Mastoidectomy

Mastoidectomy is a surgical procedure that is done to remove air cells of the mastoid bone. Mastoid bone is a hard, bony bump that you feel at the back of the ear. This bone contains honeycomb-like structures that are filled with air spaces called mastoid cells. It also connects with the air spaces in the middle part of the ear. Hence, when a person has ear diseases that affect the middle ear, it can spread to the mastoid bone. In such a situation, mastoidectomy is necessary.

The surgery is usually performed to remove the cholesteatoma. Cholesteatoma is an abnormal skin growth behind the eardrum that pushes into the middle ear or grows back to the mastoid bone. This causes wearing of the mastoid bone and may result in hearing loss. With the help of this surgery, the eardrum can be repaired, and the hearing mechanism can be reconstructed.

Mastoidectomy is performed in two ways:

• Combined approach tympanoplasty: Also called closed cavity surgery, it is usually performed in two stages with a gap of nine to 13 months. 
• Modified radical mastoidectomy: Also called open cavity surgery, this method is usually recommended for cholesteatoma.

Mastoidectomy is recommended in people with the following conditions:

• Cholesteatoma 
• Otitis media (complications of an ear infection)
• Those intending to place a cochlear implant (the surgery allows the doctor to access the middle ear for the implant)
• A mastoid bone infection that does not go away with antibiotics

Your healthcare practitioner may order this surgery if you have the following symptoms of cholesteatoma or mastoiditis (bacterial infection affecting the mastoid bone):

• Dizziness 
• Hearing loss in one ear
• Pressure sensation or fullness inside the ear
• Discharge from the ear
• Headache
• Fever
• Fatigue or irritability 
• Redness, pain, swelling, and tenderness behind the ear
• Scaly skin in and around the ear
• Pain inside the ear

This surgery is contraindicated if a person has a medical condition that prevents the use of general anaesthesia (that will make you sleep during the surgery), as this anaesthesia is required for the surgery. 

Presence of conditions like encephalocele (a sac-like protrusion of the brain and brain membranes through an opening in the skull) or meningoencephalocele (a type of encephalocele) can also be a contraindication for this surgery.

Before the surgery is conducted, the following preparation is needed:

• Keep the ear dry before the surgery. If you have an infection in the ear, the doctor will prescribe antibiotic ear drops for two weeks prior to the surgery. 
• You may be asked to stop blood-thinning medicines like aspirin or ibuprofen for two weeks before the surgery.
• Avoid smoking two weeks before and after the surgery as it may lead to scarring and delayed healing.
• Fasting for at least six hours before the surgery is required. This also includes avoiding drinks like tea and coffee with milk. You may be allowed to drink water, black tea, or black coffee until two hours before the surgery.
• Take your medicines with only a small quantity of water.
• Inform your healthcare practitioner if you take any medication. This includes both prescribed and non-prescribed drugs.
• You need to sign a consent form before the surgery. In case you have any queries about the surgery, ask your doctor before signing the consent form.

The surgeon may follow this procedure for the surgery:

• You will be given general anaesthesia. 
• A cut will be made behind the affected ear. 
• The surgeon will access the mastoid bone and the middle ear cavity by using a bone drill.

In combined approach tympanoplasty, only the mastoid bone is removed. The ear canal is preserved. 

In modified radical mastoidectomy, the back of the ear canal is removed along with the mastoid tissue. This leaves a cavity that allows easy access to the mastoid bone.

If a cavity is formed, it is stitched using cartilage - the strong, elastic tissue that makes up the firm part of the ear. The surgeon will then stitch and cover the cuts with a bandage. They may also place a drain just behind the ear to prevent fluid accumulation.

The surgery can be completed in two to three hours.

After the surgery, you will be moved to the recovery room. You will have to stay overnight in the hospital. A nurse will monitor the effect of general anaesthesia on your body along with your blood pressure, heart rate, and oxygen levels. The next morning, your doctor will remove the bandage around your head. If you have pain, they may give you painkillers after that you may be allowed to go home.

After the surgery, you may experience the following:

• You may have pain at the operation site, headache or feel ear pressure. Painkillers can help to relieve the pain. 
• There may be stiffness or soreness in your jaw since it is near the ear. To avoid that, your doctor may ask you to take soft food.
• Some people may have numbness at the incision area for months. 
• There will be packing inside the ear canal, which will dissolve or be removed on your first visit to the doctor. It is normal to have black or dark red stains on the cotton ball due to dissolvable packing. 
• You may also hear crackling or popping noises in your ear, which is normal. 
• You may have a blood-stained discharge from the wound for a few days to one to two weeks. 
• You will experience change in taste after the surgery. 
• A few people may have dizziness that may last for about a week.
• You may also have difficulty in hearing for a few months due to packing, dressing, or swelling.

You will need to take care of the following after surgery:

• You should sneeze through an open mouth. Do not blow your nose for a few weeks to avoid the build-up of ear pressure. 
• Keep your operation site dry. 
• Cover your ear and the operation site while washing your hair. 
• The cotton wool placed inside the ear canal must be changed when it gets wet with discharge. 
• You may need to use ear drops as directed by your doctor.
• You can resume your work or school after seven to 10 days. 
• You can start with some gentle activities like walking or household work for the initial three weeks after the surgery. 
• Avoid heavy lifting or doing any strenuous activity, including aerobics, jogging for four weeks.
• Avoid air travelling for at least six weeks after the surgery.
• Avoid drinking alcohol or driving while taking any painkillers.
• Avoid swimming for a minimum of two months.

Mastoidectomy can successfully help you to get rid of the infection in the mastoid bone. It also helps to hear effectively.

When to see the doctor?

Visit or contact your doctor if you have the following symptoms:

• Temperature above 38.5^°C 
• Facial weakness 
• Severe vertigo (dizziness)
• Vomiting
• A severe headache unresponsive to pain medications
• Increase in pain 
• Redness around the wound
• Discharge from operation site
• Reduced hearing
• Infection
• Bleeding

The possible risks of the surgery include:

• Hearing loss 
• Tinnitus (ringing in the ears)
• Dizziness 
• Taste disturbance 
• Infection 
• Facial weakness
• Numbness on the top of the ear 
• Leaking of cerebrospinal fluid (fluid that surrounds the brain)

You will need a follow-up visit about two weeks after mastoidectomy to remove the packing inside the ear and later in about one to two months to assess your ear and hearing ability.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.