Mastoidectomy is a surgical procedure performed to remove mastoid cells. Learn about it in Turkey in this article.
Mastoidectomy may be necessary when otitis media extends to the mastoid bone.
One of the most common conditions is a skin pocket that grows from the outer to the middle ear, known as a cholesteatoma. It causes ear inflammation with discharge and hearing loss. The pocket grows slowly, usually over many years, gradually eroding the surrounding bone structures. This bone erosion can lead to hearing loss. Mastoidectomy is the best treatment for it.
What is the mastoid bone?
The mastoid bone (mastoid process) is a part of the temporal bone in the skull located just behind the ear. It is connected to the ear through the middle part (middle ear), bordered by the eardrum, and contains the auditory ossicles (hammer, anvil, and stirrup). The mastoid bone contains air cells that have gradually developed since birth, and these cells play a role in ventilating the ear.
For whom is mastoidectomy performed?
Chronic middle ear infections or inflammation (infection), such as cholesteatoma, can spread to the mastoid bone, causing mastoiditis and pain, swelling, and redness in the mastoid bone behind the ear. This requires prompt treatment in the hospital, usually with intravenous antibiotics first and mastoidectomy surgery if things do not improve as a later step.
If the condition is not treated well or is not detected early enough, it can destroy the hearing and balance mechanisms over time and can cause facial paralysis and encephalitis.
The most common reason for this surgery is a condition called a cholesteatoma. This is a collection of dead skin cells that grow like a sac from the eardrum into the middle ear and mastoid bone. Over a few years, as this skin sac grows, it can cause recurring ear infections.
The enlarged cyst may also begin to erode surrounding structures in and around the middle ear, such as the small auditory ossicles (malleus, anvil, and stirrup) that transmit sound, the bony covering of the inner ear, the bones that protect the facial nerve, and the petrosal bones of the skull that separate the ear from the brain.
This condition is initially diagnosed as hearing loss followed by ear discharge that does not resolve with topical or oral antibiotics. Therefore, the best treatment for cholesteatoma is mastoidectomy.
Sometimes, it is performed as part of other procedures, such as cochlear implant surgery.
How is a patient prepared for a mastoidectomy?
First, your doctor will perform a comprehensive physical examination, focusing on your nose, ears, throat, sinuses, and tonsils.
Your doctor will examine your ear using a portable otoscope. A microscope can be used to examine your ear more thoroughly, and earwax suctioning may be used to get a better view. This procedure is very safe but can sometimes cause mild discomfort and dizziness. In addition, an audiogram will be performed to check your hearing levels. Your consultant may also request a CT scan or MRI scan.
Ear suction and treatment with anti-inflammatory medications will temporarily relieve the condition. However, the only safe and effective way to treat and remove a cholesteatoma is to remove it surgically.
What are the types of mastoidectomy?
Mastoidectomy surgeries are also known as combined approach tympanoplasty (CAT). There are different forms of the operation, often tailored to the size of the cholesteatoma. There are several different methods and approaches to performing mastoidectomy:
Simple mastoidectomy
This procedure removes the affected air cells.
In radical mastoidectomy
The doctor removes the mastoid air cells, eardrums, and most middle ear structures.
In modified radical mastoidectomy
The affected cells in the mastoid are removed along with a few parts of the middle ear structures.
Subcanal mastoidectomy
The lower and upper walls of the canal are removed, and the meatus is patched up, leaving the eardrum in place.
Supracanal mastoidectomy
The upper and lower walls are left in place.
Cortical mastoidectomy
Removes only the mastoid cells without affecting the middle ear.
So you should discuss with your surgeon his preferred approach to performing this surgery and what your condition requires.
What are the steps of mastoidectomy surgery?
It is also called combined mastoidectomy and tympanoplasty (CAT), modified radical mastoidectomy, tympanostomy, tympanoplasty, or mastoidectomy. These are just different approaches with the same goals.
After a thorough clinical examination, your ENT surgeon will order a hearing test (audiogram) and a CT scan of the temporal bone and mastoid before proceeding with mastoidectomy. It is usually performed under general anesthesia and takes between 1 and 4 hours.
Mastoidectomy involves making an incision above or behind the ear. Some surgeons may perform the surgery through the ear canal with the help of an endoscope (high-resolution) and an operating microscope under high magnification, especially if the tumor is limited. The mastoid bone is opened with a high-speed drill to remove the temporal bone to access the tumor. Other techniques combined with endoscopy and laser may be used in this surgery.
