Is it possible to hear normally after a radical mastoidectomy without any hearing aid?

Q. Is it possible to insert a bone-anchored hearing aid during radical mastoidectomy?

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 19, 2022

Hello doctor,

When a radical mastoidectomy is performed, does the skin in the ear canal get removed? After the operation, what happens with the hole where the outer ear once was present? Is it possible to hear anything after a radical mastoidectomy (without any hearing aid)? Is it possible to insert a bone-anchored hearing aid during the same operation as radical mastoidectomy? What happens to ear fluid (for example, when you get a cold)? When the middle ear is removed, where will the ear tube end? Kindly suggest.



Welcome to

In radical mastoidectomy, we remove the posterior meatal wall, which is the back wall of the external ear canal. The rest of the canal will be intact. After a few weeks of operation, skin from the external ear canal will grow through the posterior opening into the mastoid and middle ear. The pinna and major part of the ear canal will remain intact. From the outside, you can make out a bigger hole because the posterior meatal wall is lowered. If you put an otoscope into the ear and see you can make out the mastoid cavity, unlike in normal ears where you can see the posterior wall instead. It is possible to hear without a hearing aid after radical mastoidectomy. However, it will be poor. Even a hearing aid may not give good hearing because the eardrum and ossicles are removed in radical mastoidectomy. However, a bone-anchored hearing aid can benefit in such a situation. In radical mastoidectomy, we plug the eustachian tube. The middle ear contents, ossicles, eardrums, etc., are removed. The eustachian tube is plugged with a cartilage piece or fat. All the middle ear mastoid and antrum are exteriorly owed for regular inspection and cleaning. Since the middle ear's mucosa is removed, no ear fluid gets formed. Over time skin grows over the area, and wax can result. I hope this helps.

Thank you.

Hello doctor,

Thank you for the response. How much will the conductive hearing loss be if we remove the eardrums and let the outer and middle ears remain intact? Do you know how much hearing loss will be there in decibels? What will the sound that comes into the ear hear like? Will the hearing loss be similar to fluid in the middle ear? Have any patients with this condition described the sound as muffled, like having cotton in the ear? If one removes the eardrums by surgery, is there any risk that the hearing nerve will be affected? Is there a risk for more rapid ear infections if the eardrums are removed? Is it, for example, possible to take a shower or go for a swim, or is that a risk? Kindly help.



Welcome back to

When there is no eardrum, and outer and middle ears are intact, the hearing loss would be 40 decibels. Depending on the size of the ear drum perforation,n the hearing loss will be from 10 to 40 dB, and if the drum is not present, it should result in 40 dB. The sound that comes to the ear will not be similar to the muffled sounds one hears when fluid is in the middle ear. Instead, it will be a normal sound, but the threshold for hearing will be 40 dB. The person can hear from that particular ear only if the sound intensity is more than 40 dB. I never had any patient with big perforation describing the sounds they hear as muffled. But they often hear some ringing noises, which is attributed to the perforated drum. When the eardrum is removed surgically, the patient will experience the following in addition to the hearing loss discussed above.

1. The conductive hearing loss over time and with aging can progress into nerve-related hearing loss due to decreased stimulation of the nerve due to the hearing loss. If we perform a tympanoplasty and give a fresh eardrum to the patient, this can be prevented, and the hearing loss is bridged. But this possibility is after long periods, say a few decades.

2. Since the middle ear is not protected by an eardrum, water will enter while swimming and bathing. Consequently, the middle ear mucosa has a high chance of getting infected, and the ear can start discharging. The infection can further decrease hearing loss, dizziness, earache, fullness, etc. Repeated infection in the middle ear can cause complications that can be serious. Sometimes the infection can develop into a cholesteatoma which tends to eat away bones and progress into the skull. However, one can wear an ear plug to prevent water entry. I hope this answers your doubts.

Thank you.

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