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Home > Centers of Excellence > Otolaryngology > Tympanomastoidectomy

What is Tympanomastoidectomy?

It is a broad umbrella term for surgery of the tympanic membrane and mastoid cavity.  These types of procedures are often performed for chronic infections of the middle ear space and benign neoplasms such as cholestomas.

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Effects of Tympanomastoidectomy

Fortunately, most types of ear infections can be treated. In many cases, a clean safer ear can be expected. Hearing can also be improved in many patients depending upon the severity of disease and the function of the Eustachian tube.

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Candidates for Tympanomastoidectomy

When the tube that equalizes pressure in your ear (eustachian tube) functions poorly due to a cold or allergy, a vacuum can occur in the middle ear. This vacuum sucks areas of the eardrum weakened by repeated ear infections, causing a pouch or abnormal growth of skin behind the eardrum. This is actually a growth of the skin cells of the eardrum collecting and forming what is called a cholesteatoma. This growth can damage any bone that is near if not treated, causing dizziness, facial nerve damage, deafness, an infection in your brain, or even death. You may need to have surgery to remove the growth or infected bone from your ear.

Ear infections are one of our most common ailments. 3 out of every 4 of children in America will have at least one ear infection before growing up. Infections in adults are much less common. When they occur, they are often in people who've had many infections in childhood or who have other causes for ear congestion such as cigarettes, allergies or the common cold. In fact, congestion of the ear is the cause of most infections. The ear ordinarily receives ventilation by the Eustachian tube which is a natural connection between the ear and the nose and throat.

Warning signs of COM include the following:

                     persistent blockage or fullness of the ear

                     chronic ear drainage

                     development of balance problems

                     facial weakness

                     persistent deep ear pain

COM generally occurs gradually over many years in patients with long standing or frequent ear trouble. However, it can occasionally develop over several months in a patient with no previous history of ear disease.

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Your Consultation

The first step in treating COM is to have a complete ear examination by an otolaryngologist, a physician who specializes in the medical and surgical treatment of the ear, nose, and throat.

Treatment of COM depends upon the stage of the disease. Initially, efforts to control the causes of eustachian tube obstruction, such as allergies or other head and neck infectious problems, may prevent progression of COM. This is the reason many children with chronic eustachian tube problems have ventilation tubes inserted in their eardrums to allow normal airflow in the middle ear until they outgrow the eustachian tube problems.

Once the disease has progressed to the point of significant middle ear damage to the eardrum or ossicles, more intensive treatment is needed. If active infection is present in the form of ear drainage, antibiotic ear drops are prescribed. Occasionally, these may be supplemented with oral antibiotics.

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The Tympanomastoidectomy Procedure 

Once the active infection is controlled, surgery is usually recommended. There are three objectives of surgery for COM:

                     eradication of the disease

                     preservation or improvement in hearing

                     remodeling of the middle ear and mastoid bone, located just behind the external ear, to prevent recurrence of the disease

Surgery to achieve these objectives is called tympanomastoidectomy. The otolaryngologist first makes an incision behind or around the upper portion of the external ear. Part of the mastoid bone is then drilled away to gain access to the middle ear space. Finally, the abnormal tissues are removed. If possible, efforts are made to rebuild the eardrum and the sound conducting bones. It is sometimes necessary, however, to complete the hearing reconstruction at a later date rather than at the same time as removal of the infected or damaged parts.

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Recovery

You will wake up in the recovery room after your surgery where you will be monitored by the nurses and anesthesiologist. You should be able to go home the same day as your surgery. You will have stitches behind your ear covered with steri strips that will need to be kept on your ear until you come in for your two-week appointment when a nurse will remove them for you. You will then come back two weeks later to have packing removed from the inside of your ear by your surgeon. You should have little or no pain following surgery. You should also have little or no bleeding following surgery; you should not have any fever and little or no nausea and vomiting.

You will need to avoid getting your ear wet following surgery. Keep the dressing on until you are seen by your physician.  Your physician may prescribe drops to be used after the dressing is removed.  At least 3 or 4 visits are necessary for appropriate follow up over several months following surgery. 

Patients will have the ear bandaged for a week or two. It takes several months for complete healing and the hearing results may continue to improve throughout the healing phase. Routine checkups by the otolaryngologist are recommended at least yearly after the healing is complete and in some cases may be required two or more times yearly to maintain adequate local hygiene

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Risks

Some of the possible risks and complications of a Tympanoplasty are infection, the graft not holding and exposing the hole in the eardrum, further hearing loss, ringing in the ears, dizziness or facial nerve damage or numbness in the outer ear. Also you may experience dry mouth or notice a change in your sense of taste.

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Frequently Asked Questions

Q: Why do I need surgery?

A: When the tube that equalizes pressure in your ear (eustachian tube) functions poorly due to a cold or allergy, a vacuum can occur in the middle ear. This vacuum sucks areas of the eardrum weakened by repeated ear infections, causing a pouch or abnormal growth of skin behind the eardrum. This is actually a growth of the skin cells of the eardrum collecting and forming what is called a cholesteatoma. This growth can damage any bone that is near if not treated, causing dizziness, facial nerve damage, deafness, an infection in your brain, or even death. You may need to have surgery to remove the growth or infected bone from your ear.

Q: What happens during surgery?

A: Under general anesthesia your surgeon will make an incision behind your ear so that the inside of your ear can be reached. Any growth or infected bone is then removed. Packing will be placed in your ear to help promote healing. The incision site is then closed with stitches and covered with steri strips or tape. This surgery is usually done in about one-and-a-half to three hours so you should be able to go home the same day as your surgery.

Q: Do I have to keep water out of the ears?

A: Yes.  Avoid water in the ears until the physician indicates it is safe to allow water.

Q: How much pain should I expect?

A: Typically, this is not very painful following surgery.  The pain is well controlled with pain medication that will be prescribed.

Q: What should I expect after the surgery?

A: Your hearing may be decreased while packing is in the ear.  You may also have some dizziness temporarily and so you should take extra precautions.

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