Mastoidectomy in KPHB, Hyderabad

The operation is done while you are fully asleep (general anaesthetic), through a cut behind the ear. It takes two to three hours. Most patients stay one night. The stay is at Sinocare ENT Hospital, or at an associated hospital where an overnight bed or a larger operating room team is needed. You are told which at the first visit. You go home the next day, with a head bandage for a day or so and a pack in the ear. Stitches come out at about a week. The packing is removed in stages over the next weeks. Desk work at about two weeks. Hearing is judged only once the ear has healed, at two to three months.

• An ear that has been discharging for months or years, often with a foul smell
• Cholesteatoma seen on examination or on CT
• Hearing loss that is getting worse on that side
• An infection that clears on treatment and comes back as soon as treatment stops
• Warning signs of spread: dizziness, weakness of the face, severe headache, pain behind the ear

Cholesteatoma is not a cancer. But it acts in a way that has to be taken seriously. It eats away bone slowly, and it does not stop on its own. This is one of the few ENT conditions where the answer at the first visit is often surgery, without a trial of medicine first. The reasons are explained to you fully.

The way in is usually through a cut behind the ear. Under the microscope, the mastoid bone is opened with a drill. The disease is cleared from every corner it has reached.

Two broad methods:

Canal wall up (closed). The back wall of the ear canal is kept. The ear looks and works more normally afterwards, and it does not need cleaning for life. But there is a higher chance of disease being left behind or coming back. So a planned second look is sometimes needed.

Canal wall down (open). The back wall is taken down. This makes a single open space (a cavity) that can be checked and cleaned at the hospital. There is less chance of disease coming back unseen. In exchange, the cavity needs cleaning once or twice a year for life, and the ear must be kept dry.

The right method depends on how far the disease has spread and on the state of the other ear. It also depends on whether you can come back for follow-up reliably. The eardrum and hearing bones are often rebuilt at the same time, or at a second stage.

• CT of the ear bone (temporal bone). It maps the disease before anyone picks up a drill. It shows where the disease sits against the nerve that moves the face (the facial nerve), the balance organ and the covering of the brain.
• A hearing test (audiogram) for both ears. The hearing in the other ear changes the plan.
• An MRI in some cases, where cholesteatoma that has come back must be told apart from scar tissue.
• A check that you are fit to be fully asleep.

In hospital. A head bandage for the first day or so, a pack in the ear canal, and a drain in some cases. Pain is moderate and kept under control with regular painkillers.

First two weeks. The stitches behind the ear come out at about a week. Expect numbness around the ear and the upper part of the outer ear. It can last months. The ear stays dry, completely.

Weeks three to eight. The packing is removed in stages at follow-up. If the method was open, the cavity is cleaned and left to heal. This takes six to twelve weeks and needs several visits. Do not judge your hearing until it is done.

Long term. An open cavity needs a check and a clean once or twice a year, for life. That is not a complication. It is part of the operation you chose. That is why the method is discussed with you before surgery, not decided for you.

• Injury to the facial nerve. The nerve that moves the face runs through the area being operated on. In a diseased mastoid it is sometimes exposed or pushed out of place. It is the most serious risk of this operation, and it is uncommon. The CT maps the nerve beforehand, and the nerve is found and protected under the microscope throughout. Weakness, when it happens, may be temporary or permanent.
• Hearing loss, including, rarely, complete loss of hearing in the operated ear. Cholesteatoma itself damages hearing. Surgery removes the disease but cannot always bring back the hearing parts.
• Dizziness, usually for days. Now and then it lasts longer, if the disease has eaten into the balance organ.
• A change in taste on that side of the tongue, usually temporary.
• Disease that comes back, or is left behind, needing a second operation. This is not rare. With the closed method it is planned for, not treated as a failure.
• A cavity that discharges on and off after open surgery, managed by cleaning.
• Ringing in the ear (tinnitus).