What is a mastoidectomy or mastoid exploration?
The middle ear cleft is made up of three parts - middle ear proper, Eustachian tube, and the mastoid bone. The mastoid bone, situated right behind the ear, is a non-rigid, sponge-like structure that can get infected due to an untreated infection in the middle ear. Mastoidectomy, also called mastoid exploration, is complete removal of diseased mastoid air cells from the mastoid bone.
There are 3 different types of mastoidectomy procedures that can be undertaken as per the type and the extent of the disease:
1. Cortical mastoidectomy- for patients with safe type of middle ear disease, done to improve middle ear ventilation
2. Modified radical mastoidectomy (further divided into Inside out and outside in procedures) - for patients with unsafe type of middle ear disease/ cholesteatoma
3. Radical mastoidectomy - an extensive surgery reserved for conditions like ear cancers etc.
If you have an untreated unsafe chronic middle ear infection that has spread to the mastoid bone, it can later destroy your hearing, sense of balance and damage your facial nerve to cause facial paralysis. As the ear is situated very close to the brain, it can also cause brain infections.
It is essential to carry out a mastoid exploration to remove all diseased parts of the bone to remove or reduce the risk of these complications. The ENT surgeon can also opt to combine a mastoid exploration with myringoplasty and ossiculoplasty to improve your hearing; if required.
The surgeon’s aim in conducting a mastoidectomy is to remove all the diseased portions while still preserving the patient’s ear’s working ability as much as is possible. He will make an incision behind your ear for this surgery whose extent will be as per the extent of the disease. A mastoidectomy can be done under general or local anaesthesia.
You can think of the mastoid bone like a bony sponge riddled with small air pockets that can harbour the very harmful cholestetoma (a collection of abnormal but non-cancerous skin cells in the ear). In mastoidectomy, the surgeon removes these cholestetoma. If the disease has covered the three tiny bones of the ear known as ossicles, the surgeon will remove these too. The facial nerve runs through the ear’s bony canal and if the bone is destroyed by the disease, it affects the facial nerve as well. The surgeon will take utmost care to protect this nerve. After he has removed all the infected and diseased portions, he will use a graft to seal up any hole in the eardrum and pack the ear with gelfoam. The surgeon may also undertake reconstruction of the ear’s hearing apparatus along with this surgery or perform it as a second stage procedure.
Most of the times, it is hardly noticeable. The cut behind the ear mends well and the scar too almost fades gradually.
Pre-operative instructions for mastoidectomy are quite similar to those for myringoplasty and ossiculoplasty (given above).
After the ENT surgeon has set a date for your mastoidectomy, you are advised the following precautions:
- Till the preceding night of the surgery, duly take all medications prescribed to you by the ENT surgeon. Bring along any remaining medicines in original packaging when you check in for surgery the next morning. Also bring along any non-prescription medications in their original packaging that you are currently taking.
- Get a good night’s sleep. Do not eat anything at all from midnight onwards prior to the surgery day.
- Make sure you bring your hospital file with you at the time of the check-in for surgery duly including all required test reports such as the major surgical profile, audiological evaluation reports, pre- anaesthetic check up sheet, radiological investigation films and reports (X-ray, CT scan, MRI, PET scan etc.) and any others investigations advised by your ENT surgeon. We advise you to ready this file a day before the surgery.
- Shampoo your hair before the surgery day. Male patients are advised to ensure a short hair cut.
- You should be accompanied by an attendant. We advise bringing along a close family member.
- Please ensure that you report at the hospital at least three hours prior to your surgery’s scheduled timing.
- Report at the reception desk in time and the hospital staff will guide you through the next steps.
- If you have felt any changes in your physical condition such as cough, cold, fever or throat pain, be sure to mention it to your doctor and anaesthetist. If you are allergic to any drugs, be very sure to mention that as well.
Please read the following information carefully to get further clarity on the pre-operative instructions including special instructions for patients with diabetes, respiratory or cardiac problems.
Just like the preoperative instructions, the postoperative instructions for mastoidectomy too are very similar to those for a myringoplasty or an ossiculoplasty (given above).
