Name of the Procedure:

Mastoidectomy; modified radical
Common name(s): Modified Radical Mastoidectomy

Summary

A modified radical mastoidectomy is a surgical procedure to remove infected or diseased mastoid air cells in the skull behind the ear, typically due to chronic ear infections or cholesteatomas. The procedure aims to clear the infection and prevent further complications while preserving as much of the ear structure as possible.

Purpose

• Condition addressed: Chronic ear infections, cholesteatomas, or other mastoid diseases.
• Goals: To remove infected tissue, prevent further infection, and preserve hearing.

Indications

• Persistent ear infections not responsive to medical treatments.
• Presence of cholesteatomas (abnormal skin growth in the middle ear).
• Hearing loss associated with mastoid disease.
• Chronic ear drainage.
• Formation of abscesses or other complications from mastoid infections.

Preparation

• Pre-procedure instructions: Patients may need to fast for a certain period before the surgery. They may be advised to stop certain medications, especially blood thinners, as directed by their healthcare provider.
• Diagnostic tests: Hearing tests (audiogram), CT scans, and other ear examinations may be conducted to assess the extent of the disease.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made behind the ear to access the mastoid bone.
3. Removal: The surgeon drills into the mastoid bone to remove the infected air cells, cholesteatomas, or other diseased tissues while preserving the ear structures essential for hearing.
4. Reconstruction: Depending on the extent of the disease, the surgeon may reconstruct parts of the middle ear to improve hearing function.
5. Closure: The incision is closed with sutures, and a dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the disease.

Setting

Performed in a hospital's surgical suite or a specialized outpatient surgical center.

Personnel

• Surgeons: An otolaryngologist (ENT specialist) spearheads the procedure.
• Nurses: Assist during the surgery and in postoperative care.
• Anesthesiologists: Administer and monitor anesthesia.

Risks and Complications

• Common risks: Infection, bleeding, dizziness, changes in taste, and numbness around the ear.
• Rare complications: Facial nerve injury, hearing loss, persistent drainage, and cerebrospinal fluid leak.

Benefits

• Removal of infection and disease.
• Prevention of further complications.
• Potential improvement or stabilization of hearing.
• Reduction in ear discharge and pain.

Recovery

• Post-procedure care: Pain management with prescribed medications, keeping the surgical site clean and dry. Patients are advised to avoid strenuous activities.
• Recovery time: Initial recovery occurs within 2-3 weeks, with full recovery taking several months. Follow-up appointments are necessary to monitor healing and hearing status.

Alternatives

• Medical treatment: Use of antibiotics or ear drops for less severe infections.
• Conservative surgery: Less extensive procedures may be suitable for less advanced disease.
• Pros and cons: Conservative treatments may have lower immediate risks but might be less effective for advanced disease, potentially leading to more severe complications later.

Patient Experience

• During: The patient will be under general anesthesia, experiencing no pain or awareness during the procedure.
• After: Some pain, swelling, and drainage from the incision site are expected and managed with medications. Hearing might be affected immediately after surgery but can improve as healing progresses. Regular doctor visits ensure proper recovery and management of any issues.