The sensitive bone tissue in the inner ear just behind the auricle is called the mastoid bone. Although it is called bone, it is not similar to other typical hard bone structures in the human body. The mastoid bone, which consists of air sacs, resembles a sponge. For the mastoid to function properly, airflow from the Eustachian tube and other parts of the ear must be fully ensured. The Eustachian tube acts as the canal connecting the middle ear, nose, and throat. In the event of inflammation in the middle ear, if there is a blockage in the Eustachian tube, this can lead to an infection in the mastoid bone. This severe infection is known as a mastoid bone infection of the skull or mastoiditis.
Mastoidectomy is surgery that removes diseased cells from the air-filled spaces in your mastoid bone. A mastoidectomy is necessary if a middle ear infection (otitis media) has spread to the skull. A mastoidectomy is necessary if a middle ear infection (otitis media) has spread to the skull. Most often, mastoidectomy is performed during cochlear implant (inner ear prosthesis) procedures.
There are variations of mastoidectomy procedures depending on the spread of infections. In simple mastoidectomy operations, the surgeon opens the mastoid bone and removes the infected air cells, and drains the middle ear. In radical mastoidectomy operations, mastoid air cells, most of the middle ear tissues, ear canal, and eardrum can be removed. In radical mastoidectomy, middle ear and mastoid cells are combined into a single cavity. The goal of this surgery is primarily to prevent the spread of inflammation to surrounding tissues such as the brain. It is not intended to protect hearing.
Modified radical mastoidectomy is a procedure between radical mastoidectomy and simple mastoidectomy. A less severe form of radical mastoidectomy involves removing the posterior wall of the ear canal and repairing the eardrum to create a joint space for the mastoid and ear canal. It is also known as the Canal wall down (CWD) mastoidectomy procedure. This surgery aims to protect the sense of hearing as well as remove the infection.
It shows symptoms similar to mastoid ear infection:
- Fluid accumulation and hearing loss may occur in the infected ear.
- Sensitivity, redness, swelling behind the ear
Modified radical mastoidectomy may treat complications of chronic middle ear infections unresponsive to antibiotic treatments. In cases where treatment is delayed, it may spread to the inner ear by occupying the sacs of the mastoid bone. This can cause the mastoid bone to melt and break down. Although it is common in children, it can occur in adults as well. In addition, cholesteatoma, which is a non-cancerous skin cyst, can grow larger over time and prevent the following serious health problems:
- Abscess in the brain
- Damage to facial nerves
If you have symptoms of an ear infection, your doctor will examine whether the infection has spread to the mastoid bone and skull. Your doctor uses several tests and radiological imaging methods to clarify the diagnosis. These may include:
- Complete blood count to confirm infection
- Audiometry tests
- Imaging of computed tomography of the ear and head
- Ear and head MR (Magnetic Resonance) scan
- Skull X-Ray
Tests confirm that the infection has spread to the mastoid bone, and your doctor may also order additional lumbar puncture and spinal tap scans to check for infection in your spine.
Mastoidectomy procedures, which are usually performed under general anesthesia, allow you to be asleep and not feel pain during the operation. The surgeon accesses the mastoid bone through an incision made behind the ear. This incision is made precisely to minimize the appearance of mastoidectomy scarring. Air cells infecting the mastoid are removed with instruments used specifically to open the mastoid bone. When the procedure is finished, the surgical area is closed with sutures and covered with a sterile cloth.
After a Modified Radical Mastoidectomy, as with any surgery, mild discomfort may be experienced. An incision behind your ear can cause pain and create a feeling of fullness and congestion in the ear. Your doctor may prescribe some pain relievers and antibiotics for pain and infections. Your doctor will share the detailed planning with you for removing the bandage and sutures and controlling the surgical wound. It is important to follow the instructions given by your doctor during the healing process. After the operation, the contact of the ear and the back of the auricle with water should be avoided. After the surgery, strenuous physical activities and pressure on your ear should be avoided for at least four weeks.
Although the risks of the surgery are less than the risks caused by chronic otitis media or cholesteatoma, there are potential risks and complications in modified radical mastoidectomy as in any surgery.
Complications of modified radical mastoidectomy may include:
- Facial nerve injury that can cause facial weakness or paralysis
- Hearing loss in the inner ear (sensorineural)
- Temporary taste change (dysgeusia)
- Temporary dizziness
- Temporary tinnitus
Early diagnosis and effective treatment are important to prevent the progression of all ear infections. If you have an ear infection, seek medical treatment and fully follow the treatment and recommendations offered by your doctor. In-ear infections, antibiotics may be required for a week to ten days, only if your doctor prescribes it.