Mastoidectomy

Overview 

A mastoidectomy designed to excise diseased cells from the air-filled cavities of the mastoid bone, which is situated posterior to the ear. The mastoid bone, characterized by its sponge-like, honeycomb structure, plays a critical role in ear function.  

A mastoidectomy is commonly used for the management of cholesteatoma, a condition involving abnormal growths that can invade the skull, or for chronic ear infections that have extended beyond the middle ear. It may also be performed to facilitate the placement of cochlear implants, enhancing auditory function in patients with severe hearing loss.

Types  

There are several types of mastoidectomy:  

• Simple mastoidectomy: While ensuring that the ear canal and middle ear structures are completely unaffected, the disease in the mastoid bone is treated.   
• Canal-wall-up mastoidectomy: This procedure leaves the ear canal intact while removing more bone to access the middle ear, including the small bones that help with hearing.  
• Canal-wall-down mastoidectomy: This is often called a radical or modified mastoidectomy and is used for extensive or recurring disease that has not responded to less invasive procedures. This surgery creates a single open space by combining the ear canal and mastoid bone, called a mastoid cavity, with an enlarged ear canal opening for easier cleaning. It is done when the ear canal is severely damaged or needs to be removed to eliminate disease.  

Reasons for undergoing the procedure  

A mastoidectomy is often used to treat certain conditions, such as:  

• Cholesteatoma, or noncancerous growth behind the eardrum from chronic infections  
• Repair of a ruptured eardrum, usually with tympanoplasty  
• Otitis media, or ear infections that spread to the skull  
• As part of cochlear implant surgery 

If the eardrum is ruptured, a mastoidectomy with tympanoplasty is performed to repair it, though tympanoplasty can also refer to surgery behind the eardrum even if no repair is needed.  

Risk 

Mastoidectomy carries potential risks, such as:  

• Tinnitus, or ringing in the ears  
• Dysgeusia, or a change in taste that frequently persists for several months  
• Sensorineural hearing loss, or inner ear hearing loss  
• Damage to the facial nerve, which may result in paralysis or weakness in the face  

Before the procedure  

Your healthcare provider will provide you with detailed preoperative instructions, which should be followed carefully. In some instances, you may be required to temporarily stop taking specific medications. Since a mastoidectomy is performed under general anesthesia, it’s also essential to arrange for a trusted friend or family member to drive you to and from the procedure. 

During the procedure  

To ensure your comfort, you will be placed under general anesthesia during the procedure. The following steps outline what your surgeon will do: 

• Incision:  A careful incision will be made behind your ear to access the mastoid bone. This placement helps minimize the visibility of the scar. 
• Bone access:  Specialized instruments will be used to open the mastoid bone. 
• Removal of infected cells:  The surgeon will remove the infected air cells in your mastoid. 
• Closure:  The surgical site will be closed with stitches. 
• Wound dressing:  The area will be dressed with gauze to protect the wound. 

The entire surgery typically takes about 2 to 3 hours. 

After the procedure  

After a mastoidectomy, the healthcare provider will provide instructions that one should follow to ensure comfort during the healing process. They will be closely monitored while in the recovery room before they will be allowed to go home.   

While pain should not be felt during the surgery, mild discomfort may occur afterward, including soreness at the incision site and a full or stuffy feeling in the ear. These side effects can typically be managed with over-the-counter pain relievers like acetaminophen or ibuprofen.  

Outcome 

While on recovery, it is important to monitor for signs of complications. Seek immediate medical assistance, if any of the symptoms is experienced:  

• Loss of hearing  
• Excessive ear discharge or bleeding  
• Weakness in the face  
• Fever  
• Vertigo or dizziness

Recovery from a full mastoidectomy typically takes six to twelve weeks, but many individuals can resume work, school, and daily activities within one to two weeks. 

While mastoidectomy is generally successful, outcomes depend on the specific reasons for the surgery and the type performed. The main goal of the procedure is to eliminate infections that could cause further complications, rather than to restore hearing.   

It can help treat chronic ear infections and reduce their chances of coming back, as well as prevent serious complications from cholesteatoma, which can include:  

• Labyrinthitis  
• Meningitis  
• Brain abscess  
• Facial nerve damage  
• Hearing loss  
• Vertigo  
• Dizziness

However, some degree of hearing loss is common, especially after more extensive procedures like radical or canal-wall-down mastoidectomy.