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Mastoidectomy – Procedure, Indications & Recovery

A mastoidectomy is a surgical procedure on the mastoid bone behind the ear, used to treat infections or inflammatory conditions affecting the middle ear and mastoid region.

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Things worth knowing about "Mastoidectomy"

A mastoidectomy is a surgical procedure on the mastoid bone behind the ear, used to treat infections or inflammatory conditions affecting the middle ear and mastoid region.

What is a Mastoidectomy?

A mastoidectomy is a surgical procedure performed by ear, nose, and throat (ENT) specialists in which diseased cells of the mastoid bone are removed. The mastoid is a bony prominence located behind the outer ear and is connected to the middle ear. It contains air-filled cells that can become infected or inflamed due to bacterial infections or chronic disease. The goal of the procedure is to remove diseased bone tissue and prevent potentially life-threatening complications.

Indications – When is a Mastoidectomy Performed?

A mastoidectomy is indicated for several conditions affecting the middle ear and mastoid bone. Common indications include:

Mastoiditis: A bacterial infection of the mastoid bone, often resulting from untreated or inadequately treated acute otitis media (middle ear infection).
Cholesteatoma: An abnormal, non-cancerous skin growth in the middle ear or mastoid that can destroy surrounding bone and tissue.
Chronic otitis media: Recurrent or persistent middle ear infections that do not respond to conservative treatment.
Cochlear implant surgery: Access to the cochlea (inner ear) is frequently gained through a mastoidectomy approach.
Complications of middle ear infections: Such as meningitis, brain abscess, or facial nerve palsy.

Types of Mastoidectomy

The surgical approach chosen depends on the extent and nature of the disease:

Simple (Cortical) Mastoidectomy

In a simple or cortical mastoidectomy, the diseased mastoid air cells are removed while the ear canal wall and ossicles (small hearing bones) are preserved. This technique is commonly used for acute mastoiditis.

Radical Mastoidectomy

A radical mastoidectomy is a more extensive procedure in which, in addition to the mastoid cells, the posterior ear canal wall and parts of the middle ear structures are removed. It is typically reserved for extensive cholesteatoma or severe chronic infections.

Modified Radical Mastoidectomy

The modified radical mastoidectomy represents a middle ground between the simple and radical approaches. The ossicles are preserved where possible to maintain hearing function.

Surgical Procedure

The operation is performed under general anesthesia. The surgeon makes an incision behind the ear to access the mastoid bone. A specialized surgical drill is used to carefully remove the diseased bone tissue. Modern techniques incorporate microscopes and endoscopic instruments to ensure precision and minimize damage to surrounding structures. The procedure typically takes between one and three hours.

Risks and Potential Complications

As with any surgical procedure, mastoidectomy carries certain risks:

Hearing loss: Temporary or permanent reduction in hearing ability.
Facial nerve palsy: Temporary or, rarely, permanent weakness of the facial nerve (cranial nerve VII), which runs through the operative field.
Dizziness and balance disturbances: Due to proximity to the vestibular (balance) system.
Tinnitus: New or worsened ringing in the ears following surgery.
Wound infection or impaired healing.
Cerebrospinal fluid leak: A rare but serious complication in which fluid surrounding the brain escapes.

Aftercare and Recovery

Following surgery, patients typically remain in hospital for one to several days. The wound is dressed and bandaged, with dressings changed regularly. Water must be kept out of the ear during healing. Follow-up appointments with an ENT specialist are essential in the weeks and months after the procedure to monitor recovery. Full healing may take several weeks to months. In cases involving cholesteatoma, regular long-term check-ups are necessary, as recurrence is possible.

References

Iro, H., Zenk, J.: HNO-Heilkunde. Springer Medizin Verlag, 2021.
Lim, D.J. et al.: Mastoidectomy and Tympanoplasty. In: Otolaryngologic Clinics of North America, 2006; 39(5): 1031–1052.
Deutsche Gesellschaft fur Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC): Guideline on Mastoiditis, AWMF Register No. 017/004, 2020.

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