A surgical procedure in which diseased cells of the mastoid bone behind the ear (chronic infection, cholesteatoma) are removed under a microscope, with eardrum and ossicular chain repair performed when needed.
Indication
- Cholesteatoma (abnormal accumulation of skin epithelium in the middle ear and mastoid) — causing bone destruction
- Chronic suppurative otitis media that does not respond to medical treatment (chronic ear discharge, persistent eardrum perforation)
- Chronic mastoiditis and mastoid abscess
- Benign tumors of the middle ear and mastoid
- Ossicular chain damage causing conductive hearing loss (combined with reconstruction)
- Ear diseases at risk of intracranial complications (meningitis, brain abscess, lateral sinus thrombosis)
- Creating a surgical pathway for cochlear implant or petrous bone pathology approaches
Preparation
- Detailed ENT examination, microscopic ear evaluation, and audiometry
- High-resolution CT of the temporal bone is used to map the extent of cholesteatoma and the anatomy
- Active ear infection is calmed with antibiotic drops when possible
- No food or fluid for 6-8 hours before the procedure
- Use of blood thinners, allergy history, and chronic illnesses are reviewed
How it's performed
- The patient receives general anesthesia
- Access is gained through a postauricular (behind the ear) or transcanal approach
- Diseased cells in the mastoid bone are cleared under a microscope using a special microsurgical drill
- Intact canal wall mastoidectomy: the posterior wall of the ear canal is preserved; provides a drier and more natural ear anatomy, but the risk of cholesteatoma recurrence may be higher
- Canal wall down mastoidectomy: the posterior wall of the ear canal is removed and a wide cavity is created; recurrence is lower but regular cavity care is required
- When needed, eardrum repair (tympanoplasty) and ossicular chain reconstruction (ossiculoplasty) are performed at the same time; the skin is closed in layers
Post-procedure
- Discharge after a 1-2 day hospital stay
- The dressing is changed within a few days; sutures are removed in approximately 7-10 days
- Heavy exertion, nose blowing, diving, and air travel are avoided in the first week
- The ear canal packing is removed within 2-3 weeks
- Regular ENT check-ups: frequent in the first month, then every 3-6 months; in canal wall down cases, cavity care continues for years
- Long-term follow-up due to the risk of cholesteatoma recurrence; second-look surgery may be performed after 9-12 months if needed
Risks
- Persistence or worsening of hearing loss to varying degrees
- Facial nerve injury (facial paralysis) — rare with microscopic technique
- Taste disturbance (chorda tympani nerve involvement) — usually temporary
- Vertigo (in case of inner ear involvement)
- Recurrence of cholesteatoma and the need for repeat surgery
- In canal wall down cases, lifelong need for regular cavity cleaning
- Very rare intracranial complications (CSF leak, meningitis)
FAQ
Is intact canal wall or canal wall down mastoidectomy preferred?
The decision depends on many factors including the extent of cholesteatoma, the patient's age, anatomic features, and ability to attend follow-up. The intact canal wall technique provides a more natural ear structure but may have a higher recurrence rate; the canal wall down technique creates a safer cavity in terms of recurrence but requires lifelong cavity care. The surgeon discusses with the patient and selects the most appropriate approach.
What will my hearing be like after surgery?
The primary aim of the surgery is to clear the disease and make the ear safe. Ossicular reconstruction (ossiculoplasty) may be performed in the same or a second session, which can improve hearing to some extent. In some cases, hearing aids or bone-anchored hearing devices may be considered.
How long does recovery take?
Skin healing is largely complete in 2-3 weeks. Healing inside the ear takes 2-3 months. In canal wall down cases, full maturation of the cavity may take 6-12 months; regular cleaning visits are important during this time.
Can cholesteatoma recur?
Cholesteatoma has a tendency to recur. Because the recurrence rate is higher with the intact canal wall technique, a planned 'second look' surgery may be considered after about 9-12 months. Regular ENT check-ups and imaging help detect recurrence early.
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