The senior author has performed shunt procedures routinely for medically refractory cases of Meniere's disease starting in 1964 and ending in 1984. Five hundred and sixty-eight consecutive patients were operated on and followed from 1970 to 1984. Combining the cases of C. G. Jackson, there have been a total of 676 procedures done at the Otology Group. Initially endolymphatic-subarachnoid (ES) shunts were used, then endolymphatic-mastoid shunts (EM), and recently, the Denver valve has been employed. No significant difference between these procedures was noted in the control of vertigo or stabilization of hearing. Successful resolution of vertigo occurred in less than 60%. Sac surgery at the Otology Group, therefore, has been abandoned in favor of vestibular nerve section for the surgical management of medically refractory Meniere's disease with disabling vertigo.