What is Mastoidectomy?
Mastoid air cells are open, air-containing spaces in the skull, behind the ear. A mastoidectomy is the surgical removal of these mastoid air cells. The surgery may extend into the middle ear.
The surgery used to be a common way to treat an infection in the mastoid air cells, which usually came from an ear infection that spread to the nearby bone in the skull. Mastoidectomy is now seldom needed, as the infections are commonly treated with antibiotics. However, this surgery may be used to treat other problems such as cholesteatoma, complications of otitis media, or used as a surgical approach for cochlear implant insertion.
A mastoidectomy is performed to remove infected mastoid air cells resulting from ear infections, such as mastoiditis or chronic otitis, or by inflammatory disease of the middle ear (cholesteatoma). The mastoid air cells are open spaces containing air that are located throughout the mastoid bone, the prominent bone located behind the ear that projects from the temporal bone of the skull. The air cells are connected to a cavity in the upper part of the bone, which is in turn connected to the middle ear. Aggressive infections in the middle ear can thus sometimes spread through the mastoid bone. When antibiotics can’t clear this infection, it may be necessary to remove the infected area by surgery. The primary goal of the surgery is to completely remove infection so as to produce an infection-free ear. Mastoidectomies are also performed sometimes to repair paralyzed facial nerves
Effects of Mastoidectomy
A mastoidectomy is a surgical procedure designed to remove infection or growths in the bone behind the ear (mastoid bone). Its purpose is to create a “safe” ear and prevent further damage to the hearing apparatus.
A mastoidectomy is indicated for MASTOIDITIS that does not respond to antibiotics. A mastoidectomy is also helpful in preventing further complications of mastoiditis. These include meningitis (infection in the fluid surrounding the brain), brain abscess (pocket of infection in the brain), or blood clots in the veins of the brain.
Mastoidectomy is often indicated for other diseases that spread to the mastoid bone, such as CHOLESTEATOMA. This procedure allows complete removal of these benign yet destructive growths. Occasionally, a mastoidectomy may be used to help find and repair an injured FACIAL NERVE.
Candidates for Mastoidectomy
Ear infections are also very common in children between the ages of six months and two years. Most children have at least one ear infection before their eighth birthday.
A complete physical examination of the ear area including the appearance of the outer ear, eardrum, and middle ear is performed. FACIAL NERVE function is also evaluated. Hearing tests and pictures (mastoid x-ray or CT scan) are also obtained prior to surgery.
The Mastoidectomy Procedure
The procedure usually takes between two and three hours. It is occasionally performed on an outpatient basis in adults but usually involves hospitalization. A mastoidectomy is performed with the patient fully asleep under general anesthesia. There are several different types of mastoidectomy procedures, depending on the amount of infection present:
- Simple (or closed) mastoidectomy. The operation is performed through the ear or through a cut (incision) behind the ear. The surgeon opens the mastoid bone and removes the infected air cells. The eardrum is incised to drain the middle ear. Topical antibiotics are then placed in the ear.
- Radical mastoidectomy. The procedure removes the most bone and is usually performed for extensive spread of a cholesteatoma. The eardrum and middle ear structures may be completely removed. Usually the stapes, the “stirrup” shaped bone, is spared if possible to help preserve some hearing.
- Modified radical mastoidectomy. In this procedure, some middle ear bones are left in place and the eardrum is rebuilt by tympanoplasty.
After surgery, the wound is stitched up around a drainage tube and a dressing is applied. A hospital stay is usually required overnight for children.
The drainage tube inserted during surgery is typically removed a day or two later. Painkillers are usually needed for the first day or two after the operation. The patient should drink fluids freely. After the stitches are removed, the bulky mastoid dressing can be replaced with a smaller dressing if the ear is still draining. The patient is given antibiotics for several days.
The patient should inform the physician if any of the following symptoms occur:
- bright red blood on the dressing
- stiff neck or disorientation (These may be signs of meningitis.)
- facial paralysis, drooping mouth, or problems swallowing
The outcome of a mastoidectomy is a clean, healthy ear without infection. However, both a modified radical and a radical mastoidectomy usually result in less than normal hearing. After surgery, a hearing aid may be considered if the patient so chooses.
Complications do not often occur, but they may include:
- persistent ear discharge
- infections, including meningitis or brain abscesses
- hearing loss
- facial nerve injury (This is a rare complication)
- temporary dizziness
- temporary loss of taste on the side of the tongue
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.
Other complications can include injury to the balance system, hearing loss, or facial nerve injury. Dizziness or a ringing in the ear (tinnitus) could also result.
What is a Simple Mastoidectomy?
In a simple 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. Antibiotics are then given intravenously (through a vein) or by mouth.
What is a Radical Mastoidectomy?
A radical mastoidectomy removes the most bone and is indicated for extensive spread of a cholesteatoma. The eardrum and middle ear structures may be completely removed. Usually the stapes (the “stirrup” shaped bone) is spared if possible to help preserve some hearing.
What is a Modified Radical Mastoidectomy?
A modified radical mastoidectomy means that some middle ear bones are left in place and the eardrum is rebuilt (TYMPANOPLASTY). Both a modified radical and a radical mastoidectomy usually result in less than normal hearing.
What are the complications and risks involved in Mastoidectomy?
Although complications do not often occur, they include persistent ear drainage, infection in the mastoid cavity, and hearing loss which may be permanent. Facial nerve injury (paralysis of the face on the side of the surgery) is a rare but potential hazard in mastoid surgery. There may be dizziness for a short time after surgery, but it is rarely permanent. Loss of taste on the side of the tongue usually lasts a few weeks but may be permanent. In extremely rare instances, brain infection (meningitis) has been known to occur.