This article is on mastoidectomy, an operation on the ear. This resource is open to everyone. Patients, Medical Students and Doctors may find this useful. The additional information shown in grey boxes provides more technical information intended for Medical Practitioners.

In order to understand this topic better you may also wish to read these other articles on related topics:

Cholesteatoma

CT scan

Audiogram – Hearing test

Myringoplasty and tympanoplasty

 

What is mastoidectomy?

Mastoidectomy is the name of surgery to remove some of the bone behind the ear. This bone is called the mastoid. The mastoid contains many small air pockets. During mastoidectomy the pockets are opened to form a bigger space.

 

Why is mastoidectomy performed?

Mastoidectomy is most often performed to treat cholesteatoma. Cholesteatoma starts in the middle ear but often spreads into the mastoid.

Mastoidectomy is also performed to drain infection in the mastoid. An infection of the middle ear can spread to the mastoid, causing mastoiditis. Sometimes this can be treated with antibiotics. Urgent mastoidectomy may be required if an abscess forms, or if the infection does not improve with antibiotics.

Mastoidectomy is also performed to allow access to the other structures in the ear, including for cochlear implant surgery.

 

What happens before surgery?

Before surgery patients will be assessed by an ENT surgeon. A CT scan will often be performed. A audiogram or hearing testing will commonly be done. Your surgeon will explain the risks and benefits of surgery. You will have a chance to ask questions. Your consent will always be obtained before going ahead with surgery.

In the two weeks before surgery it is best to try to avoid an infection. If you have new or worsened ear discharge you should see your GP or contact your surgeon. Your surgery may be delayed until the infection is treated. Infection is often caused by getting your ear wet, so it is helpful to keep your ear dry before surgery.

 

How long is the surgery?

There are various types of mastoidectomy. The length of surgery depends on what type of mastoidectomy is done.

Mastoidectomy may be limited to the outer part of the mastoid bone. This is called a cortical mastoidectomy. This is the usual treatment for acute mastoid infection (mastoiditis) that requires surgery. This takes around 1.5 – 2 hours.

When mastoidectomy is performed to treat cholesteatoma, the surgery performed depends on the disease. Surgery for a small cholesteatoma is generally less difficult. If the cholesteatoma is large or spread throughout the mastoid, surgery is more difficult and will take longer. Most cholesteatoma surgery involves surgery on both the mastoid (mastoidectomy) and the middle ear (tympanoplasty). The length of surgery can range from 2-4+ hours.

 

What are the risks?

  • Most surgeons will place a head bandage after surgery to reduce bleeding.
  • Wound infections are rare but possible
  • You will have a C shaped scar behind the ear, which is usually well hidden.
  • Recurrence of cholesteatoma, which may require further surgery.
  • Taste change. Usually temporary for 1-3 months.
  • Worsened hearing
  • Weakness or paralysis of the face. Damage to the facial nerve is a very rare complication of mastoid surgery.
  • Dizziness caused by damage to the inner ear, also a very rare complication of mastoid surgery.

 

Are there alternative options?

Cholesteatoma is treated by surgical removal. It cannot be treated by medication or other treatments. Surgery is recommended to almost all patients with cholesteatoma. An elderly person, or a person with many other medical problems, may choose not to have surgery. This increases the risk of complications from cholesteatoma.

Acute mastoid infections can be life threatening and often emergency mastoidectomy is required. Some people with an acute mastoid infection can be treated with antibiotics. Mastoid surgery is usually still recommended to prevent further bouts of mastoiditis.

 

How long is the recovery?

The delicate ear canal and ear drum tissue takes about 6 weeks to fully heal. Your surgeon will tell you what activities you can and can’t do after surgery. It is important to avoid water running into your ear canal, as well as pressure changes across your ear drum. Most people can return to work around 1-2 weeks after mastoid surgery.

 

References:

 

Author + Affiliation: Dr Rachael Bentall, ENT Registrar, Waikato Hospital

Date of Publication + Review: 28 February 2022

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