Mastoidectomy
Definition
A mastoidectomy is a surgical procedure that removes an infected portion of the mastoid bone when medical treatment is not effective.
Purpose
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.
Demographics
According to the American Society for Microbiology, middle ear infections increased in the United States from approximately three million cases in 1975 to over nine million in 1997. Middle ear infections are now the second leading cause of office visits to physicians, and this diagnosis accounts for over 40% of all outpatient antibiotic use. 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.
Description
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.
Diagnosis/Preparation
The treating physician gives the patient a thorough ear, nose, and throat examination and uses detailed diagnostic tests, including an audiogram and imaging studies of the mastoid bone using x rays or CT scans to evaluate the patient for surgery.
The patient is prepared for surgery by shaving the hair behind the ear on the mastoid bone. Mild soap and a water solution are commonly used to cleanse the outer ear and surrounding skin.
Aftercare
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
Risks
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
Normal results
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.
Morbidity and mortality rates
In the United States, death from intracranial complications of cholesteatoma is uncommon due to earlier recognition, timely surgical intervention, and supportive antibiotic therapy. Cholesteatoma remains a relatively common cause of permanent, moderate, and conductive hearing loss.
Alternatives
Alternatives to mastoidectomy include the use of medications and delaying surgery. However, these alternative methods carry their own risk of complications and a varying degree of success. Thus, most physicians are of the opinion that patients for whom mastoidectomy is indicated should best undergo the operation, as it provides the patient with the best chance of successful treatment and the lowest risk of complications.
See also Tympanoplasty .
Resources
BOOKS
Fisch, H. and J. May. Tympanoplasty, Mastoidectomy, and Stapes Surgery. New York: Thieme Medical Pub., 1994.
PERIODICALS
Cristobal, F., Gomez-Ullate, R., Cristobal, I., Arcocha, A., and R. Arroyo. "Hearing results in the second stage of open mastoidectomy: A comparison of the different techniques." Otolaryngology - Head and Neck Surgery 122 (May 2000): 350-351.
Garap, J. P., and S. P. Dubey. "Canal-down mastoidectomy: experience in 81 cases." Otology & Neurotology 22 (July 2001): 451-456.
Jang, C. H. "Changes in external ear resonance after mastoidectomy: open cavity mastoid versus obliterated mastoid cavity." Clinical Otolaryngology 27 (December 2002): 509-511.
Kronenberg, J., and L. Migirov. "The role of mastoidectomy in cochlear implant surgery." Acta Otolaryngologica 123 (January 2003): 219-222.
ORGANIZATIONS
American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. http://www.entnet.org .
American Hearing Research Foundation. 55 E. Washington St., Suite 2022, Chicago, IL 60602. (312) 726-9670. http://www.american-hearing.org/ .
Better Hearing Institute. 515 King Street, Suite 420, Alexandria, VA 22314. (703) 684-3391.
OTHER
"Mastoidectomy series." MedlinePlus. <www.nlm.nih.gov/medlineplus/ency/presentations/100032_1.htm� E; .
Carol A. Turkington
Monique Laberge, Ph.D.
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
An mastoidectomy is performed in a hospital by surgeons specialized in otolaryngology, the branch of medicine concerned with the diagnosis and treatment of disorders and diseases of the ears, nose and throat. The procedure usually takes between two and three hours. It is occasionally performed on an outpatient basis in adults but usually involves hospitalization.
QUESTIONS TO ASK THE DOCTOR
- What are the alternatives to mastoidectomy?
- What are the risks associated with the surgery?
- How will the surgery affect hearing?
- What are the possible alternative treatments?
- How long will it take to recover from the surgery?
- How many mastoidectomies do you perform each year?
She has cronical infection of the ear, suffers from diziness, and loss of hearing.
However, the doctor did not give success rates for her age group .
My mother is 70 years old. I think she would prefer to go for it if only she knew her chances (in fact she would go for it given an half chance (50%), such is her suffering)
Where can I find figures for the success rate of this procedure, for her age group?
can you suggest what to do and what will be the success ratio and any other option instead of surgery
vikas bhuta
india
MY MOTHER WHOM IS 65 YEARS OF AGE HAS HAD ONGOING EAR INFECTIONS SINCE I CAN REMEMBER AND NOW HAS A LARGE TUMOR IN HER EAR ,SHE HAS ALREADY HAD SOME DRAWING OF HER FACE AND HAS SEVERE RINGING IN HER EARS , I AM CONCERNED OF TOTAL HEARING LOSS WITH THIS SURGERY AND ALSO HAVING THE POSSIBILITY OF ONGOING EAR INFECTIONS
WHAT CAN I DO TO RELIEVE HER STRESS AND WORRY ABOUT HER OPERATION
THANK YOU
TINA W
I am 39 years old now and pleased that I had the surgery although it was very painful at the time. I was quite deaf in the ear before surgery and even deafer after, which I was warned about but because the stape was left behind I was able to wear a hearing aid. I wear hearing aids in both ears and can hear really well.
