Mastoidectomy — clearing chronic disease, protecting the brain.

Overview

The mastoid is a honeycomb of bone behind the ear that connects to the middle ear. Chronic infection or cholesteatoma can fill these cells with disease that no antibiotic course will clear.

A mastoidectomy creates a single, smooth, easy-to-clean cavity (canal-wall-down) or preserves the natural anatomy (canal-wall-up), depending on the extent of disease. Where possible, the hearing chain is reconstructed in the same sitting.

When This Surgery Is Recommended

• Cholesteatoma confirmed on examination or imaging
• Chronic suppurative otitis media unresponsive to medical management
• Mastoiditis as a complication of acute infection
• Suspected intracranial extension of middle-ear disease
• Some cases of facial-nerve weakness in chronic ear disease

The Procedure

Performed under general anaesthesia through a small incision behind the ear. The procedure uses an operating microscope and a high-speed surgical drill.

• An incision is made behind the ear, exposing the mastoid bone
• The diseased air cells are drilled away under direct vision
• Cholesteatoma and granulation tissue are carefully removed
• The facial nerve and inner ear structures are kept safe under nerve monitoring
• The hearing chain is reconstructed where suitable
• The wound is closed in layers with a small drain in some cases

Pre-Surgery Preparations

• Pre-operative admission for full work-up — imaging review, blood tests, fitness
• Fast for 8 hours before surgery
• Stop blood thinners 7 days before with cardiology approval
• Hair clipped behind the ear on the day of surgery
• High-resolution CT scan reviewed and consent process completed on admission
• Companion advised at home for the first week after discharge

Post-Surgery Recovery

• 2–3 days in hospital after surgery
• A pressure dressing is worn for the first 24–48 hours
• Stitches removed at 7–10 days
• Strictly dry ear for 4–6 weeks
• Final hearing assessment at 8–12 weeks

Follow-up Schedule

• Day 3 (in hospital) — drain removal and pressure dressing change
• Day 7 — first outpatient clinic review for stitches and wound check
• Week 3 — first microscopic cleaning of the mastoid cavity
• Monthly for 3 months — cavity care and audiograms
• 6 and 12 months — long-term cavity stability checks

Potential Complications

• Disease recurrence (5–15% lifetime risk, lower with newer techniques)
• Temporary or rarely permanent facial-nerve weakness
• Altered taste on the operated side
• Hearing may not return fully if disease has been extensive
• Dizziness for 1–2 weeks during inner-ear adaptation

Why Have It Here

Mastoid surgery is unforgiving — facial nerve, inner ear, and brain coverings are all millimetres away. We perform it with facial-nerve monitoring routinely and discuss whether canal-wall-up or canal-wall-down approach suits your disease and lifestyle.