Mastoidectomy

Overview

A mastoidectomy is a surgical procedure that removes infected mastoid air cells in the mastoid bone, located behind the ear. It is often performed to treat chronic ear infections or remove noncancerous growths like cholesteatomas, aiming to prevent complications and preserve hearing.

About Mastoidectomy

A mastoidectomy is a surgical procedure performed to remove diseased mastoid air cells located in the mastoid bone, which is part of the temporal bone situated just behind the ear. This surgery is often necessary when an ear infection, such as chronic otitis media, spreads to the mastoid bone or when a noncancerous growth called a cholesteatoma develops.

What is a mastoidectomy?

A mastoidectomy is a surgical procedure performed to remove infected or damaged mastoid air cells located in the mastoid bone, which is part of the temporal bone situated behind the ear. This surgery is often necessary when chronic ear infections, known as chronic otitis media, spread to the mastoid bone, causing a condition called mastoiditis. Additionally, a mastoidectomy may be required to remove a cholesteatoma, a noncancerous growth made up of skin cells and other debris that can erode the surrounding bone and tissues if left untreated. There are several types of mastoidectomy procedures, each tailored to the specific needs of the patient. 

• A simple or cortical mastoidectomy involves the removal of the diseased mastoid air cells while preserving the bony walls of the ear canal. This procedure is often performed to treat mastoiditis and is relatively straightforward. A more complex procedure, known as a radical mastoidectomy, entails removing the diseased mastoid air cells, along with parts of the middle ear structures, including the eardrum and ossicles (tiny bones involved in hearing). This approach is typically reserved for severe cases where the infection or cholesteatoma has extensively damaged the ear structures. A modified radical mastoidectomy is similar to a radical mastoidectomy but aims to preserve some of the middle ear structures to maintain hearing function.

• A canal-wall-up mastoidectomy, also known as a closed mastoidectomy, involves removing the infected mastoid air cells while leaving the bony canal wall intact. This procedure helps maintain the natural anatomy of the ear and can be combined with a tympanoplasty, a surgery to repair the eardrum. Conversely, a canal-wall-down mastoidectomy, or open mastoidectomy, involves removing the mastoid air cells and the canal wall, creating a cavity that allows for easier cleaning and drainage. This procedure is often performed when there is a high risk of recurrence or complications.

Why is mastoidectomy performed?

Mastoidectomy is performed primarily to address infections and complications that arise within the mastoid bone, which is part of the temporal bone located just behind the ear. 

• One of the main reasons for performing a mastoidectomy is to treat chronic otitis media, an ongoing middle ear infection that can spread to the mastoid bone, leading to a condition known as mastoiditis. Mastoiditis is characterized by inflammation and infection of the mastoid air cells, causing symptoms such as pain, swelling, and redness behind the ear, along with fever and ear discharge. If left untreated, mastoiditis can lead to serious complications, including hearing loss, brain abscesses, and the spread of infection to other parts of the body.

• Another important reason for performing a mastoidectomy is to remove cholesteatomas, noncancerous growths made up of skin cells and other debris that can develop in the middle ear and mastoid bone. Cholesteatomas can erode the surrounding bone and tissues, causing damage to the structures of the ear, including the eardrum and ossicles (tiny bones involved in hearing). If not treated, cholesteatomas can lead to chronic infections, hearing loss, and other complications such as facial nerve damage and meningitis. A mastoidectomy allows for the complete removal of the cholesteatoma, preventing further damage and promoting the healing of affected tissues.

• In addition to treating infections and cholesteatomas, mastoidectomy may be performed to address other conditions affecting the mastoid bone and middle ear, such as tumors or trauma. For example, a mastoidectomy may be necessary to remove benign or malignant tumors that have developed within the mastoid bone, or to repair damage caused by injury to the ear.

The mastoidectomy procedure involves the removal of diseased or damaged mastoid air cells to create a healthy environment for the ear. Depending on the extent of the disease and the specific needs of the patient, different types of mastoidectomy procedures may be performed, including simple or cortical mastoidectomy, radical mastoidectomy, modified radical mastoidectomy, canal-wall-up mastoidectomy, and canal-wall-down mastoidectomy. 

Mastoidectomy Process

How serious is a mastoidectomy?

