Balance disorders are typically treated by a combination of balance therapy and medication. However, not all patients with intractable and debilitating vertigo respond to therapy or are appropriate for this. In such instances surgery can have a role in management. The treating clinician must exercise extreme care in prescribing a surgical option to the patient, since operating on the inner ear inappropriately can be potentially devastating. Key to the decision making process is being certain of the precise diagnosis and being confident which ear is active. This decision to offer surgery is based largely on the diagnosis and the impact that the patient's symptoms are having on their lifestyle.