A mastoidectomy is a surgical procedure performed by an ear, nose, and throat specialist (otolaryngologist). The purpose of this operation is to remove diseased or infected air cells found within the mastoid bone. This bone is a dense, honeycomb-shaped structure located just behind the ear, forming part of the skull. The procedure is necessary when infection or abnormal growths have spread from the middle ear into these air-filled spaces. Clearing the diseased tissue aims to create a safe, dry ear and prevent the spread of infection to surrounding structures.
Conditions That Require a Mastoidectomy
The primary reason a mastoidectomy is necessary is to treat a cholesteatoma. This is an abnormal skin growth that develops behind the eardrum in the middle ear space. The growth acts like a cyst, shedding layers of old skin cells that accumulate and expand, creating a mass that gradually erodes the surrounding bone structures.
If left untreated, a cholesteatoma can cause significant destruction, damaging the tiny hearing bones (ossicles), the inner ear, and the bone separating the ear from the brain. The surgery is performed to eradicate this growth and prevent severe complications. These complications include facial nerve paralysis, hearing loss, or life-threatening infections such as meningitis or a brain abscess.
A mastoidectomy is also the treatment for severe, chronic middle ear infections, known as Chronic Suppurative Otitis Media (CSOM), that have spread into the mastoid bone. If a chronic infection does not respond to antibiotic therapy, it can lead to mastoiditis, causing inflammation and pus accumulation within the mastoid air cells. The operation clears this persistent infection, stops the discharge, and prevents further disease progression. The goal is to establish a disease-free environment in the ear and preserve or improve the patient’s residual hearing.
The Steps of the Surgical Procedure
The mastoidectomy is performed under general anesthesia and typically takes between one and three hours. The surgeon begins by making an incision, usually placed in the crease behind the ear or within the ear canal. This allows access to the mastoid bone, which is then opened using a specialized surgical drill.
The extent of the disease dictates the specific type of mastoidectomy performed. The simplest form is the Simple or Cortical Mastoidectomy. This involves removing only the infected air cells from the mastoid bone while leaving the walls of the ear canal and the middle ear structures intact. This variation is suitable for disease confined to the mastoid.
When the disease is more extensive, two more involved procedures are utilized under the “canal-wall-down” category. A Modified Radical Mastoidectomy removes the diseased air cells and some middle ear structures, aiming to preserve the hearing mechanism. In contrast, the Radical Mastoidectomy is reserved for the most complicated or recurrent cases. This procedure requires the removal of the mastoid air cells, the eardrum, and most of the middle ear structures to eliminate the infection.
Both the modified radical and radical procedures involve removing the bony wall separating the ear canal from the mastoid. This creates a larger, combined space known as a mastoid cavity or “mastoid bowl.” This open cavity design allows for easier inspection and cleaning in the long term, which prevents disease recurrence. The surgical site is closed with sutures, and a dressing is applied to protect the area.
Post-Surgery Recovery and Care
Immediately following the procedure, patients wake up with a head dressing or bandage over the ear, typically removed within 24 to 48 hours. It is common to experience mild pain at the incision site, a feeling of fullness in the ear, and temporary dizziness or nausea. Prescription pain medication is provided to manage discomfort during the initial recovery period.
Activity restrictions are important for proper healing. Patients must avoid heavy lifting, strenuous exercise, and bending over for several weeks after the operation. To protect the surgical site, patients must keep the ear dry, avoiding swimming and protecting the ear from water during showering until permitted by the surgeon. When cleaning the outer ear, only a clean cotton ball should be used to absorb any expected thin, bloody, or watery discharge.
The patient will have a follow-up appointment, often within two weeks, where non-dissolvable sutures may be removed and the packing inside the ear canal is taken out. While initial recovery takes weeks, the full healing process for the middle ear and any hearing changes can continue for four to six months. Patients should contact their doctor immediately if they develop a high fever, severe dizziness, or notice foul-smelling, thick yellow or green discharge, as these can be signs of a serious infection.