At the end of the procedure, a pack will be placed in the ear to collect the secretions during the healing period. The pack can be left in for up to 3 weeks before removal from the clinic. Some surgeons may use absorbable packing that does not need to be removed.
As for the stitches, they can be removed after 7 to 10 days in the clinic by the doctor. After the mastoidectomy (removal of the mastoid process), there may also be a bandage on the head for up to 24 hours.
What are the alternatives to mastoidectomy surgery?
Surgery and mastoidectomy may not be the best option for the patient. This is a decision you and your surgeon can make. Regular ear cleaning with suction in the clinic and intermittent use of anti-inflammatory drops may contain the inflammation but will not completely cure it. There will still be a risk of complications from the enlarged cholesteatoma. These rare complications include meningitis (infection)/brain abscess, facial nerve weakness, dizziness, and complete hearing loss.
If your job involves swimming, requires the integrity of the eardrum (such as in the military), or relies on your sense of taste (chef), mastoidectomy (removal of the mammillary ridge) can cause problems, and you should discuss this with your surgeon.
What are the complications of mastoidectomy?
There are many complications, and here is a list of the most important ones:
- Taste disturbance after mastoidectomy
It is very common to experience taste disturbance after this surgery. This is because the taste nerve is located near the eardrum and can rarely be affected during mastoidectomy. This abnormal taste occurs in the tongue on the same side as the surgery. It is usually temporary but can sometimes be permanent.
- Facial nerve weakness
Rare complications of facial nerve weakness after this surgery exist. The facial nerve (the nerve that controls facial movement) passes through the mastoid bone and the middle ear. Sometimes, the nerve becomes swollen after a mastoidectomy, but this is temporary, and facial movement will recover afterward. However, if the nerve is damaged, the face may have a permanent weakness.
- Allergic reaction
Allergic reaction to the medication in the ear pads: Some patients may have a skin reaction to the ear pads. If the patient feels itchy or swollen in the ear, they should seek advice from their surgeon. The ear pads contain medication to prevent infection.
- Relapse after mastoidectomy
Relapse is very common. The risk is higher with widespread cholesteatoma and may be related to the surgical technique used by the surgeon.
- Hearing loss after mastoidectomy
Most patients have some degree of hearing loss before the operation. It is unusual to lose all of your hearing after a mastoidectomy. However, if the infection has damaged your inner ear (cochlea) or your balance system, there is a greater risk of permanent, total hearing loss.
- Vertigo
In some cases, it is temporary but can last longer if the disease has damaged the balance organ.
- Tinnitus
You may already hear noises (tinnitus) before the mastoidectomy; in rare cases, it may get worse after the surgery. You may continue to have tinnitus, especially if you have hearing loss.
What happens after mastoidectomy surgery?
Pain after (resection) surgery is common, and you will be given pain medication to take home. This discomfort usually lasts for up to two weeks.
You will have dressings in your ear, and they are usually left in for up to 3 weeks after mastoidectomy surgery. You can expect some spotting from the wound.
The stitches will be removed 7 to 14 days after surgery. It is important to keep your ear dry during this time. Your doctor will give you a list of things to avoid after mastoidectomy surgery.
If you have any concerns about mastoidectomy surgery, contact us, and we will refer you to the best ENT doctors.
How long will I stay in hospital after mastoidectomy?
Sometimes, you can go home the same day, but be prepared for the possibility of an overnight stay in the hospital.
If there are risks after (resection) surgery, you may need to stay in the hospital longer.
What is the recovery period for a mastoidectomy?
How quickly you recover depends on the type of mastoidectomy you had. You may be able to return to your normal life after two weeks, but you will need to keep water away from the incision site and your ear. Most people recover completely after 6 to 8 weeks.
Follow-up after a mastoidectomy
Patients are scheduled for a few weeks after a mastoidectomy. You may need long-term ear care after the surgery.
Before you give your consent, you should make sure you understand the benefits and risks you will gain from this surgical procedure (especially those that may concern you the most), and discuss any questions you may have with a specialist.
Bimaristan Medical Center remains your first choice for treatment in Turkey.
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We provide our services throughout Turkey, and the best place for you is our destination.
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We offer free consultations around the clock. Contact us at your family’s hospital center in Turkey. You can also read through our website about the tympanoplasty procedure and the latest treatment techniques.
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