mastoidectomies

Mastoidectomy

Definition

Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics.

Purpose

Mastoidectomy is performed to remove infected air cells within the mastoid bone caused by mastoiditis, ear infection, or an inflammatory disease of the middle ear (cholesteatoma). The cells are open spaces containing air that are located throughout the mastoid bone. They are connected to a cavity in the upper part of the bone, which is in turn connected to the middle ear. As a result, infections in the middle ear can sometimes spread through the mastoid bone. When antibiotics cannot clear this infection, it may be necessary to remove the infected air cells by surgery. Mastoidectomies are also performed sometimes to repair paralyzed facial nerves.

Description

Mastoidectomy is performed less often today because of the widespread use of antibiotics to treat ear infections.

There are several different types of mastoidectomy:

Simple (or closed). The operation is performed through the ear or through a cut (incision) behind the ear. The surgeon opens the mastoid bone and removes the infected air cells. The eardrum is cut (incised) to drain the middle ear. Topical antibiotics are then placed in the ear.
Radical mastoidectomy. The eardrum and most middle ear structures are removed, but the innermost small bone (the stapes) is left behind so that a hearing aid can be used later to offset the hearing loss.
Modified radical mastoidectomy. The eardrum and the middle ear structures are saved, which allows for better hearing than is possible after a radical operation.

The wound is then stitched up around a drainage tube, which is removed a day or two later. The procedure usually takes between two and three hours.

Preparation

The doctor will give the patient a thorough ear, nose, and throat examination as well as a detailed hearing test before surgery. Patients are given an injection before surgery to make them drowsy.

Aftercare

Painkillers are usually needed for the first day or two after the operation. The patient should drink fluids freely. After the stitches are removed, the bulky mastoid dressing can be replaced with a smaller dressing if the ear is still draining. The patient is given antibiotics for several days.

The patient should tell the doctor if any of the following symptoms occur:

Bright red blood on the dressing.
Stiff neck or disorientation. These may be signs of meningitis.
Facial paralysis, drooping mouth, or problems swallowing.

Risks

Complications do not often occur, but they may include:

Persistent ear drainage.
Infections, including meningitis or brain abscesses.
Hearing loss.
Facial nerve injury. This is a rare complication.
Temporary dizziness.
Temporary loss of taste on the side of the tongue.

Key terms

Cholesteatoma — A rare but chronic inflammatory disease in which skin cells and debris collect in the middle ear, usually as a result of an ear infection.

Mastoid bone — The prominent bone behind the ear that projects from the temporal bone of the skull.

Mastoiditis — An inflammation of the bone behind the ear (the mastoid bone) caused by an infection spreading from the middle ear to the cavity in the mastoid bone.

Resources

Organizations

American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. http://www.entnet.org.

American Hearing Research Foundation. 55 E. Washington St., Suite 2022, Chicago, IL 60602. (312) 726-9670. http://www.american-hearing.org/.

Better Hearing Institute. 515 King Street, Suite 420, Alexandria, VA 22314. (703) 684-3391.

mastoidectomy /mas·toid·ec·to·my/ (mas″toi-dek´tah-me) excision of the mastoid cells or the mastoid process.

mas·toid·ec·to·my (m

toi-d

-m

)

Surgical removal of mastoid sinuses or part or all of the mastoid process.

mastoidectomy

[mas′toidek′təmē]

Etymology: Gk, mastos + eidos, form, ektomē, excision

surgical excision of a part of the mastoid part of the temporal bone, frequently performed to treat cholesteatoma. It may also be performed to treat chronic suppurative otitis media or mastoiditis when systemic antibiotics are ineffective. Often done as part of reconstructive procedure and classified as simple modified radical. Entry is made through the ear canal or from behind the ear. In a simple mastoidectomy with the patient under general anesthesia, diseased bones of the mastoid are removed while the ossicles, eardrum, and canal wall are left intact and the eardrum is incised to drain the middle ear. Topical antibiotics are then instilled in the ear. In a radical procedure the eardrum and most middle ear structures are removed. The stapes is left intact so that a hearing aid may be used. The opening to the eustachian tube is plugged. In a modified radical procedure the eardrum and some of the ossicles are saved, and the patient hears better than after a radical mastoidectomy. After surgery any bright red blood on the dressing may indicate hemorrhage. A stiff neck or disorientation may signal the onset of meningitis. Dizziness is usual and may be expected to last for several days.

mastoidectomy [mas″toi-dek´to-me]

surgical removal of mastoid cells; the most frequent indication for this is chronic infection in the mastoid process occurring as a complication of chronic otitis media. The extent of surgery depends on extent of destruction. A radical mastoidectomy involves removal of diseased portions of the mastoid process as well as the incus and malleus of the middle ear and the tympanic membrane. The degree of hearing loss following mastoidectomy depends on the extent of surgery. In some cases tympanoplasty (plastic reconstruction of the middle ear) can preserve much of the hearing. (For nursing care after ear surgery, see ear.)