Mastoidectomy

1. Mastoidectomy is a surgical procedure to remove mastoid air cells in the space within the mastoid bone.
2. This bone is a part of the temporal bone present in the skull and is filled with air cells.

 

1. By removing the mastoid air cells, chronic infection can be avoided or their recurrence significantly minimised.
2. It can also prevent temporary or permanent hearing loss and more serious complications that can affect the brain

Why Is Mastoidectomy Done?

1. You may get a microbial infection in your mastoid bone called mastoiditis. The causes of mastoiditis are:
2. Ear infection in the mastoid bone
3. Abnormal skin growth cells that cause fluid retention inside your ear (cholesteatoma)

Mastoiditis causes the following symptoms:

1. Fluid discharge from the ear.

Procedure Description

1. For mastoidectomy, the patient is anaesthetised and placed in a supine position (lying down with face upwards). Then the surgeon performs mastoidectomy in the following manner:
2. Insert a device called a speculum in the ear and arrange the potion of the microscope to get a clear image within the ear.
3. A cut is made at the back of the ear, in the layer of tissue called the periosteum, above the mastoid.
4. Use another instrument called a periosteal elevator to lift the periosteum.
5. Raise the skin present in the ear canal.
6. Drill the mastoid bone to create a space.
7. Remove the infected mastoid bone or any other growths on the mastoid.
8. Reconstruct the ear bones.
9. Use a biodegradable substance to pack the middle ear, ear canal, and mastoid cavity.
10. Stitch the cut made at the beginning of surgery using absorbable (biodegradable) stitches and cover it with a dressing.
11. Place a drain at the back of the ear to collect fluid leaking from the surgical site.
12. The mastoidectomy procedure takes two to three hours.
13. Depending on how severe the microbial infection is, the surgeon will decide which type of mastoidectomy is the most suitable option. There are three types of mastoidectomy,

Simple

Modified radical

Radical

Canal wall up (closed)

Canal wall down (open)

1. The surgeon will remove only the infected mastoid bone.
2. Surrounding areas like ossicles (ear bone), tympanic membrane (eardrum), and external acoustic meatus (a passage from outside of your head to the eardrum) are untouched.
3. The surgeon will remove the infected mastoid bone and ossicles.
4.  The benefit of this surgery is that the normal ear appearance and its functions are retained.
5. Some ossicles and tympanic membrane are untouched so that the hearing is unaffected.
6. The surgeon will remove the infected mastoid bone, ossicles, and external acoustic meatus.
7. Some ossicles and tympanic membrane are untouched so that your hearing is unaffected.
8. Recommended during persistent ear infection or cholesteatoma.
9. The surgeon will remove ossicles, tympanic membrane, and external acoustic meatus.
10. Used to treat a complicated disease.

TWhat to Ask and Tell Your Doctor?

1. You can ask the following questions to your ENT specialist during the appointment:
2. Why do I need a mastoidectomy?
3. Is there any alternative to the surgery?
4. What can happen if I do not undergo mastoidectomy?
5. What is the benefit of mastoidectomy?
6. How long will the surgery take?
7. Do I have to stay overnight in the hospital?
8. What are the risks and complications of this surgery?
9. How much time will I take to recover after surgery?
10. Can I continue my routine medications?

 

While you are at your ENT appointment, it is crucial that you inform your doctor of the following:

1. If you are currently using any prescription, non-prescription, or herbal medications.
2. If you are currently using any medications to relieve pain
3. Your current health condition (e.g., pregnancy, diabetes, high blood pressure, breathing problems, heart problems, etc.)
4. Allergies to food and medications.
5. If you are a smoker.

What to Expect Before Surgery?

1. Pre-surgical appointment:
2. A few days before you undergo mastoidectomy, your ENT surgeon will schedule a pre-surgical appointment.
3. During the appointment, you can expect the following:
4. The surgeon will ask about your current health and medical history.
5. They will suggest blood and urine tests before surgery.
6. You will be asked to sign a consent form that states that you are completely aware of the benefits and risks of mastoidectomy.
7. You will be asked to avoid using medicines that cause blood-thinning such as aspirin. You should stop using these medications at least a week before surgery.
8. Your surgeon will also discuss the surgical procedure, total time taken for surgery, hospital stay, and cost and proceed with any insurance formalities. 
9. Your surgeon will also confirm the date of the surgery.

 

Type of anaesthesia recommended by your anaesthesiologist:

You will also meet your anesthesiologist during the pre-surgery appointment.

For mastoidectomy, your anesthesiologist will recommend general anaesthesia.

 

Medications:

Avoid aspirin or ibuprofen as they cause blood thinning.

 

What to Expect on the Day of Surgery?

