The mastoid bone is a bony lump behind the ear. It consists of air cells, mastoidectomy is removal of the cells. It is usually performed as a treatment for infection in this area. This could be mastoiditis, cholesteatoma or suppurative otitis media. Sometimes it is performed for other reasons such as in to access the area behind the eardrum or whilst inserting a cochlear implant.

Several types of mastoidectomy exist. The first is simple mastoidectomy. During this procedure the surgeon accesses the mastoid bone and drains the middle ear space behind the drum. They then take away the air cells which are infected.

In a radical mastoidectomy the surgeon can also take away the eardrum and structures of the middle ear. Occasionally a skin graft is used in the middle ear space.

During a modified radical mastoidectomy not all of the bones of the middle ear are removed and the eardrum is reconstructed. This type is not as severe as a radical mastoidectomy.

Hearing is likely to be affected by the second two operations. To start with infections are usually treated with antibiotics and surgery tends to only be used if the antibiotics do not work. This means that the operation is not as common as it used to be.

When is a mastoidectomy required?

It is often performed for the complications of chronic otitis media. This is ongoing infection in the space behind the eardrum. If left without treatment it can lead to a cholesteatoma. This is a cyst in the skin. It gets bigger and can lead to some bad complications. These include;

- Brain abscess
- Loss of hearing
- Meningitis
- Dizziness
- Chronic ear discharge
- Labyrinthitis
- Facial nerve damage
- Spread to the brain

During a cochlear implant a mastoidectomy may also be performed. A cochlear implant is a tiny electrical unit which can help very deaf people to hear.

What happens during mastoidectomy? Usually this procedure is carried out under a general anaesthetic. This means that the patient will be comfortable. During a simple mastoidectomy a cut is made behind the ear. A microscope and drill are used to open up the bone. Suction and irrigation are likely to be used to keep the area clean and free of debris. The surgeon then removes the parts which are infected and then sews up the operation site. The dressings are applied.

During the operation the surgeon might use a device to monitor the facial nerve. This makes sure that it does not suffer damage. After the operation you may have some pain and discomfort in and around the region of your mastoid. You may need painkillers and antibiotics from your doctor.

Your surgeon is likely to arrange a follow-up to check how the wound is healing and remove the stitches.

Complications include damage to the facial nerve leading to weakness of the face. This is rare. Hearing loss may occur due to nerve damage. Dizziness, altered taste and tinnitus can also occur. Make sure you contact your doctor if you have any of these problems or if there is severe bleeding or a high-temperature.

Visit your GP if you have problems with your ear or any questions about mastoidectomy. This article shouldn't be considered to be medical advice.

Dr Toby Bateson