A mastoidectomy is a significant surgical procedure, as it involves the removal of infected or damaged mastoid air cells in the mastoid bone, which is located just behind the ear. The seriousness of the surgery can be attributed to several factors, including the underlying condition being treated, the complexity of the procedure, and the potential risks and complications associated with the surgery. Mastoidectomy is often performed to address chronic ear infections, mastoiditis, or cholesteatomas, all of which can lead to serious health issues if left untreated. 

The complexity of the procedure varies depending on the type of mastoidectomy being performed. Simple or cortical mastoidectomy is relatively straightforward, focusing on the removal of diseased mastoid air cells while preserving the bony walls of the ear canal. Radical and modified radical mastoidectomies are more complex and involve the removal of additional middle ear structures, which can impact hearing. The decision to perform a canal-wall-up or canal-wall-down mastoidectomy further influences the complexity and potential risks of the surgery.

One of the primary concerns with mastoidectomy is the potential for complications, which can include infection, bleeding, damage to the facial nerve, hearing loss, and dizziness. The proximity of the mastoid bone to critical structures such as the inner ear, facial nerve, and brain underscores the importance of precision and expertise during the surgery. Patients may experience temporary or permanent changes in hearing and balance, as well as cosmetic concerns related to the surgical incision and scarring.

Mastoidectomy procedure 

Before a mastoidectomy, patients typically undergo a thorough evaluation to determine the extent of the disease and to plan the surgical approach. This preoperative assessment includes a detailed medical history, physical examination, and imaging studies such as CT or MRI scans to visualize the mastoid bone and surrounding structures. Patients may also undergo audiometric testing to assess their hearing function. The healthcare provider will discuss the procedure, its risks and benefits, and provide specific instructions for preoperative care, such as fasting and avoiding certain medications.

During the mastoidectomy, the patient is placed under general anesthesia to ensure they remain unconscious and pain-free throughout the procedure. The surgeon begins by making an incision behind the ear to access the mastoid bone. Depending on the type of mastoidectomy being performed (simple, radical, modified radical, canal-wall-up, or canal-wall-down), the surgeon will remove the infected or damaged mastoid air cells, as well as any other affected tissues. In some cases, the surgeon may also perform additional procedures, such as tympanoplasty, to repair the eardrum or ossicles. Throughout the surgery, the surgeon takes care to preserve critical structures like the facial nerve and inner ear to minimize complications.

After the mastoidectomy, patients are monitored closely in a recovery area until they regain consciousness and are stable. Pain management is an important aspect of postoperative care, and patients may be prescribed pain medications to alleviate discomfort. The surgical site is usually covered with a sterile dressing, which will need to be kept clean and dry. Patients are typically advised to avoid activities that increase pressure in the ear, such as heavy lifting or straining, and to follow a specific regimen for wound care. Follow-up appointments are scheduled to monitor the healing process and to remove any sutures if necessary.

Postoperative complications, although rare, can include infection, bleeding, hearing loss, dizziness, and facial nerve injury. Patients are instructed to report any unusual symptoms, such as persistent pain, discharge, or swelling, to their healthcare provider promptly. It is essential for patients to adhere to all postoperative instructions and attend follow-up visits to ensure proper healing and to address any potential issues that may arise.

Mastoidectomy advantages

Mastoidectomy offers several advantages, particularly for individuals suffering from chronic ear infections, mastoiditis, or cholesteatomas. 

• One of the primary benefits of this surgical procedure is the effective removal of infected or damaged mastoid air cells, which helps to eliminate the source of persistent infections. By addressing the underlying cause of the infection, mastoidectomy can prevent the spread of infection to nearby structures, such as the inner ear and brain, thereby reducing the risk of severe complications like brain abscesses and meningitis.

• Another significant advantage of mastoidectomy is the potential to improve hearing and overall ear health. Chronic ear infections and cholesteatomas can cause damage to the middle ear structures, leading to hearing loss. 

• Mastoidectomy allows for the removal of diseased tissues and the restoration of a healthy environment within the ear, which can enhance hearing function and prevent further deterioration. In cases where additional procedures, such as tympanoplasty, are performed alongside mastoidectomy, the repair of the eardrum and ossicles can further contribute to hearing improvement.