1. You can expect the following:
2. Once you reach the hospital on the day of surgery, you will meet someone from the healthcare staff who will guide you through the next process. 
3. The healthcare staff would ask you to sign informed consent if you didn’t sign it during the pre-surgical appointment.
4. If you are using any prescription medications, your surgeon will advise you to take the medicines with a small sip of water.

What to Expect During Surgery?

1. Patient position:
2. You will be kept in a supine position (lying down with face upwards).
3. The side of your head, which is to be operated, is placed up.
4. A donut pillow is used so that your head remains in the same position during the entire procedure.[6]

 

1. Cleaning and draping of the surgical site:
2. The microscope used during the surgery will be covered with a sterile drape.
3. Hair near your ear will be removed to free the surgical site from hair.
4. Adhesive drapes are used to separate hair in the surrounding portion.
5. Patient monitoring:
6. While the surgeon performs mastoidectomy, your anesthesiologist will constantly monitor your condition. The anesthesiologist will observe the following:
7. Blood pressure
8. Heart rate
9. Blood oxygen levels.

 

Patient experience during surgery:

Since you will receive general anaesthesia right before the surgery, you will remain unconscious throughout the procedure.[1]

 

What to Expect After Surgery?

The recovery process in the hospital:

1. Medications
2. Pain at the site of surgery is common, for which your surgeon will prescribe paracetamol.
3. You will be prescribed an antibiotic ointment to apply at the surgical site.

Discharge

1. Since mastoidectomy is an outpatient surgery, you will be discharged on the same day. In some cases, the surgeon will recommend an overnight stay.
2. The recovery process after hospital discharge:

Diet

You can resume your regular diet depending on how your body tolerates it.

Wound care

1. You will have stitches at the back of your ear at the surgical site.
2. Your surgeon will also put a large dressing in your operated ear. This dressing will be removed on the next day after surgery.
3. You may have a dressing for the removal of which you would not have to go to your surgeon. For such dressing, your surgeon will recommend ear drops which will help to dissolve the dressing. You may continue to have a slight discharge coming out from your ear unless your surgical site is healed.
4. Work, activity, restrictions
5. You can return to work after five days post-surgery.
6. Hair wash:
7. Prevent your ear from being exposed to water, as your ear canal should remain dry after surgery. For this, you should avoid washing your hair for a week post-surgery.
8. While washing your hair, place a cotton plug with Vaseline so that your ear canal remains dry
9. You can also visit a salon or take the help of someone else to wash your hair.
10. Avoid swimming for four to six weeks post-surgery or till the wound at the surgical site is healed.
11. Avoid strenuous activities, weightlifting or playing musical instruments that require blowing from the mouth for one-month post-surgery.
12. Avoid nose blowing for 14 days.
13. If you feel like sneezing, sneeze by keeping your mouth open for a week post-surgery.

Medications

1. Your surgeon will prescribe the following medications post-surgery:
2. You can use paracetamol to reduce pain or if you have a low-grade fever post-surgery. Avoid using aspirin or ibuprofen for pain management.
3. Your surgeon will recommend a course of antibiotics to prevent post-surgical infection. You should use these medications for seven to 10 days.
4. Your surgeon will also recommend ear drops to prevent infection. Use these eardrops for two weeks post-surgery.
5. Additionally, apply antibiotic ointment at the surgical site.

First Follow-up Appointment

You must remember the following:

1. Your ENT specialist will schedule your first follow-up appointment nearly a week after surgery.
2. During the follow-up, your surgeon will check how well you are recovering, prescribe medications if necessary, and schedule the subsequent follow-up.
3. Your ear cavity may remain dry after healing from the surgical wound. In such a case, to avoid problems, you may need to visit your ENT specialist once every six months or a year to remove wax and other dirt from the ear cavity.

 

Some of the common risks of mastoidectomy are:

1. Vomiting sensation for one to two days.
2. Low-grade fever (99.6°F to 100.3°F) for a few days.
3. Pain at the site of surgery for three to five days.
4. Dizziness (resolves in a few days post-surgery).
5. Ringing or buzzing sound in the ear.
6. Ear drainage for three to five days.
7. Alterations in the taste sensation.
8. Temporary loss in hearing sensation.

However, some complications of surgery are serious, for which you will need to consult your ENT specialist. Here are some severe complications post-mastoidectomy:

1. Infection, which causes symptoms like:
2. High body temperature (> 102° F).
3. Too much blood or fluid drainage from the ear.
4. Foul odour coming from drainage.
5. Fluid drainage or swelling at the site of surgery.
6. Recurrent infection.
7. Rupture in the tissue that separates your eardrum from the middle ear.
8. Decreased or complete loss of hearing.
9. Dizziness that lasts for more than seven days
10. Facial nerve palsy (inability to control facial movements such as smiling). Our facial nerve passes through the ear canal and mastoid area; hence, this nerve can get damaged during the surgery. However, this complication is rare and occurs in < 1% of patients.
11. Fluid drainage from your spinal cord.