This chapter describes the surgical treatment options for Ménière’s disease, focusing on the controversial efficacy of two specific procedures: the traditional endolymphatic sac decompression and the newer endolymphatic duct ligation. It aims to summarize the conflicting evidence regarding their effectiveness in controlling vertigo, noting that while some studies question their value, others report high success rates. It concludes that duct ligation may be more effective but is also more complex and riskier.