In spite of the development of antibiotics and diligent research on the part of physicians, ears occasionally become infected with persistent tissue (cholesteatoma, cholesterol granuloma, or granulation tissue), beyond the point where medicine will be any further help to them. When this situation arises, the patient needs a surgical procedure to help correct the infection. Fortunately, new procedures using the operating microscope are available. These procedures provide greater success (of controlling disease and restoring function), with much less risk than previously. The mastoid in a honeycomb cavity in the temporal bone directly behind the ear and is connected to middle ear space. Mastoidectomy is done to remove infection, granulation tissue, and other growths or tumors of the ear.
Usually, hearing is improved by mastoidectomy, but occasionally it is made worse. Preservation of hearing is not the primary objective of mastoid surgery, but rather the number one goal is to get rid of the infection, which is of potential danger to the patient. Mastoid surgery, when done in the proper setting, is successful in attaining this goal in the vast majority of patients.
There are certain complication that may arise from mastoid surgery due to the close relationship between the disease process and structures within the middle ear and mastoid bone itself. There may be alterations in taste on the side of the tongue matching the ear involved in the disease process, due to removal of the disease. In almost all cases, this subsides after a few weeks or months 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 6 months. It is also possible, although quite uncommon, that infections in the ear may follow 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 the disease process, resulting in weakness or paralysis on that side of the face. The weakness is almost always temporary, but 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 damage during surgery.
Patients commonly are up and about on the evening of the day of surgery and usually are discharges form the hospital on the day following surgery. Following mastoidectomy it may be necessary to perform a minor skin graft procedure called a Thiersch graft. A transparent 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 in 10 to 30 days following the mastoidectomy. Patients will need appointments for ear cleanings at least twice yearly for the rest of their lives after mastoidectomy, as their ear will no longer be able to clean itself as normal ears do.