mastoidectomy

A mastoidectomy is a surgical procedure to remove disease from the mastoid air cells of the temporal bone. It is commonly performed to eradicate chronic infection and to provide access to the middle ear and adjacent structures for treatment. The operation is frequently combined with tympanoplasty or other reconstructive procedures to restore function and drainage.

Indications include chronic suppurative otitis media with mastoiditis, cholesteatoma, persistent or recurrent ear discharge, and intracranial or intratemporal complications such as abscess, meningitis, or sigmoid sinus thrombosis. It may also be used to address facial nerve disease, labyrinthine fistula, or intractable vertigo when other medical therapies have failed.

Anatomy and approaches: the mastoid comprises a system of air-filled cells that communicate with the middle ear via the aditus ad antrum. The facial nerve and semicircular canals lie in close proximity, requiring careful planning. Surgeries are commonly performed as canal-wall-up (CWU) or canal-wall-down (CWD). In CWU, the posterior canal wall is preserved to maintain the ear canal anatomy; in CWD, the posterior canal wall is removed to create a large, open cavity for drainage and surveillance.

Technique and postoperative care: the procedure is usually done under general anesthesia through a postauricular incision. Diseased bone is removed to enter the mastoid and, if needed, to eradicate cholesteatoma or granulation tissue. In CWU, the tympanic membrane and ossicles may be reconstructed (tympanoplasty) while preserving the canal wall. In CWD, a single open cavity is created, often requiring ongoing cleaning and dressing changes. Postoperative care includes antibiotics, analgesia, ear packing, and activity restrictions; follow-up is essential to monitor healing and function.

Complications can include facial nerve injury, CSF leak, meningitis, vertigo, persistent drainage, wound infection, or suboptimal hearing outcomes. Overall, mastoidectomy aims to eradicate disease and restore drainage, with individualized plans for reconstruction as needed.