Mastoidectomy; complete
CPT4 code
Name of the Procedure:
Mastoidectomy; complete
Common Terms: Complete Mastoidectomy, Radical Mastoidectomy
Summary
A complete mastoidectomy is a surgical procedure that involves the removal of diseased mastoid air cells located in the mastoid bone behind the ear. This procedure is often performed to treat infection or other ear problems that do not respond to medication alone.
Purpose
The procedure is typically performed to address chronic ear infections, cholesteatoma (abnormal skin growth), or other issues in the middle ear that cause persistent problems. The goal of a complete mastoidectomy is to remove the infection and restore normal ear function to prevent complications such as hearing loss or the spread of infection to nearby structures.
Indications
- Chronic mastoiditis (persistent ear infections)
- Cholesteatoma
- Complicated ear infections resistant to antibiotics
- Hearing loss related to infections or growths in the middle ear
- Presence of abscess or fistula in the mastoid bone
Preparation
- Fasting for 6-8 hours prior to surgery
- Stopping certain medications such as blood thinners, as advised by the physician
- Preoperative imaging (CT or MRI) to assess the extent of disease
- Complete physical examination and blood tests
Procedure Description
- Anesthesia: The patient is given general anesthesia.
- Incision: An incision is made behind the ear to access the mastoid bone.
- Bone Drilling: The surgeon uses a drill to open the mastoid air cells and remove the infected tissue.
- Middle Ear Assessment: Examination and cleaning of the middle ear structures including the ossicles (hearing bones).
- Cleaning and Closure: The surgical area is cleaned, and the incision is closed with sutures.
Tools and Equipment: Surgical drill, microscopic instruments, suction, and irrigation system.
Duration
The procedure typically takes 2-4 hours, depending on the extent of the disease.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Otolaryngologist (ENT Surgeon)
- Anesthesiologist
- Surgical nurses and assistants
Risks and Complications
- Common: Infection, bleeding, temporary dizziness, changes in taste
- Rare: Hearing loss, facial nerve injury, cerebrospinal fluid leak, persistent ear discharge
Management may include antibiotics for infection, additional procedures for complications, and hearing rehabilitation.
Benefits
- Relief from chronic ear infections
- Prevention of further complications like hearing loss or brain abscess
- Improved quality of life
Benefits are typically realized within a few weeks postoperatively after the initial healing phase.
Recovery
- Hospital stay: Usually 1-2 days
- Postoperative care: Keeping the surgical site dry and clean, using prescribed ear drops, avoiding strenuous activities
- Follow-up appointments: Regular check-ups to monitor healing and ear function
- Full recovery: Approximately 4-6 weeks, with some activity restrictions during this period
Alternatives
- Medical Management: Antibiotics and ear drops (often insufficient for chronic conditions)
Less Extensive Surgery: Simple mastoidectomy (removal of fewer bone sections)
Pros and Cons: Alternatives might be less invasive but also less effective for severe conditions.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel any discomfort. Postoperatively, patients might experience some pain and swelling around the incision site, which can be managed with prescribed pain medications. Dizziness and changes in taste are also common but typically resolve over time.
Patients are encouraged to rest and follow postoperative instructions to ensure a smooth recovery. Regular follow-up appointments with the ENT specialist are essential to monitor progress and address any concerns.