Mastoidectomy is an operation for chronic ear infection usually involving perforation of the ear drum or cholesteatoma.  It is common for patients with these serious conditions to have had minimal symptoms when they first see an otolaryngologist.

Cholesteatoma is a ‘skin cyst’ in the middle ear which develops in long-standing infection.  As the skin in the cyst sheds its surface skin cells, the cyst enlarges.  A growing cholesteatoma can destroy the ear drum and the middle ear ossicles which conduct sound vibrations.  This results in ‘conductive’ or vibrational hearing loss.  The cholesteatoma can damage the inner ear causing nerve hearing loss and dizziness.  It can damage the facial nerve causing facial paralysis.  Infection can spread to produce meningitis or a brain abscess.  The cholesteatoma usually grows into the mastoid, which is an area of bone behind the ear with many tiny air pockets which are connected to the air space beneath the ear drum.

Antibiotics, ear drops and microscopic cleaning can temporarily settle active infection, but cannot cure the problem.  Surgery is required to remove all infected tissue and the entire skin cyst.  Tympanomastoidectomy is the operation to remove the infection and when possible to rebuild the ear drum and ossicles.  The surgery involves an incision behind the ear requiring stitches.  The patient usually stays in hospital overnight after surgery.

Depending on the extent of disease, various types of tympanomastoidectomy may be performed, and this decision must be made in the operating room.  In most cases the hearing mechanism can be rebuilt, improving hearing.  The prime goal of surgery is to completely remove infection and cholesteatoma to produce an infection-free ear.  Middle ear reconstruction is then done to produce the best hearing possible.  Sometimes the best hearing results are obtained by waiting for several months until inflammation has completely settled, and then rebuilding the hearing mechanism with a second operation.  In severe disease, no reconstruction is practical, and the result is a “radical mastoidectomy” which gives a clean, healthy ear with poor hearing.  After surgery, a dry non-infected ear with conductive hearing loss is suitable for a hearing aid, if the patient so chooses.