Depending on the specific condition in patient’s ear, an operation on the mastoid bone to control infection may be done, together with a procedure to restore hearing. This procedure is called a tympanomastoidectomy. The mastoid is a honeycomb cavity in the temporal bone, which lies directly behind the ear and is connected to the middle ear space. When a hole arises in the eardrum due to previous injury or infection, or when a long-standing infection persists with tissue in the middle ear or mastoid, mastoid surgery often becomes necessary to alleviate this infection. This part of the procedure is called mastoidectomy.
The procedure used to restore or retain hearing is called a tympanoplasty. “Tympanum” refers to the middle ear cavity; “plasty” means “repair of”; thus “tympanoplasty.” Special techniques are used to graft the eardrum (tympanic membrane) and to reconstruct the middle ear. The middle ear bones (ossicles) may need to be replaced due to damage from infection. A prosthetic device made of plastic materials, wire, or cartilage is used n the replacement of the natural ossicles. “T.O.R.P.” refers to the Total Ossicular Replacement Prosthesis; “P.O.R.P.” refers to the Partial Ossicular Replacement Prosthesis. Our physicians have developed and utilizes various methods. A new technique (one stage) called “I.B.M.” or “intact bridge tympanomastoidectomy” has been widely used with good results to date. Our new methods include “cartilage-collagen tympanoplasty” and “tympanoplasty for atelectatic ear.”
There are certain complications that may arise from this surgery due to the close relationship between the disease process and structures within the middle ear and the mastoid bone itself. There may be alteration in taste on the side of the tongue matching the ear involved in the disease process, due to the removal of disease. In almost all cases, this subsides after a few weeks because other taste nerves to the tongue take over. Rarely, due to the disease being so close to the balance system, there may be a period of unsteadiness following surgery. This could conceivably, although quite rarely, last up to six months. It is also possible, although quite uncommon, that infections in the ear may follow the surgery resulting in a residual hole in the new eardrum. This generally can be patched by a second operation and is of little long-term consequence. The facial nerve, controlling the muscles of the face, crosses through the middle ear and mastoid and is often involved in the mastoid infection. On extremely rare occasions, this nerve may be injured or irritated in the effort to remove all of the disease process, resulting in weakness on that side of the face. When this does occur, the weakness is almost always temporary, however some long-term weakness may result. In our experience, the likelihood of the disease (infection) damaging the nerve is much greater than the likelihood of the treatment doing so.
Patients commonly are up and about on the evening of the day of surgery and usually are discharged from the hospital on the day following surgery. Following tympanomastoidectomy, it may be necessary to perform a minor skin grafting procedure called Thiersch grafting. A transplant layer of skin is removed from the inside part of the upper arm and is placed over the surgical area inside the ear. This aids in the healing process and protects the ear from infection. If this is necessary, it is usually done 10 days following the tympanomastoidectomy.
Patients will need appointments for ear cleanings at least twice yearly after tympanomastoidectomy as their will no longer self clean as normal ears usually do.