You want advice? Go with your family member to see your doctor...
I am diagnosed with bilateral cholesteatoma. And I am suggested to have a radical mastoidectomy. I have discharge for 1 year and since last month there was no more pus coming out from my right ear. I did a CT scan and the doctor said I have cholesteatoma in both of my ears. I would like to know if it is possible that I do not do the operation? Since I do not have complete hearing both of my ears, I do not want to take the risk to loss them all.
Please help!
Michelle
thankyou.
I had the ear canal and ear drum rebuilt along with the removal of the infection.
For the rest of my life I will have to go back every 6 months for a check-up as this disease can come back anytime.
I am 37 now, can hear fine. I cant get water in my ear or go underwater while swimming, but other then that I am 100% cured!
Is this types of surgery are successful with already some past surgery miringoplasty done on the same year.
Please help.
From,
Vinay jaiswal
They tried the plug that they do in their office,(That hurt worse than anything) Maybe the forgot to numb it!! Anyway that lasted over night, by morning it was on my pillow case.
So they did the surgery, it is well worth it, the only problem I have with it is the sound is like you are under water, I know this is because it is not the eardrum you were born with, But sometimes I feel like there is something behind my ear drum, Like it needs to drain!
I still have a lot of ear infections, but they are mild compared to before the surgery!!
Thanks for letting me blow off some steam, if anyone else has these same feelings, sound off!!!
It sounds like you really need to talk to someone about your suicidal thoughts as soon as you can, I know this is about 2 months after you wrote this, But I have had these thoughts too, I acted on mine. I was lucky, I'm still here! Please get help!!
THE RISKS FOR NOT HAVING THIS SURGERY WHEN RECOMMENDED CAN EVENTUALLY LEAD TO BRAIN ABSCESS(Infection of the brain),TOTAL LOSS OF HEARING and even death!
Risks from surgery include: Hearing loss, tinnitus, dizziness, and altered taste. More severe complications can include: Brain Abscess, Facial Paralysis, total loss of hearing. If you have a good ENT specialist than they will advise you of best options and always remember to write down questions you have b/c we always forget when we're in the moment.
CONCERNED SISTER
FLORENCE
The question is:
What is the type of Mastoidectomy necessary to his case, and through where the operation must be performed, through the ear or through a cut (incision) behind the ear?
10x for help
But now i am scared after reading this forum.The doctor told me that this surgery would cure it but many people here have another surgery and still have infection.
I to have had multiple ear problems and surgeries. I do know that I am going to have to see my E.N.T. every --so that he may examine my ears and catch any infections early on.
My question is, "Is there a place of the internet where people who are of "Bad-Ears-Anonymous" groups, or something... ;)
Thank you for you time and consideration.
I had a mastoidectomy only a week ago still not had a full nights sleep. My ears still weeping at the moment and keep getting quite a lot of stabbing pains within my ear as anyone else experienced this and if so for how long. I havent found any comments on how theve felt after the op. Please share comments
and may in fact have gotten a bit worse (not totally unexpected), I can't say I'm displeased.
While the discharge I was experiencing FOR YEARS was treated effectively with antibiotic drops,
from all indication I won't have to be dealing with the chronic infection again. Down the line it appears I'll be undergoing another surgery to have a prosthetic bone grafted in my ear to hopefully restore some hearing. Guess what I'm saying is if yoyu have confidence in your surgeon, its pretty much a no-brainer having the surgery.
The surgery itself took nearly 6 hours, under full anesthesia. It is kind of a strange feeling, as I went "to sleep" at like 1pm and when I woke up it was like 8pm. I had to stay the night in the hospital, for further observation, but the next morning they sent me back home. The next couple of month I had to visit the doctors once every week for changing some sort of bandage - that's something related with wall down mastoidectomy - they put inside the ear (and couldn't hear a thing). But after the 2 months passed and the doctors completely removed the bandage I could feel my hearing improving to a very good level.
One thing to keep in mind is: Cholesteatomas produce the so-called "columella effect" (they actually conduct the sound through the middle ear, just like the little bones), so even if you have a cholesteatoma you can still have a very good hearing, and then believe you have no problem at all. CT scans are probably the best to identify a cholesteatoma properly (normal mastoid/middle ear structure should appear in a black colour - meaning it is "empty" -, but cholesteatoma will appear as a grey area filling all the cavity).
And as awkward as it may seem, experienced doctors are able to distinguish between normal middle ear otitis and cholesteatoma even from the unpleasant smell of the discharge. Believe it or not, one of the doctors smelt some drainage from my left ear to rule out the possibility of another cholesteatoma!!! O_o I had to have a tympanoplasty - more simple surgery - done in my left ear in 2010, but no cholesteatoma was found then. But they said I should keep monitoring the left ear as well, to make sure it won't develop another cholesteatoma, as the eardrum is a bit retracted on my left ear, even after the surgery (according to them, it has something to do with my mastoid bone anatomy).
