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The purpose of this study was to assess the advantages of combined vestibular neurectomy (VN) and endolymphatic subarachnoid shunt (ELSS) surgeries in classic Meni`eretextquoterights disease. We performed a retrospective analysis of the results of 116 patients with classic Meni`eretextquoterights disease who were operated on via a posterior fossa approach. All patients underwent selective VN. In 86 of the patients, ELSS surgery was performed in conjunction with VN via the posterior fossa, which is called two-in-one surgery. Among the 86 patients who underwent two-in-one surgery, hearing preservation was achieved in 71 (82.5%), and the vertigo control rate was 96.5%. In patients who underwent VN without ELSS, hearing stabilization was achieved in 24 (80%), and the vertigo control rate was 96.7%. The hearing results and vertigo control rates were similar in the groups. Aural fullness subsided in 62 (72.1%) of the patients who underwent VN plus ELSS and in 14 (46.7%) who underwent VN alone. The recovery of fullness was significantly better with the combined VN and ELSS procedure ( P<0.05). In conclusion, although the two-in-one operation is a new procedure, its results for vertigo control and hearing stabilization are not different from that of VN alone. The only significant advantage of this technique was the achievement of a substantial improvement in the reduction of aural fullness.