Is it possible to hear anything after a radical mastoidectomy?

Question

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.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

In a radical mastoidectomy, the posterior meatal wall, which is the back wall of the external ear canal, is removed. The rest of the canal remains intact. After a few weeks post-operation, skin from the external ear canal will grow through the posterior opening into the mastoid and middle ear. The pinna and the major part of the ear canal will remain intact. From the outside, a larger opening can be observed due to the removal of the posterior meatal wall. When using an otoscope, you will see the mastoid cavity, whereas in normal ears, the posterior wall is visible instead. Hearing without a hearing aid is possible after a radical mastoidectomy, but the quality of hearing will be poor. Even with a hearing aid, the hearing may still be limited because the eardrum and ossicles are removed. However, a bone-anchored hearing aid may offer some benefit in this situation.

During a radical mastoidectomy, the eustachian tube is typically plugged with a piece of cartilage or fat. The middle ear contents, including ossicles and eardrum, are removed. The middle ear, mastoid, and antrum are left open for regular inspection and cleaning. Since the mucosa of the middle ear is removed, no ear fluid is produced. Over time, the skin will grow over the area, and wax may accumulate.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

When there is no eardrum and the outer and middle ears are intact, the hearing loss is typically around 40 decibels (dB). Depending on the size of the eardrum perforation, hearing loss can range from 10 to 40 dB. If the eardrum is completely absent, the hearing loss will generally be about 40 dB. The sound heard will not be muffled like when fluid is present in the middle ear; instead, it will be a normal sound, but the hearing threshold will be 40 dB. The person will only be able to hear if the sound intensity is greater than 40 dB. In my experience, patients with large perforations have not described their hearing as muffled. However, they often report hearing ringing noises, which are attributed to the perforated eardrum.

When the eardrum is removed surgically, the patient may experience additional issues beyond the hearing loss described above:

Over time, conductive hearing loss may progress to nerve-related hearing loss due to decreased stimulation of the auditory nerve. Performing a tympanoplasty to replace the eardrum can prevent this progression and help bridge the hearing loss, but this is a concern primarily over long periods, such as a few decades.
Without the protection of an eardrum, water can enter the middle ear while swimming or bathing. This increases the risk of infection in the middle ear mucosa, which can lead to ear discharge, further hearing loss, dizziness, earache, and a sensation of fullness. Repeated infections can cause serious complications, including the development of a cholesteatoma, which can erode bone and potentially progress into the skull. To prevent water entry, using earplugs is advisable.

I hope this clarifies your concerns.

Thank you.