Mastoidectomy

Cortical mastoidectomy

This is removal of air cells within the mastoid by drilling whilst maintaining the posterior wall of the ear canal. It is performed via a post-auricular incision, called a Wilde's incision, named after the famous otologist father of Oscar Wilde.

 

Indications

 

Acute mastoiditis when medical treatment has failed, occasionally for persistent discharge through a perforation to improve ventilation.

 

Risks

 

Risks of hospital admission, anaesthesia, failure of the surgery, persistent discharge, wound infection, dizziness, tinnitus, altered sense of taste, facial nerve palsy, reduction in hearing and complete loss of hearing (a dead ear) (0.5%).

Mastoid surgery (other)

(includes atticotomy, atticoantrostomy, modified radical and radical mastoidectomy)

These procedures include various approaches to treat cholesteatoma by removing diseased bone and tissue. Atticotomy involves the removal of the outer attic wall, additional removal of the mastoid antrum is termed atticoantrostomy.

 

A modified radical mastoidectomy involves additional removal of the posterior ear canal, the head of the malleus and incus bone with grafting of the tympanic membrane (as in myringoplasty) and widening of the canal (meatoplasty).

The diagram below shows a modified radical mastoid cavity.  It is a left sided cavity with the eardrum shown to the left of the image and a space where the sputum and posterior canal wall should be. The cavity is self cleaning.

 

 

 

 

Radical mastoidectomy involves removal of all ossicles and leaves the middle ear exposed without a graft. This is very rarely done.

 

Indication

Cholesteatoma. The smaller the disease the smaller the cavity will be.

 

Risks 

Risks of hospital admission, anaesthesia, failure of the surgery, persistent discharge, wound infection, dizziness, tinnitus, altered sense of taste, facial nerve palsy (1-2%), reduction in hearing and complete loss of hearing (a dead ear) (0.5%).