Mastoidectomy

In a nutshell

Mastoidectomy is an operation that involves the removal of part or all the mastoid bone, a structure located behind the ear.
It is usually needed when you have been diagnosed with cholesteatoma. This is a growth of dead skin cells, like a sac behind the ear drum. Most of the times, it requires surgery, as a growing cholesteatoma can result to a range of serious conditions, such as worsening hearing loss / deafness, meningitis, abscess in the brain, weakness of facial muscles and vertigo/dizziness.
After mastoid surgery, it is common to have dizziness, which usually resolves within hours, but rarely can last for months. The hearing can be the same, better or even worse. Some people develop tinnitus, which usually resolves. Rarely the facial muscles may be weak after the operation, but this usually recovers.
It is done under general anaesthetic and most people will be able to go home the following day.

This webpage provides an overview of mastoidectomy, including the indications for surgery, alternatives, the procedure itself, potential risks, and recovery information.

What is Mastoidectomy?

The mastoid bone is part of the temporal bone in the skull, located just behind the ear. It contains a series of air-filled cavities known as mastoid air cells. These air cells are connected to the middle ear and play a role in regulating air pressure in the ear.

Mastoidectomy is performed when the mastoid bone becomes infected, inflamed, or damaged, typically due to a cholesteatoma (dead skin cells, like a sac growing inwards, behind the ear drum and towards to the mastoid bone) or chronic middle ear infection (chronic ear discharge) or less frequently due other ear conditions that do not respond to non-surgical treatments. The goal of the surgery is to remove infected tissue, eliminate sources of chronic infection, and prevent complications such as the spread of infection to nearby structures.

When Mastoidectomy is indicated?

Mastoidectomy is typically performed when other treatments, such as antibiotics or ear drops, are unsuccessful in treating persistent ear problems. The main reasons for performing a mastoidectomy include:

Cholesteatoma: A cholesteatoma is an abnormal growth of dead skin cells in the middle ear that can erode the ear structures, including the mastoid bone or the small bones behind the eardrum called ossicles. If left untreated, cholesteatomas can lead to hearing loss/deafness, dizziness, weakness of facial muscles and even life-threatening complications, such as meningitis or abscess into the brain. Mastoidectomy is often necessary to remove the cholesteatoma and prevent further damage to the ear and surrounding structures.
Chronic Middle Ear Infections: Usually patients have persistent ear discharge and sometimes earache and dizziness. When a middle ear infection becomes chronic and does not respond to antibiotics or other treatments, it can spread to the mastoid air cells, causing mastoiditis. If left untreated, chronic mastoiditis can lead to further complications like hearing loss or the spread of infection to the brain or other parts of the skull.

Are there any alternatives to avoid surgery?

This depends on the underlying condition. If you have been diagnosed with cholesteatoma, unless it is in very early stages or you are unfit for a general anaesthetic, cholesteatoma almost always requires surgery.
Regular cleaning of the ear with microsuction and microscope, application of local antibiotics, when needed, can sometimes help, but will rarely provide a cure.

What does the Mastoidectomy operation involve?

Mastoidectomy is typically performed under general anaesthesia. Dr Fragkiadakis will assess your condition, the complexity and will jointly form a treatment plan, taking account your needs and wishes.

Preoperative Evaluation: Before surgery, a thorough evaluation is done, which will include a hearing test (audiometry) and sometimes imaging studies (such as a CT scan and MRI scan) to assess the size and location of the disease.
Pre anaesthetic assessment: You are going to have a preoperative assessment in the hospital, to ensure you are fit for a general anaesthetic. You are going to meet your anaesthetist on the day and discuss about the anaesthetic.
Surgery: Dr Fragkiadakis will usually need to do a small incision behind the ear. He will then remove the infected or abnormal tissue, such as the cholesteatoma or damaged air cells. He might need to repair the hearing mechanism, if this is damaged. Finally, the closure of the incisions is done with dissolvable sutures, the ear canal is packed with dissolvable material and a sterile dressing is applied to protect the wound. Sometimes a pressure dressing is applied for the first night after the operation.
Postoperative Care: After the procedure, you will be monitored for a short period and typically can go home the following day. The ear may be protected with a temporary bandage and a cotton wick to keep the ear dry and prevent infection.

