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Tympanomastoidectomy: What Is it & Are You a Candidate?

What is Tympanomastoidectomy?

A tympanomastoidectomy is a combination surgery that is done to fix middle ear problems both in the eardrum (aka tympanic membrane) and the hard bump right behind your ear (called the mastoid bone) that is filled with air cells and resembles a honeycomb. 

Hence, tympanomastoidectomy entails both: 

  • repair of the eardrum called tympanoplasty
  • removal of the infected mastoid air cells called mastoidectomy

Who Are the Candidates for Tympanomastoidectomy?

Surgical treatment is not always the first step when it comes to treating middle ear and eardrum problems. However, surgery becomes imperative when more conservative treatments fail or when complications stem from other non-surgical treatments. 

Conditions that necessitate tympanomastoidectomy include: 

  • Chronic or recurrent middle ear infections 
  • Cholesteatoma (a noncancerous skin growth in the middle ear behind the eardrum, or in the mastoid bone—can weaken and erode the eardrum, causing it to rupture)
  • Chronic/recurrent eardrum perforations
  • To place a cochlear implant in patients with severe hearing loss 
  • As part of another ear surgery to gain access to the middle ear, such as surgery on the three tiny ossicles (bones) of the middle ear 
  • Removal of skull base tumors

Types of Mastoidectomy

There are different versions of mastoidectomy:

  1. Simple mastoidectomy

This type of mastoid surgery entails opening your mastoid bone, drilling out the infected air cells, and draining your middle ear. 

  1. Radical mastoidectomy

This involves removing your mastoid air cells, middle ear components, your eardrum, and your ear canal. Patients with more complicated mastoid disease are usually the candidates for this type of mastoid surgery. 

  1. Modified radical mastoidectomy

This is a less intense form of radical mastoidectomy that entails drilling out and removing the diseased mastoid air cells. With this type, however, some middle ear bones are preserved, and the eardrum is reconstructed (tympanoplasty).

The goal of this type of mastoidectomy is to remove the diseased parts while preserving as much hearing as possible by restructuring the hearing mechanism at the same time or in second-stage operation. This type of surgery is often reserved for patients with a cholesteatoma in their better hearing ear. 

Both types of radical mastoidectomies result in less than normal hearing. 

How is a Tympanomastoidectomy Done?

When performing a tympanomastoidectomy, our specialists at the Ear, Nose, Throat & Allergy Specialist will decide which option is the best for each case. This may vary with the cause of the condition, the severity of the problem, and whether or not there’s an infection. 

After the necessary preparations, you will be placed under general anesthesia (i.e., you will be unconscious during the entire procedure). 

The surgery is split into two parts:

1. Mastoidectomy

During mastoidectomy, our experts use a less invasive approach called the post-auricular approach by making a cut behind your ear instead of accessing the mastoid bone from within the ear.

Once exposed, the mastoid bone is then drilled to gain access to the interior of your middle ear while taking care not to injure the facial nerve. 

Suction irrigation is used intermittently to keep the view clear and allow us to work on the targeted site. 

We then drill out the infected mastoid air cells and remove any growth. The incision is not closed until your eardrum is also repaired as follows: 

2. Tympanoplasty

Inside the ear, we get rid of any surplus or scar tissue with the help of laser. The rim around the perforated eardrum is tidied with an instrument. After making cuts in the ear canal skin, it is elevated, along with any healthy remnant your eardrum. 

We then cover the hole in your eardrum with a sheet of tissue called fascia. The canal skin is then replaced, and the canal packed with gauze piece.. We then stitch up the incision. Sterile bandage is finally placed over the operated site. 

The goal of this surgical procedure is not only to seal the hole but also to improve hearing. 

How is the Recovery after Tympanomastoidectomy?

When you wake up, you can expect to have bandages over your ear and stitches behind your ear. You may also experience some ear pain, headache, and some skin  numbness. That is why we prescribe painkillers, give you antibiotics ear drops and pills to prevent or treat any infection, and ask you to schedule a follow-up appointment for a wound check and to remove any bandages and stitches.

Activity

We recommend: 

  • not to put pressure on the operated ear
  • sleep with the operated ear up 
  • refrain from all strenuous activity, especially lifting anything heavy, for at least two to four weeks afterward, and as advised
  • not to swim or fly in an airplane until healing occurs (which can take anywhere from 4 to 6 weeks after surgery).

Showering 

Avoid getting water in your ear until you’re advised. When you take a shower or bath, use a cotton ball lightly moistened in petroleum jelly to keep water out. You may also place earplugs in the very outside of your ear, but be sure NOT to place anything inside your ear canal. Also, if you use earplugs, choose the ones of the silicone variety. Plastic earplugs can go inside the ear canal. The goal is to keep your ear dry while avoiding any pressure on the dressing at the same time. 

Potential Complications of Tympanomastoidectomy

The surgery is generally safe and uncomplicated. However, it’s important to be aware of the risks of the procedure. 

  1. Bleeding 

The packing in the ear is left for 1 to 2 weeks. During this time, it will keep absorbing some blood-stained fluid until it’s removed. Hence, it’s normal to experience some bloody fluid draining from your ear for 1 to 2 days after the gauze is taken out.

  1. Nausea and vomiting

Nausea & vomiting is a rare and unpleasant complication that may occur after surgery, but not in all people.. We, however, make every effort to prevent or at least reduce its intensity.

  1. Unsteadiness

It’s common to feel unsteady and dizzy for the first few days following surgery. This should subside over the next few weeks.

  1. Hearing loss

Hearing is likely to get affected after surgery, especially if the hearing bones were affected but failed to be reconstructed during surgery. Some patients may require a second procedure to improve hearing, this is called an ossiculoplasty. 

  1. Tinnitus

Tinnitus, which is the ringing or buzzing in your ears, may also become more noticeable after tympanomastoid surgery. 

  1. Infection 

Infection may rarely develop after surgery. While we take all precautions to prevent it, should an infection occur, long-term antibiotics become mandatory. The ear infection can spread to your brain, causing meningitis (an infection of the coverings called meninges surrounding your brain and spine). 

  1. Facial nerve weakness 

Our highly trained experts make every effort to avoid damaging your facial nerve. Nonetheless, this nerve is at risk to some extent in all forms of middle ear or mastoid surgeries, causing weakness of your facial muscles. During the surgery the facial nerve is monitored to prevent injury.

  1. Altered taste 

Taste disturbances, such as a metallic taste, are common after middle ear surgeries. This is because of the damage to the small taste nerve that traverses your ear-drum. Most taste disturbances resolve on their own.