Types and Procedure of Mastoidectomy | ENT Specialist

What is mastoidectomy?

Mastoidectomy is a surgical procedure that excludes diseased mastoid air cells. These cells are found behind the ear in a hollow area of the skull. In general, mastoidectomy (with or without tympanoplasty) is recommended for patients with chronic cholesteatoma and/or chronic otitis media that have not responded to medical treatment. Your doctor is specially trained to perform mastoidectomy surgery on your suburban ear, nose, and throat.

Types of mastoidectomy

Various procedures are described, such as simple mastoidectomy, canal-wall-up, and canal-wall-down mastoidectomy.

Simple mastoidectomy: The lateral wall of the mastoid is excluded. The upper posterior wall of the external vocal cords is preserved. The eye chain cannot be visualized.

Canal wall up (closed) mastoidectomy: Similar to a normal mastoidectomy in which the lateral wall of the mastoid is excluded and the superior posterior wall of the external vocal cords is conserved. Besides, the septum of the cochlea is removed, providing access to the middle ear cavity and helping to visualize the first ossicle.

Canal wall down (open) mastoidectomy: Similar to the canal wall of the mastoidectomy, the septum of the cochlea is removed to create a conversation with the lateral wall of the mastoid and the cavity of the middle ear. The main difference is that the upper back wall of the external healthy meat is also removed. The tympanic membrane is usually rebuilt. Mastoidectomy is similar to the modified downward canal wall but does not change the ossicular chain of the tympanic membrane.

Purpose of mastoidectomy

Mastoidectomy is done to exclude infected mastoid air cells made by an ear infection such as mastoiditis or chronic otitis, or by inflammatory disease of the middle ear (cholesteatoma). Mastoid air cells project from the temporal bone of the skull into the open spaces, which contain air throughout the mastoid bone, the prominent bone behind the ear.

The air cells are connected to a cavity in the upper part of the bone, which is connected to the middle ear. Sometimes aggressive middle ear infections spread through the mastoid bone. When antibiotics cannot clear the infection, it may be necessary to surgically remove the infected area. The main goal of surgery is to completely remove the infection to produce an infection-free ear. Mastoidectomies are sometimes performed to correct frozen facial nerves.

Risk factors of mastoidectomy

Risk factors may include:

  • Changes in taste
  • Dizziness
  • Hearing loss
  • Infection that persists or keeps returning
  • Noises in the ear (tinnitus)
  • A weakness of the face

Mastoidectomy procedure

Preparation: Healthcare provider will talk with you about how to prepare for surgery. They may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medications to take or not take on the day of your surgery. If you have an ear infection, you may be given antibiotics before surgery. Before surgery, you may need blood tests, hearing tests, X-rays, or CT scans.

During the procedure: Your doctor will usually perform a mastoidectomy under general anesthesia. This will ensure that you are asleep and not in pain. For a general mastoidectomy, your surgeon will generally do the following:

  • Access your mastoid bone through the cut made behind your ear
  • Use a microscope and a tiny drill to start your mastoid bone
  • Use suction watering to keep the surgical area clear of bone dust
  • Drill out the infected air cells
  • Stitch up the operative site
  • Cover the site with gauze to keep the wound clean and dry

Your specialist may also use a facial nerve adviser during surgery. Helps limit facial nerve injury.

After the procedure: There are stitches behind the ear. You may also have a large dressing on your operated ear. A gauze mastoid bandage or flexible neoprene bandage is placed around the head over the operation site to collect drainage from the ear and reduce the risk of bruising from injury. This dressing is removed 24 hours after surgery. Patients are usually instructed by covering the operative ear with a cup or by placing a petroleum jelly-coated cotton ball in the external ear canal while bathing.

You must stay in the hospital overnight. Your provider will give you pain relievers and antibiotics to prevent infection.

Postoperative care is usually visited to remove the plugging in the ear canal 1-2 weeks after surgery. Patients may receive topical antibiotic drops the day after surgery or several days before the initial surgery. Topical antibiotic drops serve the dual purpose of reducing the risk of postoperative infection and hydrating the package to facilitate removal during the initial post-surgery visit.

Patients undergoing the canal wall descent procedure may have reusable sponge packs, gauze strips, or packings in the mastoid cavity and/or metastasis. This tamponade is often removed in the first 2 weeks after surgery. It takes weeks to months for the cavity canal wall to heal completely. Intermittent debridements of the lower canal wall cavity are required periodically (3-12 months) even after the cavity has fully healed.

Complications of mastoidectomy

Like other surgeries, mastoidectomy can be associated with certain risks and complications. There are common problems:

  • Temporary Dizziness
  • Dry mouth
  • Temporary loss of taste on the surface of the tongue
  • Infections, including meningitis or brain abscesses
  • Determined ear discharge
  • Tinnitus
  • Hearing loss
  • General anesthesia problems

Rare complications include:

  • Facial weakness
  • Eye problems
  • Hematoma

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