Meniere's disease is a pathologic condition of the inner ear that is characterized by vertigo, tinnitus and a progressive loss of hearing. When Meniere's disease is unresponsive to medical treatment and when destructive surgery is not advisable, patients, particularly the elderly, often benefits from endolymphatic sac enhancement, a conservative, nondestructive surgical procedure. We evaluated the outcomes of 62 such patients, aged 65 years and older, who underwent a total of 78 endolymphatic sac enhancements. We assessed their response to surgery by means os a questionnaire, which classified pre- and post-surgical data according to criteria established by the American Academy of Otolaryngology-Head and Neck Surgery. Of the 27 patients who returned questionnaires, 23 reported significant alleviation of vertigo symptoms and 19 said their hearing ability had either improved or was maintained at presurgical levels. Endolymphatic sac enhancement resulted in no mortality was documented in only one patient. We conclude that endolymphatic sac enhancement is a safe and viable treatment for elderly patients with Meniere's disease that is refractory to medical therapy.