A tympanomastoidectomy combines two distinct operations: a tympanoplasty and a mastoidectomy. This approach addresses disease involving both the middle ear space and the mastoid bone, the air-filled, honeycomb-like section of the skull located behind the ear. The primary goal of this surgery is to completely remove chronic infection and diseased tissue, making the ear safe and preventing serious complications. Following disease removal, surgeons reconstruct the ear’s delicate structures to preserve or improve hearing function.
Conditions Treated by Tympanomastoidectomy
A tympanomastoidectomy is necessary when chronic ear disease progresses beyond the middle ear and spreads into the mastoid air cells. The most frequent reason for this extensive surgery is a cholesteatoma. A cholesteatoma is a non-cancerous, expanding skin cyst that forms in the middle ear or mastoid, which can erode surrounding bone and damage delicate hearing structures, the balance organ, and the facial nerve.
If left untreated, a cholesteatoma can lead to severe complications, including total hearing loss, permanent dizziness, or the spread of infection toward the brain, potentially causing an abscess or meningitis. The only effective treatment is surgical removal of the cyst. This procedure is also required for severe, refractory Chronic Suppurative Otitis Media (CSOM) where persistent infection has caused structural damage to both the middle ear and the mastoid bone. Extensive cleaning is required in these cases to eliminate the infection and prevent recurrence.
Understanding the Surgical Procedure
The tympanomastoidectomy is performed under general anesthesia and typically takes several hours due to the precision required when working around delicate nerves and bones. The surgeon makes an incision, usually placed either behind the ear or within the ear canal itself. The mastoidectomy component begins by using a specialized drill to open the mastoid bone and remove the thin bony partitions between the air cells.
The mastoidectomy aims to drill out all diseased and infected air cells from the mastoid cavity to create a clean, safe space. The surgeon works meticulously using a surgical microscope to ensure complete disease removal while avoiding structures like the facial nerve, which passes through this area. Once the mastoid is clear, the tympanoplasty component focuses on the middle ear.
The tympanoplasty involves repairing the eardrum (tympanic membrane), usually by grafting tissue or cartilage taken from around the ear. This closes any perforation and restores the eardrum’s function. If infection has damaged the three middle ear bones (ossicles)—the malleus, incus, and stapes—the surgeon attempts to reconstruct this sound-transmitting mechanism, sometimes using a small artificial prosthesis.
A significant variation is the choice between the Canal Wall Up (CWU) and Canal Wall Down (CWD) techniques. The CWU procedure preserves the posterior bony ear canal wall separating the ear canal from the mastoid cavity. The CWD procedure removes this bony wall. The surgeon’s choice depends on the extent of the disease; CWD is often required for more extensive disease, as it exteriorizes the mastoid cavity, allowing for easier long-term cleaning and monitoring.
Navigating the Recovery Period
Following the procedure, patients are typically observed in the hospital for one to two nights, especially if they experience post-operative dizziness or nausea. Immediate discomfort includes a sore ear and jaw pain, which is managed effectively with prescribed oral pain medication. The ear canal is usually packed with material to hold the reconstructed tissues in place, which causes a temporary feeling of ear fullness and muffled hearing until the packing is removed, usually within one to two weeks.
Activity restrictions are put in place to protect the healing graft and prevent pressure changes in the middle ear. Patients must avoid heavy lifting, straining, or any strenuous activity for at least four to six weeks. A crucial instruction is to prevent water from entering the operated ear, requiring the use of a petroleum jelly-coated cotton ball while showering or bathing until the doctor clears water exposure.
Activities that create pressure, such as blowing the nose forcefully, should be avoided for several weeks; patients should sneeze with their mouth open to equalize pressure. Most individuals can return to light work or school activity within one to two weeks. Full recovery and a return to all normal activities, including air travel, typically takes four to six weeks. Follow-up appointments are scheduled to remove sutures, examine the healing ear, and clear residual packing material.
Potential Surgical Outcomes and Risks
The primary objective of a tympanomastoidectomy is to achieve long-term control by eradicating chronic disease and creating a healthy ear. Most patients achieve this goal, preventing serious complications associated with persistent infection. A secondary goal is the improvement of hearing, and patients often experience a significant gain in hearing status after the surgery.
While the operation is generally safe, potential risks are associated with any procedure near the delicate structures of the ear. Temporary dizziness or vertigo can occur due to proximity to the balance organs, but this usually resolves within a few days or weeks. A temporary change in taste, or dysgeusia, affects approximately 10% of patients, as the taste nerve for the front of the tongue passes through the middle ear.
The most concerning risk is injury to the facial nerve, which controls movement on that side of the face. This complication is uncommon, with the reported incidence of immediate injury being less than one percent. In the rare event of a facial nerve issue, the prognosis for recovery is generally good, especially for cases of delayed onset facial weakness.