Name of the Procedure:

Revision Mastoidectomy; resulting in Modified Radical Mastoidectomy

Summary

A revision mastoidectomy with subsequent modified radical mastoidectomy is a surgical procedure that aims to treat chronic ear infections or complications by removing diseased mastoid air cells and creating an open cavity in the mastoid bone while preserving some structures of the middle ear.

Purpose

This procedure is primarily performed to address chronic ear infections, cholesteatoma, or other conditions that have not been adequately treated by prior surgeries. The goal is to eradicate the infection, remove disease-causing tissues, and improve hearing, while creating a safer ear environment by preventing further complications.

Indications

• Chronic otitis media with or without cholesteatoma
• Recurrent ear infections not responsive to medical treatment
• Previous mastoidectomy with persistent or recurrent disease
• Ear drainage (otorrhea) that does not resolve with conventional treatments
• Hearing loss due to chronic ear disease

Preparation

• Patients may be required to fast for at least 6–8 hours before the procedure.
• Adjustments to medications, especially blood thinners, as advised by the physician.
• Preoperative imaging studies, such as CT scans, and hearing tests to assess the extent of disease.
• Complete a preoperative health assessment including blood tests and a physical exam.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made behind the ear to access the mastoid bone.
3. The surgeon drills into the mastoid bone to remove diseased mastoid air cells.
4. The middle ear cavity is then explored, and disease-causing tissues like cholesteatoma are removed.
5. Parts of the ossicular chain (hearing bones) might be preserved or reconstructed depending on the extent of the disease.
6. A modified radical mastoid cavity is created, ensuring safe and effective aeration.
7. The surgical site is closed with sutures, and a dressing is applied.

Duration

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

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• ENT (Ear, Nose, and Throat) surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a resident or surgical fellow

Risks and Complications

• Bleeding
• Infection
• Hearing loss
• Dizziness or balance issues
• Facial nerve injury
• Risk of recurrent disease
• Issues with wound healing

Benefits

• Resolution of chronic ear infections and associated symptoms
• Improvement or stabilization of hearing
• Reduced risk of further ear disease or complications
• Creation of a safer ear environment

Recovery

• Postoperative care includes keeping the surgical site dry and clean.
• Pain management with prescribed medications.
• Antibiotics may be administered to prevent infection.
• Patients are often advised to avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments are necessary to monitor healing and manage ear care, typically involving specialist visits within the first couple of weeks post-surgery.
• Full recovery can take several weeks, with specific restrictions on activities provided by the surgeon.

Alternatives

• Conservative medical management including topical and oral antibiotics or steroids.
• Less invasive surgical procedures like myringotomy with or without tube placement.
• Radical mastoidectomy if an extended disease is present requiring more aggressive removal of tissues.

Patient Experience

Patients will be under general anesthesia and will not feel anything during the surgery. Postoperative discomfort is managed with pain medications. Initially, there might be some dizziness, ear drainage, or muffled hearing, which should improve over time. Ensuring clear communication with the healthcare team regarding symptoms and following post-operative care advice is crucial for a smooth recovery.