A mastoidectomy is a type of surgery that removes an infection from the bone behind the ear, called the mastoid bone. The mastoid bone looks like a honeycomb, and the spaces are filled with air.
Due to the mastoid bone's connection to the middle ear, ear infections can sometimes spread to its air-filled spaces. This causes a bacterial infection called mastoiditis. A mastoidectomy intends to create a safe and dry ear by preventing further complications of mastoiditis or hearing damage.
What Are the Indications for a Mastoidectomy?
Mastoidectomy indications are any signs, symptoms, or conditions that may lead a doctor to recommend the procedure. A doctor will typically recommend a mastoidectomy if you have mastoiditis that hasn't responded to antibiotics or if you have chronic mastoiditis.
A mastoidectomy may also prevent further complications of mastoiditis, such as:
- Meningitis — an infection of the lining of the brain and spinal cord
- Brain abscess — a pus-filled pocket of infected material in your brain
- Blood clots in the veins of the brain
You may need to have a mastoidectomy if you have other diseases that spread to your mastoid bone, such as a cholesteatoma, which is an abnormal collection of skin cells deep inside your ear. A mastoidectomy will remove these harmful benign growths.
A doctor may also perform a mastoidectomy to place a cochlear implant. This is a small electronic device that helps people hear.
Generally speaking, if you have recurring ear infections or you're experiencing complications due to chronic ear infections, a mastoidectomy may be your best treatment option. Your doctor will let you know if a mastoidectomy seems like a good idea, depending on your medical history and other factors.
Types of Mastoidectomy Surgeries
There are several types of mastoidectomy surgeries. Some are more extensive than others.
- In a simple mastoidectomy, a surgeon opens the mastoid bone and removes the infected area.
- A canal wall up mastoidectomy removes more bone than a simple mastoidectomy does. Sometimes, removing more of the bone is necessary so the surgeon can access your middle ear.
- A canal wall down (or radical) mastoidectomy is usually necessary when the infection severely damages your ear canal. Usually, the surgeon attempts to preserve as much hearing as possible. But in some cases, they may need to completely remove your eardrum and middle ear structures.
- In a modified radical mastoidectomy, the surgeon leaves some of the middle ear bones in place and rebuilds your eardrum.
The type of mastoidectomy your doctor recommends will depend on several factors, including:
- Your anatomy
- The extent of the infection
- The possible risks to your overall hearing or balance
- Your likelihood to follow up consistently with the doctor
More extensive procedures, like radical or modified radical mastoidectomies, require more follow-up appointments for mastoid cleanings.
What Are the Potential Risks of a Mastoidectomy?
As with any surgery, there are some risks involved with a mastoidectomy. The potential complications include:
- Dizziness
- Hearing loss
- Changes in taste
- Recurring infection
- Ringing in the ear (tinnitus)
- Facial nerve injury leading to facial weakness or paralysis
- Leaking of fluid from around the brain and spinal cord
What Happens Before the Procedure?
Before a mastoidectomy, you’ll need to follow any pre-op instructions your doctor gives you. This may include not taking certain medications for a short time and not eating or drinking after midnight before the day of the surgery. Because the surgeon will use general anesthesia to perform the procedure, you’ll also need to arrange for a ride to and from the medical facility.
What Happens During a Mastoidectomy?
On the day of the surgery, you’ll receive general anesthesia, so you won’t feel any pain during the operation. Your surgeon will make a small cut right behind your ear and use specialized medical instruments to open your mastoid bone. Then, the surgeon will remove the infected parts of the bone or ear tissue, close the cut with stitches, and bandage the area.
Overall, a mastoidectomy takes about 2 to 3 hours.
Mastoidectomy Recovery
Mastoidectomy recovery is usually relatively straightforward. Although you shouldn’t feel any pain during the procedure, you may have some mild discomfort afterward. You’ll likely have to stay at the medical facility overnight, but the majority of mastoidectomy post-op care happens at home.
After the procedure, you’ll have stitches behind your ear. You may also have a small rubber drain that helps avoid fluid build-up. The incision is likely to be sore, and you might experience a feeling of stuffiness inside your ear. This is all normal. Your doctor will let you know when it’s okay to remove the bandage.
Before you go home, your doctor will advise you on how to use over-the-counter (OTC) pain relievers to manage the side effects. In some cases, they may give you prescription pain medication and antibiotics to prevent infection.
Once you’re home, you’ll need to keep the incision area dry and avoid getting water in the recovering ear. The stitches will dissolve on their own. Try to sleep on the opposite ear and avoid blowing your nose for about two weeks after surgery.
If you have to sneeze during the recovery period, do so with your mouth open. Holding in a sneeze will cause pressure to build up in your ear.
Full recovery from a mastoidectomy takes about 6 to 12 weeks. Most people can return to work or school in about 1 to 2 weeks.
Mastoidectomy Outlook (Prognosis)
In most instances, a mastoidectomy completely eliminates the infection in your mastoid bone. However, the outlook can vary depending on the type of procedure you had and the reason for your mastoidectomy. Unfortunately, some hearing loss is common with canal wall down or radical mastoidectomy.
Your doctor will ensure your ear is healing correctly at your follow-up appointment. They’ll also address any complications and provide treatment options if they haven’t resolved.
When to Call the Doctor
If you're concerned about your recovery from a mastoidectomy or if you’re experiencing any of the following symptoms after the procedure, you should contact your doctor:
- A fever (100.5 degrees Fahrenheit or higher)
- Heavy bleeding or discharge from the incision site
- Hearing loss
- Dizziness
- Vertigo
- Facial weakness or paralysis