- Types of Mastoidectomy: • Cortical mastoidectomy (Simple mastoidectomy or Scwartz operation)Exenteration of all the accessible mastoid air cells preserving the posterior meatal wall. • Modified radical mastoidectomy (Bondy’s operation) Eradication of disease from the attic and mastoid antrum which is exteriorized into the external auditory canal by removing the posterior meatal wall and lateral attic wall. • Radical mastoidectomy (Zaufal’s operation)Eradication of the disease from the middle ear, attic and mastoid antrum which is exteriorized into the external auditory canal by removing the posterior meatal wall and lateral attic wall. Opening of the eustacian tube is closed by packing a piece of muscle or cartilage into the eustacian tube.
- Indications: • Acute mastoiditis ○ When symptoms and signs have not been controlled by adequate course of an appropriate antibiotic ○ Patients with complications of CSOM ○ When symptoms and signs subside but otorrhoea continues 3-4weeks after the onset • Secretory otitis media • Tuberculous mastoiditis
- Pre operative investigations: • Routine blood tests • Chest xray and xray mastoid schuller’s view • Pure tone audiogram
- Anaesthesia: • Local - cortical mastoidectomy • General - modified radical and radical mastoidectomy
- Surgery: • Post aural incision • Temporalis fascia graft harvested • Tympanomeatal flap raised • Middle ear entered • Exposure of Mac Evan’s triangle • Drilling started and mastoid antrum opened • Complete clearance of the disease from middle ear attic and mastoid antrum with exteriorization of air cells • Insertion of small drain or betadine soaked pack in the mastoid antrum • Closure of wound
- Post operative care: • Facial nerve examination, tunning fork tests, nystagmus • Post operative antibiotics for 2 weeks • Drain should be removed when there is no further discharge usually 2-5 days after the surgery • Keep ear dry • Post operative audiogram as soon as the ear is dry usually 3 months post operatively
- Complications: • Injury to facial nerve • Dislocation of incus • Injury to horizontal semicircular canals • Injury to sigmoid sinus with profuse bleeding • Injury to dura of middle cranial fossa • Post operative wound infection
