Mastoidectomy Surgery: An Overview

In a mastoidectomy, infected air cells are removed from the mastoid, which is made up of the mastoid bone and covers a part of the back of the skull behind the ear. The major indications of this type of surgical procedure are chronic infections, cholesteatoma, or other specific conditions affecting the middle ear and mastoid bone. Complications such as hearing loss, brain abscess, and meningitis can be avoided by a mastoidectomy.

Types of Mastoidectomy Surgery

Mastoidectomy is of several types, depending on the quantum of the surgical procedure and the root disease:

1. Simple (Cortical) Mastoidectomy—This simply refers to the removal of infected mastoid air cells while keeping the middle ear structures intact.

2. Radical Mastoidectomy—A radical mastoidectomy involves the removal of the mastoid air cells, parts of the ear canal walls, and the tympanic membrane. This condition usually means you lose all hearing sensation in your ears.

3. Modified Radical Mastoidectomy—Similar to the radical mastoidectomy operation but allows preservation of some auditory structures.

4. Canal Wall Up Mastoidectomy—This procedure preserves the ear canal wall to promote regular healing and enhance natural hearing.

5. Canal Wall Down Mastoidectomy—This procedure removes the ear canal wall, leaving an open cavity leading to an improved draining of infections.

Symptoms of Mastoidectomy Requirement

Those patients presenting with the following symptom complex may need mastoidectomy:

• A history of chronic drainage, fever, or a painful, swollen ear is indicative of persistent ear infections (chronic otitis media).

• Ear discharge (otorrhea) in general cases may be indicative.

• Decline or diminution of hearing acuity

• Most people have ear pain or pressure.

• Dizziness or vertigo

• Swelling behind the ear on top of recurring cholesteatoma (skin-like growth in the middle ear) cases.

Diagnosis of Mastoidectomy

We will diagnose mastoid disorders by taking a thorough history, conducting a clinical examination, and ordering the necessary imaging studies.

• Otoscopy

• CT scan of the temporal bone

• MRI

• Pure tone audiometry

• Tympanometry

Causes for Mastoidectomy

There are several conditions necessitating mastoidectomy:

• Chronic suppurative otitis media (CSOM)—repetition of ear infection ultimately injuring the mastoid bone.

• Cholesteatoma—a benign yet insidious type of cystic growth, destructive to the major structures within the middle ear.

• Mastoiditis—an inflammation or infection in the mastoid bone.

• Sequelae of ear infections, like meningitis, brain abscess, and facial nerve paralysis.

• Tumors in the Middle Ear—Naming nontumor and tumor types affecting acoustic structures within the ear.

Risks and Complications of Mastoidectomy Surgery

Though generally safe, there are some complications and risks tied to this surgical procedure:

• Hearing loss due to disturbances with middle ear structures

• Facial nerve injury leading to facial weakness or paralysis

• Dizziness and balance risks postoperatively

• Ear drain edge persistence

• Tinnitus or ringing sounds in the ear

• Infection or pus formation

• Effect on taste due to reduced nerve contents in the chorda tympani nerve

Preparation Required for Mastoidectomy Surgery

Mastoidectomy has preoperative needs for effective success:

• Preoperative tests: blood tests, the likely possibility of radiographic studies, and probably a hearing test.

• Fasting instructions: no eating or drinking for 6–8 hours.

• Pooled meds—discontinuation of aspirin or warfarin-based an intensive care management routine involving blood thinners

• IPD: Antibiotic Prophylaxis—Preventive drugs administered

• Anesthesia Con Option: Patients should familiarize themselves with the advantages/disadvantages of anesthetics (local vs. general) and probably personal experience.

Procedure for Mastoidectomy Surgery

As a rule, the operation should follow these steps.
1. Application of Anesthesia—We typically use general anesthesia.
2. Incision behind the ear—This is done to approach the mastoid bone.
3. Drilling into the Mastoid Bone—Eroding out and evacuating the infected or damaged bony structures.
4. If Necessary—Middle Ear Repair—Reconstruction of the eardrum and ossicles.
5. Closure—Closing the incision.
6. Placement of Dressing—Bandaged ears to promote healing.

Recovery After Mastoidectomy

The recovery time varies depending on the procedure's complexity.

• Fewer days of hospital stay—it usually only goes up to 1-2 days for observation.

• Pain Management: Your doctor will prescribe painkillers to help you feel less pain.

• Mitigating Dizziness—This can occur due to the temporary balance issues.

• Continuous—To prevent from contracting a post-surgery infection.

• No Water Exposure—Wait until healing finishes to keep the ear dry.

• Follow-Up Check-ups—These are check-ups every so often to have the doctor check on how much the ear is healing now and how much better it is hearing.

Clinical Trials for Mastoidectomy Surgery

Current research and clinical trials fall under the following categories:

• Imaging techniques improve so that it can be diagnosed more accurately.

• New trends in surgical instruments that allow minimally invasive surgeries.

• Biological materials are used for the purpose of ear reconstruction.

• Innovative preservation strategies for hearing.

Side Effects of Mastoidectomy Surgery

The post-operative problems of mastoidectomy surgery involve:

• Temporary hearing loss.

• Null or modest ear pain and swelling.

• Taste disturbances.

• Scar at the rear end of the ear.

• Ear drainage of a fluid.

Success Rate of Mastoidectomy Treatment

Using the appropriate indications for mastoid surgery is a certainty.

• Infection Control—The total cure rate for recurring infections has been almost 90%.

• Hearing Preservation—Almost 70-80% success rate in mild to moderate hearing afflictions.

• Prevention for Cholesteatoma Recurrence—Around 10% experience recurrences when having the right kind of follow-up treatment regime.

Diet to Follow After Treatment

A well-balanced regular diet plays a significant role in post-surgery recovery:

• Protein-Rich Foods: Animal protein like lean meat, fish, and eggs, and vegetarians source their protein from lentils and legumes, which facilitate tissue repair.

• Vitamin C & A: Citrus fruits, carrots, and dark, green vegetables prime the immune system.

• Omega-3 Fatty Acids: Mainly found in nuts and fish, as well as a general anti-inflammatory agent.

• Water: Drinking enough fluids is important for healing.

• Refrain from Alcohol & Caffeine: Necessary to lessen dehydration and complications.

The cost of mastoidectomy surgery in India

The cost of mastoidectomy surgery in various parts of the country varies based on the hospital and on the surgeon's skills and experience.

• Government Facilities—INR 30,000 to 60,000

• Private Hospitals—INR 80,000 to 2.50 lakhs

• Advanced Procedures (Laser-Assisted) - INR 1.50 - 3.50 lakhs Health insurance coverage may reduce overall expenses.

Conclusion

Mastoidectomy is a key procedure in the management of chronic ear infections and any other complications this comes with. It is a good way to go with numerous successful concerts and progress in surgery, making it an effective modality for the betterment of ear health and killing severe complications. Usually, early diagnosis, early surgery, and good postsurgical care will lead to greater success and an improvement in the quality of life.