Introduction
Tympanomastoidectomy combines two surgical methods to fix middle ear defects in the tympanic membrane (eardrum) and the mastoid bone present behind the ear and filled with air cells. Therefore, tympanomastoidectomy surgery comprises tympanoplasty, or repair of the ruptured eardrum, and mastoidectomy, or removal of the infected mastoid air cells during the procedure. The recovery rate and prognosis of the tympanomastoidectomy procedure are usually expected to be 80 to 90 percent. A person needs at least four weeks of rest to recover completely and resume normal daily life routines.
What Are the Conditions Necessary to Undergo Tympanomastoidectomy?
The conditions necessary for tympanomastoidectomy are as follows:
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Chronic or recurrent eardrum perforations.
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Chronic or recurrent middle ear infections.
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Removal of tumor from the skull base.
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Placement of cochlear implants in people with severe hearing loss.
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Cholesteatoma, a noncancerous skin growth in the mastoid bone or the middle ear behind the eardrum, causes the weakening of the eardrum and its rupture.
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Tympanomastoidectomy is performed to gain access to the middle ear as a part of another ear surgery on the bones (three tiny ossicles) of the middle ear.
What Are the Various Types of Mastoidectomy?
The various types of mastoidectomy are
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Simple Mastoidectomy: In this surgical method, the middle ear is drained by opening the mastoid bone and drilling infected air cells.
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Radical Mastoidectomy: This surgical method is usually performed on people with complicated and severe mastoid disease. This method removes middle ear components, mastoid air cells, ear canal, and eardrum.
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Modified Radical Mastoidectomy: This surgical method is less severe than radical mastoidectomy. It involves drilling out the infected air cells and removing the disease. Further, this method also helps preserve some middle ear bones and reconstruction (tympanoplasty) of the eardrum.
What Are the Different Types of Tympanoplasty Methods?
The main goal of all tympanoplasty surgeries is to patch the ruptured eardrum. The various tympanoplasty methods differ in the approach used to gain access to the middle ear to repair the eardrum. These methods include
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Endaural: This surgical technique makes the incision above the ear canal.
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Postauricular Tympanoplasty: In this technique, the curved incision is made at the crease of the outer ear or behind the auricles.
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Transcanal: In this method, access to the middle ear is gained through the ear canal if the perforation in the eardrum is small and located at the back of the eardrum.
How Is Tympanomastoidectomy Performed?
Tympanomastoidectomy is performed by the specialist depending on the condition's cause, any infection's presence, and the disease's severity. After accessing the case, the doctor places the person under general anesthesia and makes them unconscious during the procedure. The surgery is performed in two parts, which include
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Mastoidectomy: The surgeon makes an incision behind the ear to access the mastoid bone during this procedure. After exposing the mastoid bone, access to the middle ear is gained by drilling the bone and preventing facial nerve injury simultaneously. The infected air cells are then removed along with any abnormal growths, and the surgical site is not closed until the repair of the eardrum as well. Therefore, mastoidectomy is followed by tympanoplasty to repair the ruptured eardrum.
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Tympanoplasty: This procedure repairs the ruptured or perforated eardrum. The surgeon obtained the small temporalis fascia (connective tissue) or cartilage to create a patch or graft for the ruptured eardrum. The ear canal skin is then cut and elevated, and the perforation or hole in the eardrum is covered with a tissue called fascia. The ear canal skin is then placed back and packed with gauze, and the incision suturing is done. The operated site is finally covered with a bandage. This surgical method not only fixes the perforations or holes but also improves hearing issues.
What Happens After the Tympanomastoidectomy?
After the surgery, the person may experience headaches, ear pain, and skin numbness because of the stitches behind the ear. The doctor prescribes antibiotics, painkillers, and ear drops to prevent surgical site infection and pain, along with regular follow-ups to check the wounds and remove bandages and stitches. The patient is also recommended to follow instructions, such as
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Avoid sleeping on the operated ear side or keeping the operated ear up.
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Avoid strenuous activities for at least two to four weeks. This includes lifting any heavy objects.
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Avoid putting pressure on the operated ear.
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Avoid flying in an airplane and swimming post-surgery until the healing process is completed.
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Do not take a shower or put water in the ear. Take a bath only with cotton balls or earplugs placed outside the ear to prevent water from entering the ear canal. Do not push the cotton ball or earplugs inside the ear canal to prevent any pressure on the dressing on the operated site.
What Are the Complications Associated With Tympanomastoidectomy?
The complications associated with tympanomastoidectomy include
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Nausea and Vomiting: This is a rare complication that may occur in some people after the surgery. However, nausea and vomiting can be prevented, or the doctors can minimize their intensity.
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Bleeding: A person can also experience bleeding for one or two days after removing the gauze piece from the ear canal. Bleeding occurs because the ear packing during surgery is kept for one to two weeks, absorbing blood-stained fluid until it gets removed.
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Tinnitus: After the tympanomastoidectomy surgery, a person may also feel a buzzing or ringing sound in the ear for some time.
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Unsteadiness: A person can feel dizzy and unsteady for the initial few days after the surgery.
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Infection: Ear infections may also occur after the tympanomastoidectomy procedure and can cause meningitis or spine and brain infection. Therefore, long-term antibiotic therapy is given to the patient to avoid complications post-surgery.
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Hearing Loss: Tympanomastoidectomy often causes hearing loss in a person if the affected hearing bones cannot be reconstructed during the surgery. In some cases, second surgery called ossiculoplasty may be required to improve hearing in a person.
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Altered Taste: Middle ear surgeries often cause a metallic taste. The taste disturbance mainly occurs due to damage to the taste nerve during the surgery, which passes through the eardrum. Altered taste usually gets resolved on its own.
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Facial Nerve Weakness: The mastoid and middle ear surgeries threaten damage to the facial nerve despite preventive measures being taken. This further leads to the weakening of the facial muscles; therefore, the facial nerve is being monitored and taken care of during such surgeries.
Conclusion
The doctor recommends a tympanomastoidectomy to treat conditions such as recurrent middle ear infections, excess tissue growth, and tumors causing damage to the eardrum and other surrounding tissues. This safe surgical method removes infected tissues from behind the mastoid. However, there are some possible complications associated with this procedure, but it also has a high success rate. In some cases, a person may need a second surgery after 6 to 18 months to prevent the recurrence of the disease.
