ABSTRACTThe evidence for the existence of secondary endolymphatic hydrops in patients with perilymphatic fistulas is reviewed and the indications for treatment of such hydrops in patients with fistulas are discussed. The indications for and results of combined fistula repair by middle ear exploration and endolymphatic sac surgery in fifteen patients are presented. The preliminary results in these patients appear encouraging. Patients with recurrent perilymphatic fistulas, or with symptoms of attacks of spinning vertigo after fistula repair, and those who present with severe imbalance with findings of a perilymphatic fistula appear to be candidates for combined fistula and sac surgery.