The part of the skull that is present behind the ear is known as a mastoid. It resembles the shape of a honeycomb as it consists of bones filled with air cells. The mastoid air cells become diseased due to the spread of the ear infection into the skull. Therefore, for the removal of cholesteatoma (abnormal growth in the ear), mastoidectomy is performed.
The mastoidectomy has several variations in procedure such as:
Simple mastoidectomy: It includes the opening of the mastoid bone, removal of infected air cells, and the drainage of the middle ear.
Radical mastoidectomy: It is applied to mastoid disease that is complicated. It includes the opening and removing mastoid air cells, eardrums, ear canal, and other middle ear structures.
Modified radical mastoidectomy: It is simple compared to radical mastoidectomy. It requires the removal of a few middle ear structures and mastoid air cells.
Radical and modified radical mastoidectomy may cause hearing loss. Usually, antibiotics help cure infections, but surgery is necessary when antibiotics do not work.
The procedure of mastoidectomy
The complications of middle ear infection known as chronic otitis media are treated by mastoidectomy. These infections lead to a skin cyst known as cholesteatoma.
Severe complications arise as the cyst grows, such as:
Brain membranes inflammation.
Inner ear inflammation.
Therefore, mastoidectomy surgery is initiated to reduce the complication and treat the cyst and mastoid air cells. Its procedure follows as:
The doctor uses anesthesia to numb the tissue before performing a mastoidectomy.
Behind the ear, a cut is made by the doctor, and the mastoid bone is accessed first.
The mastoid bone is opened by using a small drill with the help of a microscope.
The surgical area is kept clean from the bone dust by using suction irrigation.
The air cells which are infected are drilled out using a drill.
The doctor stitches up the operated site after removing the diseased mastoid air cells.
The wound is kept clean and dry by covering the whole area with gauze.
To avoid facial nerve injury, the surgeon uses a facial nerve monitor in complicated situations.
Complications involved in mastoidectomy
Several complications arise due to underlying factors before, after, and in between the surgery.
The complications involved in the mastoidectomy are as follows:
Facial nerve injury: It is most commonly seen in people who underwent mastoidectomy surgery. It is also known as facial nerve paralysis. Usually, after 2-4 hours of the postoperative period, the facial nerve paralysis resolves independently. However, if it does not resolve, immediate action is necessary.
Hearing loss: It occurs after mastoidectomy due to the accumulation of the serous fluid, blood, and packing in the middle ear area.
Vertigo: It also known as dizziness, is observed frequently in patients of otologic surgery. Several factors cause vertigo which includes anesthesia duration, cool irrigation, and ossicle manipulation.
Change in taste: It occurs in patients due to the removal of the chorda tympani nerve as it passes through the mastoid portion and joins in cholesteatoma. The major taste observed is a sour taste or metallic taste.
Other complications include the mastoid cutaneous fistula, dural injury, and vascular injury.
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