Procedure Description
- For mastoidectomy, the patient is anaesthetised and placed in a supine position (lying down with face upwards). Then the surgeon performs mastoidectomy in the following manner:
- Insert a device called a speculum in the ear and arrange the potion of the microscope to get a clear image within the ear.
- A cut is made at the back of the ear, in the layer of tissue called the periosteum, above the mastoid.
- Use another instrument called a periosteal elevator to lift the periosteum.
- Raise the skin present in the ear canal.
- Drill the mastoid bone to create a space.
- Remove the infected mastoid bone or any other growths on the mastoid.
- Reconstruct the ear bones.
- Use a biodegradable substance to pack the middle ear, ear canal, and mastoid cavity.
- Stitch the cut made at the beginning of surgery using absorbable (biodegradable) stitches and cover it with a dressing.
- Place a drain at the back of the ear to collect fluid leaking from the surgical site.
- The mastoidectomy procedure takes two to three hours.
- Depending on how severe the microbial infection is, the surgeon will decide which type of mastoidectomy is the most suitable option. There are three types of mastoidectomy,
Simple
Modified radical
Radical
Canal wall up (closed)
Canal wall down (open)
- The surgeon will remove only the infected mastoid bone.
- Surrounding areas like ossicles (ear bone), tympanic membrane (eardrum), and external acoustic meatus (a passage from outside of your head to the eardrum) are untouched.
- The surgeon will remove the infected mastoid bone and ossicles.
- The benefit of this surgery is that the normal ear appearance and its functions are retained.
- Some ossicles and tympanic membrane are untouched so that the hearing is unaffected.
- The surgeon will remove the infected mastoid bone, ossicles, and external acoustic meatus.
- Some ossicles and tympanic membrane are untouched so that your hearing is unaffected.
- Recommended during persistent ear infection or cholesteatoma.
- The surgeon will remove ossicles, tympanic membrane, and external acoustic meatus.
- Used to treat a complicated disease.
TWhat to Ask and Tell Your Doctor?
- You can ask the following questions to your ENT specialist during the appointment:
- Why do I need a mastoidectomy?
- Is there any alternative to the surgery?
- What can happen if I do not undergo mastoidectomy?
- What is the benefit of mastoidectomy?
- How long will the surgery take?
- Do I have to stay overnight in the hospital?
- What are the risks and complications of this surgery?
- How much time will I take to recover after surgery?
- Can I continue my routine medications?
While you are at your ENT appointment, it is crucial that you inform your doctor of the following:
- If you are currently using any prescription, non-prescription, or herbal medications.
- If you are currently using any medications to relieve pain
- Your current health condition (e.g., pregnancy, diabetes, high blood pressure, breathing problems, heart problems, etc.)
- Allergies to food and medications.
- If you are a smoker.
What to Expect Before Surgery?
- Pre-surgical appointment:
- A few days before you undergo mastoidectomy, your ENT surgeon will schedule a pre-surgical appointment.
- During the appointment, you can expect the following:
- The surgeon will ask about your current health and medical history.
- They will suggest blood and urine tests before surgery.
- You will be asked to sign a consent form that states that you are completely aware of the benefits and risks of mastoidectomy.
- You will be asked to avoid using medicines that cause blood-thinning such as aspirin. You should stop using these medications at least a week before surgery.
- Your surgeon will also discuss the surgical procedure, total time taken for surgery, hospital stay, and cost and proceed with any insurance formalities.
- Your surgeon will also confirm the date of the surgery.
Type of anaesthesia recommended by your anaesthesiologist:
You will also meet your anesthesiologist during the pre-surgery appointment.
For mastoidectomy, your anesthesiologist will recommend general anaesthesia.
Medications:
Avoid aspirin or ibuprofen as they cause blood thinning.
What to Expect on the Day of Surgery?
- You can expect the following:
- Once you reach the hospital on the day of surgery, you will meet someone from the healthcare staff who will guide you through the next process.
- The healthcare staff would ask you to sign informed consent if you didn’t sign it during the pre-surgical appointment.
- If you are using any prescription medications, your surgeon will advise you to take the medicines with a small sip of water.
What to Expect During Surgery?
- Patient position:
- You will be kept in a supine position (lying down with face upwards).
- The side of your head, which is to be operated, is placed up.
- A donut pillow is used so that your head remains in the same position during the entire procedure.[6]
- Cleaning and draping of the surgical site:
- The microscope used during the surgery will be covered with a sterile drape.
- Hair near your ear will be removed to free the surgical site from hair.
- Adhesive drapes are used to separate hair in the surrounding portion.
- Patient monitoring:
- While the surgeon performs mastoidectomy, your anesthesiologist will constantly monitor your condition. The anesthesiologist will observe the following:
- Blood pressure
- Heart rate
- Blood oxygen levels.
Patient experience during surgery:
Since you will receive general anaesthesia right before the surgery, you will remain unconscious throughout the procedure.[1]