Endolymphatic sac revision after an initially successful ESE procedure has been found to have a useful role for patients who have recurrent intractable Meniere's disease. Most of these patients have benefited from revisional surgery with loss or control of vertigo, retention or improvement of hearing, and improvement of symptoms of pressure, tinnitus, and inability to tolerate loudness. In addition to its clinical efficacy, endolymphatic sac revision provides the best opportunity to observe objective findings (eg, fibroblastic and osteogenetic invasion, an obstructed, tight sac and contiguous dura, and marked yellow discoloration of previously placed Silastic T-struts and spacers) that enhance a visible observation and understanding of the pathogenesis over time. Correction of these pathologic findings in the region of Trautmann's triangle seems to improve malabsorption and dysfunction in the endolymphatic sac. Endolymphatic sac enhancements and revisional procedures correct a patient's symptoms by reversing (affecting) the role of the endolymphatic sac in the pathogenesis of Meniere's disease.