Risks and Potential Complications

Mastoidectomy is generally a safe procedure, but like any surgery, it carries some risks. Some potential complications include:

Infection: Although infection is uncommon (1:100), there is always a risk of developing an infection at the surgical site. Postoperative antibiotics may be prescribed to help prevent this. If it happens, you will experience worsening pain post operatively. In this case you need assessment by Dr Fragkiadakis.
Bleeding: This is rather uncommon, although you might notice a small leak in the first few post operative days. It usually resolves on its own.
Hearing Loss: It’s very likely that you already had some degree of hearing loss prior to the operation. Sometimes the hearing will be worse afterwards. Very rarely, complete deafness can happen, when the inner ear is damaged.
Tinnitus: Some patients may experience tinnitus (ringing in the ear) after the surgery, though this usually resolves over time. Immediately postoperatively, you will experience some noises in the operated ear, due to the packing, but this should resolve within a few weeks. Persisting tinnitus is rare.
Vertigo or Dizziness: Sometimes, patients may experience dizziness or balance issues after the surgery, particularly if the inner ear is affected during the procedure. This is usually temporary and resolves over time and very rarely is permanent.
Altered taste: One of the nerve responsible for taste, might be damaged during the operation, leaving you with a metallic taste. This usually recovers with time, but can be permanent in some occasions.
Facial weakness: The nerve moving the muscles of the face is called facial nerve and runs through the ear. There is a very small chance it being damaged during surgery. This results in weakness of the facial muscles, meaning that you might it find difficult to close your eye, smile or raise the eyebrows. This could be partial or complete, temporary or permanent. It can happen immediately after surgery or with some delay within the first few days. Recovery can be complete or partial.
Recurrence of cholesteatoma or infection: In some cases, the cholesteatoma or infection may recur after surgery, especially if the initial condition was severe or extensive. Follow-up care is essential to monitor the healing process and detect any recurrence early. You will need a follow up imaging, like an MRI.
Allergic reaction to packing: Some patients are prone to develop an allergic reaction to the packing material. If your ear becomes itchy, painful or swollen please ask for a review by Dr Fragkiadakis
Risks relating to the general anaesthetic: For more info for anaesthetic risks, you can check this link.

What is the recovery like after Mastoidectomy?

The recovery process after mastoidectomy generally takes several weeks, but most patients can return to normal activities within a few weeks to a month. It is important to follow the instructions below for proper healing. Here’s what to expect during recovery:

Immediate Postoperative period: After surgery, you may experience mild discomfort, which can typically be managed with paracetamol. Most of the times, you will need to stay for overnight observation. After you have eaten, been to the toilet, mobilised and manage with the post operative pain, you will be allowed to go home. You will not be allowed to drive for 48 hours following a general anaesthetic. You will need to keep the ear dry for several weeks. Avoid getting water in the ear during showers or swimming, as this can interfere with healing and increase the risk of infection. The packing can sometimes fall out or you might see a small amount of bleeding. You do not need to worry, unless the bleeding persists for more than a day.
Follow-Up Appointments: A follow-up appointment will be scheduled about two to three weeks after surgery to check the healing process, remove any packing and ensure there are no signs of complications. You might need additional follow-up visits.
Activity Restrictions: You will need to avoid strenuous activities or heavy lifting for several weeks after the surgery to reduce pressure on the ear and support the healing process. If you need to sneeze, do not try to hold it. Instead open the mouth and expel the pressure through the mouth. It’s also important to avoid blowing your nose forcefully, as this can cause pressure changes in the middle ear and disrupt the repair.
Hearing Recovery: It may take a few weeks to a few months for the full benefits of the surgery to become apparent. Some patients notice an improvement in hearing almost immediately, while others may need additional time for the eardrum to fully heal and the hearing to stabilize.
Postoperative Medications: If an infection is suspected, a course of antibiotics may be prescribed. Pain relief medications like paracetamol may also be needed to be taken regularly for the first few days.
Sick note/off work: You will be provided with a sick note if necessary. Usually, one is given for two weeks if needed.

Further links for information

Cholesteatoma surgery

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