Mastoidectomy

Mastoidectomy - What it is

mastoidectomy conditions and treatments

Mastoidectomy is a surgery done to remove mastoid air cells, which is part of the skull bone, behind the ear. There are various types of mastoidectomies, and this is dependent on the condition that you have and the extent of the disease. This surgery is done under General Anaesthesia. Most commonly, you would have a C shaped scar hidden behind your ear. Other times, there might just be a small scar just at the top of the ear, near the hair line. The most common reasons to undergo this surgery would be if you have cholesteatoma, or infection of the mastoid air cells (otomastoiditis). Mastoidectomy can also be done as part of other procedures, such as tympanoplasty (repair of ear drum perforation), cochlear implant and ossiculoplasty.

The mastoid bone is located behind the ear. It normally contains many air spaces. A mastoidectomy comprises the removal of the bony walls separating the air spaces.

This surgery may be needed if you have these following condition(s):

To remove disease or infection in the mastoid air cells or in the middle ear, such as cholesteatoma (abnormal skin in the middle ear) or mastoiditis (infection in the mastoid bone).
To create access for surgery to the rest of the ear, such as for cochlear implantation or removal of tumours.

What does it involve?

The surgery is performed under general anaesthesia. An incision is made behind the ear an incision behind the ear to expose the mastoid bone. Surgery is performed while avoiding vital structures. A facial nerve monitor is sometimes used as an adjunct during surgery.

Common risks and complications:

Giddiness

Mild giddiness is common after mastoidectomy. Rarely, the balance organ may be damaged, resulting in severe giddiness. This is usually temporary as the healthy balance system on the other side will compensate.

Uncommon risks and complications:

Bleeding from injury to the sigmoid sinus

A blood vessel that drains blood from the brain into the neck may be injured during the surgery. This is an uncommon complication and can usually be controlled with pressure.

Injury to the brain lining (Dura Mater) with leakage of brain fluid into the middle ear

This can sometimes result in headaches and rarely meningitis (inflammation of the membranes surrounding the brain). If the leak is detected intra-operatively, it can be repaired. Patients may develop this later in life and require a second operation to repair it.

Disease recurrence

Recurrent disease may necessitate further subsequent operation(s).

Injury to the facial nerve

The risk is higher in more extensive operations or revision operations. The facial nerve controls the facial muscles. Weakness will result in an asymmetrical smile, drooping of the mouth, drooling and inability to close the eyes. Weakness can be temporary from traction/stretch injury or permanently (from the nerve injury). Permanent injury may require other treatments to reduce the deformity.

Hearing loss

The sense of hearing may worsen after the surgery if the ossicles need to be removed in order to eradicate all middle ear disease. Hearing can be improved with hearing aids, or subsequent middle ear ossicular reconstruction. The risk of complete deafness is low and varies depending on what the procedure is performed for.

Loss or altered sense of taste

The taste nerve runs closely to the facial nerve and is sometimes removed for access, or excised to minimise the risk of residual/ recurrent disease. The opposite side usually compensates but this process takes time.

Wound infection

Appropriate antibiotics will be prescribed for you according to your clinical condition.

Duration of Surgery

Approximately: 2-3 hours

Duration of Hospital Stay

Average: 1-2 days

Mastoidectomy - Post-surgery care

You will be discharged from the hospital after a night’s stay after your operation. Sometimes, a "Day Surgery" option is also possible. Your doctor will discuss the various options with you. It is important that you observe water precautions after surgery and prevent water from entering the operated ear after the surgery, especially when showering. Also, avoid heavy lifting and straining / sneezing for at least 1 month after your surgery. Any external scars should also be taken care of. An ointment will usually be prescribed for you to apply on the external scar. Ear drops will also be prescribed for you to apply into your ear. Rest assured that the doctor and the nursing team will teach you the wound care and give you specific instructions prior to your discharge. A doctor’s appointment will usually be fixed for you about one week after your discharge to review your wound.

Mastoid dressing

There will be a bandage dressing placed around the head to apply local pressure to the wound and it will be removed by the surgical team on the following day.

Wound care

Ear packing will be placed into the ear canal. You will not be able to hear well from the operated ear during the first 2 weeks after surgery due to the ear packing. There will be stitches placed behind the operated ear and will be removed a week after surgery. The ear has to be kept strictly dry after surgery to prevent infection. A cotton ball can be used to prevent fluid from leaking out of the ear and can be changed as necessary. However, deeper packing in the ear canal should not be tampered with.

Antibiotic eardrops will be prescribed and may be started immediately after surgery or later.

Mastoidectomy - What it is

What does it involve?