Name of the Procedure:

Mastoid Obliteration

• Common names: Mastoid packing, Mastoid cavity closure
• Medical term: Mastoid obliteration surgery

Summary

Mastoid obliteration is a surgical procedure where the mastoid cavity, a part of the ear located behind the ear canal, is filled with soft tissue or bone to eliminate a cavity that may lead to infections or other complications.

Purpose

Medical conditions addressed:

• Chronic ear infections (chronic otitis media)
• Recurrent or persistent mastoiditis
• Cholesteatoma

Goals/Expected outcomes:

• Elimination of chronic infection
• Rendering the mastoid cavity self-cleaning and dry
• Prevention of recurrent disease
• Improvement in hearing

Indications

Symptoms/Conditions warranting the procedure:

• Persistent ear drainage despite medical treatment
• Chronic ear infections not responsive to antibiotics
• Persistent or problematic mastoid cavity after previous surgeries
• Presence of cholesteatoma (abnormal skin growth in the middle ear)

Patient criteria:

• Patients with chronic ear conditions not responding to less invasive treatments
• Patients with complications from previous mastoid surgeries

Preparation

Pre-procedure instructions:

• Fasting typically 6-8 hours before surgery

• Medication adjustments as directed by your surgeon (e.g., stopping blood-thinning meds)

  Diagnostic tests/assessments:

• Hearing tests
• CT or MRI scan of the ear
• Blood work to assess overall health

Procedure Description

Step-by-step explanation:

1. Anesthesia is administered (usually general anesthesia).
2. An incision is made behind the ear.
3. The mastoid bone is accessed, and the infected or diseased tissue is removed.
4. The mastoid cavity is then filled with tissue or material from the patient (e.g., bone graft or muscle flap), or occasionally synthetic materials.
5. The incision is closed with stitches or surgical staples.

Tools/Equipment used:

• Surgical microscope
• Micro-drills
• Bone curettes
• Grafting materials (bone, muscle tissue)

Anesthesia/Sedation details:

• General anesthesia to ensure the patient is asleep and pain-free during the procedure.

Duration

The procedure typically takes 2-3 hours.

Setting

Performed in a hospital operating room or specialized surgical center.

Personnel

• Ear, Nose, and Throat (ENT) surgeon or otologist
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Temporary dizziness or imbalance

Rare risks:

• Facial nerve injury
• Hearing loss
• Failure of the graft to integrate

Management of complications:

• Antibiotics for infections
• Close monitoring and additional interventions if bleeding occurs
• Physical therapy for balance issues
• Additional surgeries if necessary

Benefits

Expected benefits:

• Relief from chronic ear infections and drainage
• Improved hearing in some cases
• Reduction in the need for ongoing ear care and cleanings

Timeframe for realization:

• Immediate relief from symptoms, with full benefits realized over a few weeks to months as tissues heal.

Recovery

Post-procedure care:

• Dressing and wound care
• Pain management with prescribed medications
• Keeping the ear dry and avoiding water exposure

Expected recovery time:

• 2-4 weeks for initial recovery
• Full recovery and return to normal activities within a few months

Restrictions and follow-up:

• Avoid heavy lifting or strenuous activities
• Follow-up appointments to monitor healing and success of the graft

Alternatives

Other treatment options:

• Conservative treatments (antibiotics, ear cleaning)
• Revisions of previous surgeries
• Tympanomastoidectomy

Pros and cons of alternatives:

• Conservative treatments may not be effective for severe cases, but they are less invasive.
• Revision surgeries may be necessary but involve similar risks.

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel or remember the procedure.

After the procedure:

• Pain and discomfort managed with medications
• Possible temporary dizziness or imbalance
• Follow-up visits for removal of dressings and stitches, and to monitor healing

Pain management and comfort measures:

• Prescription pain medications
• Rest and limited activity to aid in recovery