Mastoid surgery is performed when infections in the middle ear spread to the mastoid cavity. Commonly a pocket of skin (Cholesteatoma) develops on the ear drum and may invade the middle ear and subsequently the mastoid. This may cause recurrent ear discharge. The Cholesteatoma may also invade the ossicles (3 bones in the ear that are involved in hearing), causing hearing loss.
Hearing tests and CT scan are also obtained prior to surgery.
A mastoidectomy is performed with the patient fully asleep (under general anesthesia). A surgical cut (incision) is made behind the ear. The mastoid bone is then exposed and opened with a surgical drill. The infection is then removed. The incision is closed with stitches under the skin. A drainage tube may also be placed.
The operation is usually carried out under a general anesthetic.
Depending on the amount of infection or Cholesteatoma present, various types of mastoid operations can be performed.
Simple Cortical Mastoidectomy, the surgeon opens the bone and removes any infection. A tube may be placed in the eardrum to drain any pus or secretions present in the middle ear.
Modified Radical Mastoidectomy (MRM) means that some middle ear bones are left in place and the eardrum is repaired-Tympanoplasty.
In more extensive Cholesteatoma, the disease may have eroded through the bony wall which separates the middle ear from the mastoid. This may require a more radical operation, removing the wall separating the middle ear from the mastoid. The result is a so-called open cavity which requires life-long follow-up in the outpatient clinic, every few months.
Radical Mastoidectomy removes the most bone and is indicated for extensive spread of a Cholesteatoma. The eardrum and middle ear structures may or may not be completely removed. Usually the stapes bone is spared if possible to help preserve some hearing.
Intact Canal wall Mastoidectomy
In less extensive Cholesteatoma, especially when infection is well controlled before surgery, an intact canal wall operation may be the favored procedure. This operation preserves the wall between the middle ear and mastoid. The principal advantages of the intact canal wall operation are a more normal canal and ear drum, and a greater possibility of hearing restoration. In addition, most patients with the intact canal wall operation can allow water in the ear. The chief disadvantage of the intact canal wall operation is that a regrowth of cholesteatoma may not be evident. Thus, many ear surgeons will delay rebuilding the bones of hearing for a year after an intact canal wall operation for cholesteatoma.
The ear drum is opened at the second operation and the bones of hearing are then reconstructed. If a regrowth of cholesteatoma is found, the disease is again removed and reconstruction may be delayed for another 6 months or a year. Repeat CT scans may also be performed in some cases to avoid further surgery.
After the disease has been removed, a graft will be used to seal up any hole in the eardrum, and packing placed in the ear canal.
There are multiple variations of the mastoid operation, so your surgeon will explain the details which apply to you.
Bleeding and/or infection of the wound area are possible complications with any incision. Antibiotics and good surgical technique help prevent this. Some blood-tinged drainage is common in the first two days.
Complications can include injury to the balance system, hearing loss, or facial nerve. Dizziness or a ringing in the ear (tinnitus) could also result.
Patient in post operative recovery station
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