First 24 hours:
- Take complete bed rest. Do not lie on the side of the operated ear.
- You are not allowed any drink or food till 4-5 hours after the surgery. After the surgical staff gives the go-ahead, you can sip water. A while later you can take milk or Horlicks etc. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided as these can cause gastric irritation when consumed on an empty stomach. You can start a semi-solid diet in moderate quantities after 12 hours. You can resume normal food from second day onwards.
Precautions from the day of discharge:
- Take all medications on schedule as prescribed by your surgeon.
- Do not oil your hair.
- Do not clean your ear.
- Stay away from people with cold or cough.
- Do not blow your nose with excessive force.
- If you have to sneeze, do so with your mouth open.
- Do not have a head bath for a full one month after the surgery. No water should get into your ear.
- Do not sleep on the operated side for a month afterwards.
- Do not undertake strenuous work for a month afterwards.
- Do not travel by air for 3 months after the surgery.
The following activities are allowed:
- A daily bath that does not wet or spoil your head bandage till the time it is on your head.
- Resumption of regular office work after 3 days of surgery (unless specially advised by your operating surgeon)
When you should contact the hospital immediately:
- If your prescription medicines cause any drug reactions such as rashes or stomach upset etc, call your doctor immediately.
- If your ear bandage becomes loose or gets soiled between days 1 and 7 i.e. from operation till suture removal, visit your doctor for a fresh bandage.
Precautions after suture removal:
- Strictly follow all the dos and don’ts mentioned above.
- Change the cotton outside the ear three times a day using the method demonstrated to you by the hospital staff.
- Clean behind your ear while bathing.
- Disregard low to moderate ear discharge as it is a normal occurrence for up to 3 months after the surgery. But keep an eye open for excessive ear discharge.
- A follow-up audiological evaluation is advised 3 months from the date of surgery.
When you should contact the hospital immediately:
- If you get any severe pain in the ear or surrounding region.
- If you get any swelling in or around the ear.
- If you feel dizzy or are vomiting.
- If you feel facial weakness.
- If your ear is oozing excessive discharge.
Timeline for specific activity resumption:
- Head bath: 1 month after surgery
- Office work/ housework: 3 days from the date of surgery (your ear bandage will stay on for 7 days)
- Air travel: 1 month after surgery
- Swimming and other water activities: 3 months after surgery
After surgery and subsequent discharge from the hospital, the following post-operative visits with your operating surgeon will be scheduled:
- 7 days later for suture and ear bandage removal (1st visit)
- Following first visit, visits every 10 days in the first month (2nd & 3rd visits)
- Visits every 15 days in the second and third month (5th to 8th visits)
- One visit every 3 months for the rest of year
- One visit every 6 months from the second year following the surgery
Mastoidectomy, like any other surgery, carries some risks that you should know prior to giving consent to this treatment. While these occur rarely, please consult your surgeon for further risk evaluation in your individual case.
- Taste disturbance: The taste nerve runs close to the eardrum and may sustain some damage to cause abnormal taste on one side of the tongue. While this taste disturbance is mostly a temporary phenomenon, it may be permanent in some cases.
- Dizziness: Dizziness for a few hours after the surgery is normal. In some cases, it may last longer.
- Hearing loss: Very rarely, if the patient’s inner ear is damaged, severe deafness can occur.
- Tinnitus: If the hearing loss worsens, the patient may suffer from tinnitus or noises in the ear.
- Facial Paralysis: As the facial nerve controlling face muscles runs through the ear, there is a slight chance of a partial or total facial paralysis affecting movements such eye closure, smiling and raising the forehead. This facial paralysis can occur immediately after the surgery or after a while. Recovery can be partial or total.
- Allergic reaction to ear dressings: Occasionally the ear may show allergy to the dressings in the ear canal leading to a red, swollen and inflamed pinna (outer ear). Consult your surgeon for dressing removal and settling down of the allergic reaction.
- Risks of a general anaesthetic must also be kept in mind.