A mastoidectomy is a surgical procedure that removes diseased cells from the mastoid bone, located directly behind the ear. This surgery primarily addresses infections or abnormal tissue growths within the bone. An ear, nose, and throat (ENT) surgeon performs this specialized operation.
Understanding the Mastoid Bone
The mastoid bone, part of the temporal bone, is located just behind the ear. This bone is not solid; instead, it has a honeycomb-like structure filled with numerous small, air-filled spaces called mastoid air cells. These air cells connect to the middle ear cavity, allowing for air pressure regulation.
Its close proximity and connection to the middle ear make it relevant to ear health. If an infection develops in the middle ear, it can potentially spread into these air cells, leading to inflammation or more serious complications.
Reasons for Mastoidectomy
A mastoidectomy is performed to address conditions affecting the mastoid bone that, if untreated, could lead to serious health complications. One common reason is chronic middle ear infections (chronic otitis media), especially when they do not respond to antibiotic treatment. If these persistent infections spread into the mastoid air cells, they can cause inflammation and damage, a condition called mastoiditis. The surgery aims to clear this infection and prevent its spread.
Another significant indication is cholesteatoma, a noncancerous, but destructive, skin cyst that can develop behind the eardrum. These growths expand over time, eroding the mastoid bone and potentially damaging delicate structures of the middle and inner ear, leading to hearing loss, dizziness, or facial nerve damage. Removing the cholesteatoma is important to prevent further destruction and potential complications like meningitis or brain abscess.
Less frequently, a mastoidectomy may be necessary for other conditions, including tumors affecting the mastoid bone or severe trauma to the temporal bone. It can also be performed as part of other procedures, such as cochlear implant placement, where access to inner ear structures through the mastoid bone is required. The goal across all these indications is to create a safe, dry ear and prevent disease progression.
The Procedure Explained
The mastoidectomy procedure is carried out by an ear, nose, and throat (ENT) surgeon in a hospital operating room. It is performed under general anesthesia, ensuring the patient is asleep and experiences no pain during the surgery. The surgical team also monitors the facial nerve during the operation.
The surgeon begins by making an incision, usually behind the ear, to access the mastoid bone. This incision is often placed carefully to minimize visible scarring. Using a specialized surgical drill and a microscope, the surgeon meticulously opens the mastoid bone to reach the air cells and the middle ear cavity. The diseased or infected tissue, such as cholesteatoma or inflamed cells, is then carefully removed.
Throughout the removal process, suction and irrigation are used to keep the surgical area clear of bone dust and to prevent overheating. Depending on the extent of the disease, the surgeon may perform different types of mastoidectomy, such as a canal-wall-up procedure (preserving the ear canal) or a canal-wall-down procedure (removing part of the ear canal wall for more extensive disease removal). Once the diseased tissue is cleared, the incision is closed with stitches, and a dressing is applied to the ear. The entire procedure typically takes between two to three hours.
Recovery and Aftercare
Following a mastoidectomy, immediate post-operative care focuses on managing discomfort and protecting the surgical site. Patients typically wake with a dressing over the operated ear, which may be removed within a day or two. Some pain and mild discomfort, including headaches and numbness around the ear, are common and can be managed with prescribed pain medication.
Full recovery from a mastoidectomy can take between six to twelve weeks, though many individuals can return to light activities and work or school within one to two weeks. During initial recovery, keeping the ear dry is important; this means avoiding water in the ear during bathing and refraining from swimming for at least six weeks. Patients should also avoid strenuous activities, heavy lifting, or anything that causes pressure changes in the ear, such as vigorous nose blowing or flying, for several weeks.
Follow-up appointments with the surgeon are important to monitor healing, remove any remaining packing, and address concerns. It is important to watch for signs of potential complications, such as a fever above 100.4°F (38°C), increased redness or swelling around the ear, foul-smelling drainage, persistent dizziness, or new facial weakness, and to contact the healthcare provider if any of these occur.