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.
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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.
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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.
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Your
Consultation
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.
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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.
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Recovery
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:
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.
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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
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.
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Frequently Asked
Questions
Q: What is a Simple Mastoidectomy?
A:
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.
Q: What is a Radical Mastoidectomy?
A:
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.
Q: What is a Modified Radical Mastoidectomy?
A:
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.
Q: What are the complications and risks
involved in Mastoidectomy?
A:
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.
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