This surgery involves removal of the disease from the middle ear and repair of the damaged bones and the hole in the ear drum. It also involves the drilling of the bone behind the ear in order to remove the disease in that area.
Ear infections for a prolonged period may lead to hole in the ear and spread of the ear disease to surrounding structures including the bone behind the ear called the mastoid .
The three tiny bones in the ear get involved and are destroyed as the disease progresses.
This will also lead to significant hearing loss. The diagnosis is made by otoscopic examination and audiometry tests. The patient is sometimes asked to get CT scan of the ear to see the involvement of bones and to see spread of disease.
This surgery can be performed under general or local anaesthesia. The surgery can be done either by endoscopy of by giving a cut behind the ear.
The ear drum is lifted and the middle ear is examined. All the disease in the middle ear are removed. The bone behind the ear is drilled to clear away all the disease.The tiny bones are then examined and destroyed parts are removed. The repair of the bones is called ossiculoplasty. The destroyed bones can be reshaped and placed in the ear or cartilage from patients ear can be used.
Artificial bones called as prosthesis are also available to repair the bones and make hearing better. The ear drum is them repaired by placing tissue from behind the ear ( temporalis fascia graft) or cartilage grafts. The ear cavity wall that is drilled away may be reconstructed or sometimes it is left open and a large hole is left in the ear cavity lined by skin. This will allow easy drainage of ear of the infection reoccurs. This procedure is called modified radical mastoidectomy and will require frequent visits after operation to clean the collected debris in the huge cavity that is hence formed. The ear is then filed with medicated sponge like substance and pack is placed. The cut is stitched up and ear bandage applied. The ear bandage will be removed after two days and the pack and stitches will remain for about two to four weeks.
Patient will be discharged after one or two days with medicines for a week. Patient after surgery should avoid strain and heavy weight lifting. Water entry should be avoided in ear for few weeks.
Modified radical Mastoidectomy cases will require special care as they may experience giddiness in contact with water or cold air.