Mastoid obliteration surgery-various aspects-
What you need to understand regarding your surgery
Mastoid cavities are created during surgery by drilling into the bone surrounding the ear to eliminate a cholesteatoma or serious infection. These cavities extend backward from the initial ear canal.
Most mastoid cavities do not present issues, but patients should keep them dry and avoid letting water enter them to help prevent ear infections. At times, this means refraining from swimming.
Some mastoid cavities do pose challenges for patients. They may gather a significant amount of skin debris as the skin is unable to migrate out of the ear canal as it usually does. This dry skin debris must be removed periodically to ensure that patients can hear and to avert the risk of infection from the dead skin.
Certain mastoid cavities do not heal properly and remain moist internally. These cavities can become infected, leading to a foul-smelling discharge. Such cavities require frequent cleaning and the application of antibiotic ointments or powders to attempt to prevent infections, which can be quite distressing for patients.
Suction cleaning can also lead to considerable Vertigo (a spinning sensation) for patients. This occurs because the balance organ (lateral semicircular canal) has been exposed due to the drilling of the bone and is now only covered by a thin skin layer. Therefore, when suction is applied, the swift movement of air over the Lateral canal results in a spinning sensation and sometimes nausea as well. This can complicate thorough cleaning of a mastoid cavity. On occasion, patients may experience Vertigo when exposed to wind or extreme cold for the same reason.
Due to these issues, some patients encounter significant difficulties using hearing aids as well.
What can be done concerning this?
Revision surgery might be considered to eliminate these problems. I carry out mastoid obliteration surgery, where the infected tissue is excised, and subsequently, the mastoid cavity is filled with a prosthetic material (Bon Alive granules) to close the cavity. The granules are lined with fragments of cartilage taken from your own ear to reconstruct a smooth new ear canal wall. This approach will typically mean that most ears will not require cleaning, and patients can wet them without developing ear infections. The procedure is successful in over 90% of cases.
Alongside the obliteration of the mastoid, a Tympanoplasty can be performed if feasible to attempt to enhance any conductive hearing loss that may be present. With a dry ear, it is also comparatively simpler to use a hearing aid.
What does the surgery entail?
The procedure is essentially the same as your other ear surgeries.
Before the surgery:
Arrange to have 3 weeks off work.
Confirm that you have a friend or relative who can drive you home post-surgery.
You must refrain from driving for at least 24 hours after receiving a general anaesthetic.
Ensure you have a stock of basic pain relief medication in your home.
The day of the procedure:
Admission typically occurs on the day of the surgery. The nurses will handle some standard paperwork and assessments. You will be requested to change into a gown in preparation for the procedure. The anaesthetist will come to meet with you and go over the anaesthetic aspects. A member of the ENT team will also meet you before your surgery.
The anaesthetic:
The procedure is conducted under general anaesthesia.
The procedure itself:
The procedure is carried out while you are asleep (under general anaesthesia) and lasts a total of 2-3 hours.
Usually, one of two potential methods for accessing the mastoid bone is employed. In the first, the posterior approach, the incision is made in the skin crease located behind the ear. In the second, anterior approach, the incision starts from the top of the ear canal and extends upwards into the hairline. All incisions through the skin result in cutting through some of the smaller nerves, leading to some skin numbness. The numbness typically improves over time, but it may take weeks or months as the nerves regenerate very slowly.
The bone in the mastoid is progressively removed using a fine drill, starting from the hole or pocket in the eardrum and moving backwards and upwards, gradually enlarging the ear canal as necessary to eliminate the infected tissue. Often, certain sections of the eardrum need to be excised, as do some of the small bones that transfer sound from the eardrum to the inner ear, if they are also affected by disease and infection. Whenever feasible, efforts will be made to restore hearing (a Tympanoplasty).
The area of bone exposed in the mastoid that has resulted from the drilling (the cavity) is subsequently covered with a thin piece of graft tissue taken from the outer layer of a flat muscle in the region. The cavity and ear canal are filled with an antiseptic dressing. This may comprise a long piece of gauze bandage saturated in a yellow antiseptic ointment that contains iodine or a dissolving sponge dressing soaked in antibiotics. If you have an allergy to iodine, please inform us prior to the surgery. In certain situations, the wall of the ear canal can either be maintained (Combined Approach Tympanoplasty) or reconstructed (Mastoid Obliteration) to some extent at the conclusion of the operation, so that no cavity remains following the surgery. Dressings will be placed in the ear canal after this procedure.
The skin wound is closed using stitches, and a pressure dressing is wrapped around your head to minimize any swelling or bruising around the ear over the next few hours. This dressing will be taken off before you leave.
The stitches used for closing the skin may be submerged and do not require removal as they will dissolve on their own. If the stitches are not submerged, you will be provided with instructions on when to have them removed.