• Mastoidectomy also helps to alleviate symptoms associated with chronic ear infections and cholesteatomas, such as pain, swelling, and discharge. By surgically removing the infected or abnormal tissues, patients can experience relief from these discomforts and enjoy an improved quality of life. 

• Additionally, the procedure can address cosmetic concerns, especially when the mastoiditis or cholesteatoma causes visible swelling or deformity behind the ear.

Mastoidectomy disadvantages

While mastoidectomy can provide significant benefits, it also carries certain disadvantages and risks that should be considered. 

• One of the primary disadvantages of mastoidectomy is the potential for complications during and after the surgery. These complications can include infection, bleeding, and damage to surrounding structures such as the facial nerve, which runs through the mastoid bone. Facial nerve injury can result in facial weakness or paralysis, affecting the patient's ability to move facial muscles and potentially leading to long-term functional and cosmetic concerns.

• Another notable disadvantage is the risk of hearing loss. Although the procedure aims to preserve or improve hearing, the removal of infected or damaged tissues and structures within the ear can sometimes result in unintended damage to the delicate components of the middle and inner ear. This can lead to a reduction in hearing ability, which may be temporary or permanent, depending on the extent of the surgery and the individual patient's condition.

• Postoperative complications can also arise, such as dizziness, tinnitus (ringing in the ears), and changes in taste due to the proximity of the chorda tympani nerve, which is involved in taste sensation. Additionally, patients may experience pain, swelling, and discomfort at the surgical site, which can affect their overall well-being and quality of life during the recovery period.

• The recovery process itself can be lengthy and challenging. Patients are typically required to follow strict postoperative care instructions, including keeping the surgical site clean and dry, avoiding activities that increase pressure in the ear, and attending multiple follow-up appointments. These requirements can be burdensome and may impact the patient's daily activities and lifestyle.

Mastoidectomy recovery

Recovery from a mastoidectomy is a critical phase that ensures proper healing and minimizes the risk of complications. The process begins immediately after the surgery, as patients are closely monitored in the recovery area until they regain consciousness and are stable. This initial phase involves managing pain and discomfort, which are common after the procedure. Pain relief is typically provided through prescribed medications, and the surgical site is covered with a sterile dressing to protect it from infection.

Once patients are discharged from the hospital, they must follow specific postoperative care instructions to promote healing and prevent complications. These instructions usually include keeping the surgical site clean and dry, avoiding activities that increase pressure in the ear, such as heavy lifting, straining, or blowing the nose, and refraining from inserting anything into the ear canal. It is essential to avoid water exposure to the ear, so activities like swimming or taking baths should be postponed until the healthcare provider gives the all-clear. 

Patients are also advised to sleep with their head elevated to reduce swelling and facilitate drainage from the surgical site. It is common for patients to experience some degree of dizziness, hearing changes, or tinnitus (ringing in the ears) during the initial recovery period. These symptoms usually improve over time as the ear heals, but it is crucial to report any persistent or worsening symptoms to the healthcare provider.

Follow-up appointments are a vital part of the recovery process, as they allow the healthcare provider to monitor the healing progress and address any potential issues. During these visits, the provider may remove any sutures and assess the surgical site for signs of infection or complications. Audiometric testing may also be performed to evaluate hearing function and determine if any additional treatments are necessary.

In some cases, patients may require additional interventions, such as tympanoplasty, to repair the eardrum or ossicles if they were affected during the mastoidectomy. Physical therapy may be recommended to help manage balance issues or dizziness that persist after the surgery.

Mastoidectomy in Iran

Equipped hospitals, and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who need Mastoidectomy.

Mastoidectomy cost in Iran

The cost of mastoidectomy in Iran can vary significantly depending on several factors, including the type of mastoidectomy, the healthcare facility, the surgeon's expertise, and the patient's specific condition. Generally, Iran is known for offering high-quality medical procedures at a fraction of the cost compared to many Western countries, making it an attractive destination for medical tourism.

The price of a mastoidectomy in Iran ranges around 1,000-5,000 USD, depending on the complexity of the procedure and the healthcare facility. Simple or cortical mastoidectomy, which involves the removal of infected mastoid air cells while preserving the bony walls of the ear canal, tends to be on the lower end of the cost spectrum. More complex procedures, such as radical or modified radical mastoidectomy, which involve the removal of additional middle ear structures, can be more expensive due to the increased surgical complexity and potential need for additional interventions.