This article takes the reader through the two main approaches for a labyrinthectomy for intractable Meniere’s disease. These are the traditional trans-mastoid and the less well known trans-canal. They state that according to the House clinic, the selection criteria for labyrinthectomy should be 70dB hearing or greater and a word score of 30%. However, one must bear in mind that some patients may forego any hearing they have in the affected ear just to resume a normal life without devastating vertigo affecting it. The authors describe both techniques, supported by line drawings to illustrate the approaches. The trans-canal was especially interesting as I personally had not encountered it – it made me wonder why, until I reached the end of the descriptions where the authors reviewed the outcomes. Trans-canal appears to have similar vertigo control to trans-mastoid but postoperative imbalance was much more common with trans-canal (22% vs 62%). The hypothesis was that trans-mastoid offered improved surgical access to remove all neuro-epithelium as compared with trans-canal. A more thorough review of the literature with respect to large case series and postoperative complications would have been complimentary. Nonetheless, the article serves as a useful aide memoire for those embarking on occasional labyrinthectomy surgery.