So, to finish these long posts. Cholesteatomas are a serious problem, but can be treated, and the sooner the better. Recovery depends on the patient as well (I actually got this problem because I "loved" to clean my ears with cotton swabs, and perforated my own eardrum! That together with swimming and recurrent middle ear infection made the problem get worse and worse to the point I had this little 2cm diameter thingy grown inside my ear that could've killed me), so: No more ear cleaning (leave it to the doctors), no swimming if swimming causes you ear infection (likely to happen if you have a teared eardrum).
I hope my posts are somehow helpful to people facing the same problem I did!
Good luck to all of you! :)
I had a full radical mastoidectomy perfomed on my left ear 51 years ago.. If any one is suffering from after effects such as pain, after infections , and needs adequate self treatment of the ear I can give you tons of prooven advice.
my email is greswell@hotmail.com
This is a difficult issue for the sufferers but life can still be pleasant.
best wishes to all open ear sufferers.
I had a full radical mastoidectomy perfomed on my left ear 51 years ago.. If any one is suffering from after effects such as pain, after infections , and needs adequate self treatment of the ear I can give you tons of prooven advice.
my email is greswell@hotmail.com
This is a difficult issue for the sufferers but life can still be pleasant.
best wishes to all open ear sufferers.
I think i can smell the ear every so often when i move my head. Im so bored of infections in that ear, no idea why it just keeps coming back!? dont think anyone does know. its just one of those things inniee.
Do some research on the track record of the ENT's in your area and check their success rate. You do get good ENT specialists and mediocre one's. Anand
It took about 4months for the doctors to figure out my mastoiditis. Ive have had i again since. How many times do.i have to be symppyomatic, until i am refereed to the ent will it mean then only solution is surgery?
My first mastoidectomy was at age 12 (radical, right ear) and my second at age 16 (modified radical, left ear). The scans showed in each case that cholesteatoma cysts had broken through my skull and were resting on my brain. After both surgeries, recovery was relatively easy and uneventful. There was no facial paralysis or taste distortion. Really, the only hardship was the big bald spot and strange dome-like dressing on the side of my head I had to deal with post-surgery. Trying to wash your hair with a plastic bag over a quarter of your head is a bit of an adventure, too.
It has now been 12 years since my last surgery. Since the cholesteatomas damaged my hearing to begin with, I wear bilateral hearing aids. I also have to go in to an ENT every six months to a year for a "debridement" (cleaning) and I frequently have to use ear drops (Oflaxacin) for drainage (usually odorless). It's not that big of a deal, though. I do have to be careful about showering/bathing, since water in the ears can lead to an infection. Swimming is pretty much out of the question, since I don't really trust any ear plugs to actually stay in. There is still some numbness at the incision site on my left and both sides tend to get pretty tender if I wear sunglasses or headbands, which can lead to some wicked headaches.
Hmmm, what else? I haven't been able to wiggle my ears since the surgeries, which is truly a tragedy. I was a great ear-wiggler.
When I was 13, a mastoidectomy was performed due to infection in my right ear that would not be healed with antibiotics and office visit manual drainage. The surgery caused great hearing loss and made me incredibly sensitive to nausea due to motion sickness and change of temperature. The resulting cavity in my ear affected the canal and made it more difficult for my ear to fight infection with its own defenses. The surgery was performed in the state of Alabama in America. Several infections and several treatments of antibiotics later, I obtained the advice of a doctor in Germany. I made a 50% alcohol, 50% white vinegar solution. Warmed it to prevent nausea. Applied several drops to the infected ear. Let it soak. Then used a warmed saline and water solution and irrigated the ear over the sink several times with an ear syringe. This manually removes much of the infection in the ear canal. I gently dry the ear with tissue and carefully with Q-tips. When mostly dry several minutes later, I add the alcohol/vinegar solution to the ear, which helps sterilize, adjust pH balance, and dry the affected area. I repeat as necessary. This has worked very well. Under the advice of my naturopath, I also had a blood work up to discover food allergies. In my case, I had to remove gluten, dairy and egg. I took a full array of high quantity probiotics to replace the flora that was killed by the antibiotics and greatly affected my immune response. These actions greatly reduced allergic and hystaminic reactions that actually was a great cause of the infections. After a couple of decades of some ear infections every year, I have been ear infection free for over two years.
If you're wearing a hearing aid or something that is causing infections I would advise to just deal with the hearing loss, unless this is particularly troublesome.
I guess I'm lucky because it's not painful most of the time but honestly the best way to clear it up in my experience is looking after yourself. Even after one night drinking or not sleeping the stuff in my ear gets alot worse.
If you can't use antibiotics and the doctor hasn't given you a spray, a few drops of 3% FOOD GRADE hydrogen peroxide from a health food shop will clear it up, but might not be permanent. ASK YOUR DOCTOR though I'm not a professional.
Not sure if my canal wall is up or down but I've been told not to get it wet and had an ear plug molded, I lost it years ago though but I still go swimming and surfing the only noticeable effect is I get dazed sometimes; my ear is beyond doing damage to it though as there is nothing there so again ask your doctor and don't stick random stuff in your ears!.