MASTOIDECTOMY

Abhishek Kalambi
Roll No.:06
3rd Year MBBS
OVERVIEW

• What is a mastoidectomy?
• A mastoidectomy is a surgery that removes diseased mastoid air cells. These air cells form in the hollow spaces within your mastoid
— a sponge-like, honeycomb-shaped bone that sits just behind your ear.

• Why is mastoidectomy performed?

• A mastoidectomy is necessary when an ear infection (otitis media) spreads to your skull. The procedure is also used to
treat cholesteatoma — a noncancerous growth that forms behind your eardrum, often as a complication of chronic ear infections. In
many cases, mastoidectomy is performed during cochlear implant surgery.

• If you have a ruptured eardrum, your surgeon will perform a mastoidectomy with tympanoplasty.
TYPES OF
MASTOIDECTOMIES • CORTICAL MASTOIDECTOMY

• MODIFIED RADICAL
MASTOIDECTOMY

• RADICAL MASTOIDECTOMY
CORTICAL MASTOIDECTOMY
• Cortical mastoidectomy, known as simple or complete mastoidectomy or Schwartz operation, is complete
exenteration of all accessible mastoid air cells and converting them into a single cavity. Posterior meatal wall is
left intact (Figure 80.1). Middle ear structures are not disturbed.

• INDICATIONS

• 1. Acute coalescent mastoiditis (see p. 84).

• 2. Incompletely resolved acute otitis media with reservoir sign.

• 3. Masked mastoiditis.

• 4. As an initial step to perform:

• a. endolymphatic sac surgery

• b. decompression of facial nerve

• c. translabyrinthine or retrolabyrinthine procedures for acoustic neuroma.

Radical Mastoidectomy
• Radical mastoidectomy is a procedure to eradicate disease from the middle ear and mastoid without any
attempt to reconstruct hearing. Posterior meatal wall is removed and the entire area of middle ear, attic, antrum
and mastoid is converted into a single cavity. All remnants of tympanic membrane, ossicles (except stapes
footplate) and mucoperiosteal lining are removed. Eustachian tube is obliterated by a piece of muscle or
cartilage. Aim of the operation is to permanently exteriorize the diseased area for inspection and cleaning. The
radical mastoidectomy is infrequently required these days

• INDICATIONS

• 1. When all cholesteatoma cannot be safely removed, e.g. that invading eustachian tube, round window niche,
perilabyrinthine or hypotympanic cells.

• 2. If previous attempts to eradicate chronic inflammatory disease or cholesteatoma have failed.

• 3. As an approach to petrous apex.

• 4. Removal of glomus tumour.

• 5. Carcinoma middle ear. Radical mastoidectomy followed by radiotherapy is an alternative to en bloc removal
Modified Radical Mastoidectomy

• It is a modification of radical mastoidectomy where as much of the hearing mechanism

as possible is preserved. The disease process which is often localized to the attic and
antrum is removed and the whole area fully exteriorized into the meatus by removal of
the posterior meatal and lateral attic wall (Figure 82.1).

• INDICATIONS

• 1. Cholesteatoma confined to the attic and antrum.

• 2. Localized chronic otitis media. Irreversibly damaged tissues are removed,preserving

the rest to conserve or reconstruct hearing mechanism.
COMPLICATIONS AND RISKS
• As with any surgery, there are potential risks or complications.
Mastoidectomy complications may include:

• Inner ear hearing loss (sensorineural hearing loss).

• Facial nerve injury, which could cause facial weakness or paralysis.

• A change in taste, which often lasts several months (dysgeusia).

• Ringing in your ear (tinnitus).

RECOVERY AND OUTLOOK
• Full mastoidectomy recovery takes about six to 12 weeks.

• Mastoidectomy is largely successful, but the outlook varies based on the reason for the surgery and the type of mastoidectomy
performed. The primary goal of mastoidectomy isn’t to restore hearing, but rather, to eliminate infection that can lead to further
problems. It’s important to note that some hearing loss is common with radical or canal-wall-down mastoidectomy.