Mastoidectomy

What is Mastoidectomy?

Mastoidectomy is a surgical intervention in which the mastoid air cells (portion of the mastoid bone) are removed due to their being infected or damaged.

Types

There are five different types of mastoidectomy:

• Simple mastoidectomy
  • The mastoid cortex is opened and the aditus ad antrum is identified
• Complete mastoidectomy (canal up)
  • Removal of all the mastoid cells from the following areas: tegmen, presigmoid dural plate, sigmoid sinus and external auditory canal (posterior wall)
  • Even though the mastoid cells from the posterior wall of the external auditory canal are removed, the wall itself is maintained
• Complete mastoidectomy (canal down)
  • The mastoid cells are removed from all the above mentioned areas
  • Apart from that, parts of the external auditory canal are going to be removed as well (posterior wall and superior osseous part)
  • The intervention requires the reconstruction of the tympanic membrane, so as to guarantee a separation between the middle ear and the mastoid cavity, with the ear canal
• Modified radical mastoidectomy
  • Procedure similar to the one of canal down mastoidectomy
  • Difference – no manipulation of the middle ear space or of the tympanic membrane
  • Recommended – no extension of cholesteatoma (squamous epithelium) in the middle ear space or in patients who have this problem in the ear with the better hearing
• Radical mastoidectomy
  • Procedure similar to the one of canal down mastoidectomy
  • Tympanic membrane and ossicles are not reconstructed
  • The middle ear and the mastoid remain exteriorized
  • Soft tissue is used for the obliteration of the Eustachian tube, so as to reduce the risk for chronic conditions, such as otorrhea
  • Skin grafts are often placed at the level of the middle ear, thus reducing the risk for otorrhea or other chronic problems, such as mucosalization.

Why is Mastoidectomy performed?

These are the most common reasons why mastoidectomy is performed:

• Infection of the air cells that are part of the mastoid bone
  • Infection spread from the middle ear
  • Mastoiditis
  • Chronic otitis media (with or without cholesteatoma)
• Cholesteatoma (inflammatory disease)
  • Excess growth of epithelium in the middle ear
• Repairing of the paralyzed facial nerves
• Placement of a cochlear implant
  • Purpose – rehabilitate the acquired or congenital hearing loss
  • Mastoidectomy – step of the overall procedure
• Removal of lateral skull base neoplasms (epidermoids, paragangliomas of the temporal bone, meningiomas and vestibular schwannomas)
  • Mastoidectomy – step of the overall procedure
• Complications of otitis media
  • Intratemporal/intracranial suppuration
  • Lateral venous sinus thrombosis.

Mastoidectomy Procedure

The procedure is performed under general anesthesia. The patient is placed in a supine position, with the head rotated at an angle of 30-45 degrees. After the anesthesia has kicked in, the head of the patient is going to be rotated at an even higher angle (180 degrees).

For the procedure, the surgeon will access the infected or damaged part of the mastoid bone through the ear or by making a cut behind the ear. Small surgical instruments are going to be used in order to access the actual mastoid bone. Suction irrigation is going to be used to remove any small bone particles, after the surgeon has drilled into the mastoid bone. The infected mastoid air cells are going to be removed and the surgeon is going to close the surgical field. The operation site is going to be covered with a gauze, allowing for the excess fluid to be drained. During the procedure, the surgeon might use a special monitor, so as to prevent the damaging of the facial nerve.

How long does a mastoidectomy take?

On average, if there are no complications, the procedure takes approximately 3 hours.

Cost

In calculating the costs of the procedure, you will have to take several factors into account, such as: anesthesia fees, doctor fees and the clinic in which the intervention is performed. Also, if there are any complications during the surgery or you may need to spend some time in the ICU, this might also translate into higher overall costs. You will also have to check your insurance policy, so see if this procedure is covered or not. In general, you can expect to pay around $7000 for a procedure, with a discount given by the insurance. Keep in mind that this cost refers strictly to the mastoidectomy – if you are having a cochlear implant, for example, you will have to pay extra.

Complications

These are the complications that can occur with the mastoidectomy procedure:

• Paresis or paralysis of the facial nerve (nerve injury)
• Hearing loss (occurs in 6% of the patients)
• Vertigo (temporary complications, goes away on its own a few days after he surgery)
• The taste can be affected (patients describe having a metallic or a sour taste; others complain of their taste being reduced in intensity – temporary complication as well, goes away in a couple of months)
• Ringing sound in the ears (tinnitus) or other abnormal noises (popping or hissing)
• Mastoid cutaneous fistula – rare complication
• Dural injury – occurs during the drilling of the mastoid bone
• Vascular injury – often at the level of the sigmoid sinus (large bleeding).

Recovery

The recovery process is slow and there are some patients who might require a second intervention in the next six to twelve months. The recovery process can be shortened by following the advice of the doctor and protecting yourself against the risk of infection.

What to expect after mastoidectomy surgery?

After the surgery, the doctor will recommend that you use antibiotic ear drops, so as to reduce the risk of postoperative infection. Pain medication might also help with the pain and inflammation during the recovery period (avoid taking aspirin as this can increase the risk for bleeding). During bathing, you will need to cover the surgical site. For the first weeks after the surgery, you will have to avoid the excess physical exercise. You must not place pressure on the ear and it is important to avoid flying until you get the okay from the doctor. Swimming should also be postponed until the doctor says it is alright.

Mastoidectomy Anatomy Pictures