mastoidectomy


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Related to mastoidectomy: cholesteatoma, radical mastoidectomy

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″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.)

mas·toi·dec·to·my

(mas'toy-dek'tŏ-mē),
A group of operations on the mastoid process of the temporal bone and middle ear to drain, expose, or remove an infectious, inflammatory, or neoplastic lesion.
[mastoid (process) + G. ektomē, excision]

mastoidectomy

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

mastoidectomy

(măs′toi-dĕk′tə-mē)
n. pl. mastoidecto·mies
Surgical removal of mastoid cells 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

A procedure used to close a persistently discharging mastoid cavity, which does not improve with regular cleansing and antibiotics, as a way of eliminating mastoid infection and obliterating or filling a previously created mastoid cavity.
 
Method
An incision is made behind the ear; the lining of the mastoid cavity is elevated and, if there is residual infection, the infected bone is curetted and the cavity filled with hydroxyapatite granules and covered with cartilage and skin flaps to create a healthy ear canal. The procedure may require reconstruction of eardrum with cartilage and the native ossicular chain replaced with a titanium graft. The ear is then packed with ribbon gauze and soaked with antiseptic paste to keep the graft in place until it heals.

Prognosis
85% of patients have dry, trouble-free ears; 60% hear better.

mastoidectomy

Head&neck surgery Partial excision of part of the mastoid cells or mastoid process. See Modified radical mastoidectomy, Radical mastoidectomy.

mas·toi·dec·to·my

(mas'toy-dek'tǒ-mē)
Hollowing out of the mastoid process by curretting, gouging, drilling, or otherwise removing the bony partitions forming the mastoid cells.
[mastoid (process) + G. ektomē, excision]

mastoidectomy

An operation to chisel off part of the surface bone of the mastoid process behind the ear so as to release pus, allow drainage and prevent inward spread of infection in MASTOIDITIS.
References in periodicals archive ?
The initial surgery consisted of a mastoidectomy and biopsy.
In the last surgery which was performed approximately 4 years prior to presentation, the patient underwent right radical mastoidectomy due to recurrent cholesteatoma.
CONCLUSION: Single-stage CWDM with reconstruction of the posterior canal wall, ossicular chain, and tympanic membrane is a safe and reliable technique with the advantages of Canal wall up Mastoidectomy (CWUM).
Conclusion: Combining canal wall up mastoidectomy with Type I tympanoplasty can treat otitis media safely and effectively due to high postoperative dry ear canal rate, satisfactory reconstruction of hearing and maintenance of ear morphology.
Although surgical treatment may be withheld until after a trial of antibiotics in immunocompetent patients, early surgical debridement with mastoidectomy should be encouraged in patients whose immune systems are weakened or suppressed by anti-rejection medications if a rapid response to medical therapy does not occur.
Mastoidectomy audit: results of the Royal College of surgeons of England comparative audit of ENT surgery.
Unit of Study: All patients who had undergone tympanoplasty procedure with cortical mastoidectomy surgery, were included in the study.
Key Words: Suppurative otitis media, Meningitis, Brain abscess, Atticotomy, Mastoidectomy.
She responded well to surgical drainage and mastoidectomy with myringotomy tube placement and initial parenteral therapy with vancomycin (plus ceftriaxone), and was transitioned to oral levofloxacin.
She responded well to surgical drainage and mastoidectomy with myfingotomy tube placement and initial parenteral therapy with vancomycin (plus ceftriaxone), and was transitioned to oral levofloxacin.