Mastoidectomy

The mastoid is the knob of bone you can feel behind your ear. It is not solid: it is a honeycomb of air cells connected to the middle ear. Mastoidectomy is the removal of those cells with a drill, opening the honeycomb into a single smooth cavity so that unhealthy tissue can be cleared out of it.

There are two broad forms, and which you have changes your life afterwards more than anything else about the operation. In the closed form, the back wall of the ear canal is kept intact and the mastoid is cleared from behind it, so the ear looks and behaves normally. In the open form, that wall is taken down, so the mastoid and the ear canal become one larger space that opens to the outside.

An open cavity is chosen when disease is extensive or hard to reach, and it needs cleaning in clinic once or twice a year for life. Reconstruction of the eardrum and the small bones of hearing is very often done in the same operation, and your surgeon will explain what is planned for yours.

This is an Inpatient operation under general anaesthetic. You come in on the morning of surgery or the night before, having not eaten for six hours, and you are fully asleep throughout.

Your surgeon usually works through a curved cut behind the ear, hidden in the crease, which lets the ear be folded forward to expose the bone. A high-speed drill under continuous irrigation removes the air cells, working towards the middle ear. A nerve monitor is commonly used, with fine wires on your face, to warn the surgeon of the facial nerve's position as they drill near it.

The operation takes two to four hours depending on how much disease is found and whether the hearing mechanism is reconstructed at the same time.

You wake with a firm head bandage and packing in the ear canal, and a drain is sometimes left behind the ear. Expect one to two nights in hospital. The bandage comes off the next morning and the stitches or clips are removed at about a week.

The wound behind the ear is sore for several days and the ear feels blocked from the packing for weeks. Numbness of the outer ear and the skin around the wound is very common and usually recovers over months.

Most people take two to three weeks off work, and longer for heavy or dusty jobs. Mild unsteadiness for the first few days is usual. Do not drive until dizziness has gone, which is generally at one to two weeks.

Keep the ear absolutely dry until your surgeon says otherwise, which is normally at least six weeks. No swimming, no diving and no flying for six weeks, no nose blowing for three weeks, and no heavy lifting for three to four weeks.

Packing is removed at clinic visits over the following weeks, and the cavity takes two to three months to line itself with skin and stop discharging, which is slower than most people expect. Hearing is tested formally at about three months. Where an open cavity was made, plan on a cleaning appointment every six to twelve months for the rest of your life.