms. Endolymphatic sac decompression or shunt procedures aim to reduce inner ear fluid pressure while preserving hearing and are often first-line, outpatient surgical choices. Vestibular nerve section provides effective vertigo control by interrupting vestibular signals from the faulty inner ear but requires craniotomy and carries a slightly higher risk of hearing loss. For patients with non-serviceable hearing, transmastoid labyrinthectomy is highly effective, removing the neuroepithelium from the balance organ entirely; a trade-off is the loss of all remaining hearing in the ear. Each surgical approach balances vertigo control, hearing preservation, and procedural risk. Selection depends on patient goals, anatomy, and hearing status.