Name of the Procedure:

Mastoidectomy; Radical

Summary

A radical mastoidectomy is a surgical procedure to remove disease-infected mastoid cells by accessing the mastoid bone behind the ear. It is typically more extensive than a standard or modified mastoidectomy, involving the removal of mastoid air cells, and sometimes parts of the ear canal and middle ear structures.

Purpose

This procedure is done to treat chronic mastoiditis, cholesteatoma, or severe ear infections that don't respond to other treatments. The goal is to eliminate infection, prevent its spread, and preserve as much of the ear's anatomy and hearing function as possible.

Indications

• Chronic ear infections
• Cholesteatoma (abnormal skin growth in the middle ear)
• Complications from mastoiditis such as brain abscess or meningitis
• Persistent drainage from the ear despite medical treatment
• Hearing loss or disequilibrium due to infection

Preparation

• Patients are generally required to fast (no food or drink) for 6-8 hours before the surgery.
• Blood tests, hearing tests, and imaging studies (like a CT scan of the ear) are often done to assess the extent of disease.
• Medications may need adjustment; blood thinners are typically stopped several days prior to reduce bleeding risk.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision behind the ear to access the mastoid bone.
3. Using specialized tools like a drill, the surgeon removes the diseased mastoid cells, and if necessary, parts of the ear canal and middle ear structures.
4. The surgical area is cleaned thoroughly to eradicate any infection.
5. The incision is closed with sutures, and a dressing is applied to protect the area.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity and extent of the disease.

Setting

Radical mastoidectomy is performed in a hospital operating room.

Personnel

• An ENT (Ear, Nose, and Throat) surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Hearing loss
• Dizziness or balance issues
• Facial nerve injury, leading to facial muscle weakness
• Infection at the surgical site
• Tinnitus (ringing in the ears)
• Cerebrospinal fluid leak (rare)

Benefits

• Elimination of chronic infection
• Prevention of complications related to mastoiditis or cholesteatoma
• Potential improvement in hearing and balance
• Enhanced quality of life by resolving persistent symptoms

Recovery

• Patients typically stay in the hospital for 1-2 days post-surgery.
• Keep the head elevated and avoid strenuous activities for a few weeks.
• Ear dressings are usually removed after a week.
• Follow-up appointments are essential for monitoring healing and managing any complications.
• Full recovery can take several weeks, and patients may experience maintenance drainage and cleaning of the ear.

Alternatives

• Conservative management with antibiotics and ear drops
• Less extensive surgeries like canal wall up or canal wall down mastoidectomy
• Use of hearing aids if hearing loss is a primary concern

Patient Experience

During the procedure, patients are under general anesthesia and will not feel pain. Post-operatively, there may be discomfort, which can be managed with prescribed pain medication. Patients might experience temporary dizziness, balance issues, and changes in hearing that improve as healing progresses. Proper care and follow-up are crucial for optimal recovery.