A cholesteatoma is a collection of debris produced by entrapped skin within your middle ear. Unfortunately, this debris will continue to accumulate over time, until the entrapped skin is removed. If allowed to grow unchecked, it can become infected, and also produces enzymes that erode bone causing hearing loss, dizziness and eventually even facial weakness or brain abscess. Cholesteatomas can be congenital, or can result from trauma, but most commonly, occurs in patients who have chronic middle ear infections, which eventually cause the eardrum to retract inwards and trap skin beneath it.
Mastoidectomy is a surgical procedure where some of the bone behind your ear is removed, allowing access to the middle ear space, and its connected air cells. This is typically performed to remove cholesteatoma, but may also be performed for severe ear infections eroding into the mastoid bone. The procedure is performed under general anesthesia. A nerve monitor is used to protect the nerve to the muscles of your face which runs through the middle ear. Your surgeon will make an incision behind your ear to expose the mastoid bone, and a drill (similar to a dental drill) will be used to remove some of the bone to expose the middle ear space. Your surgeon will likely also make an incision in your ear canal and lift up your eardrum to further expose this space. If you have a cholesteatoma, this will be removed, while carefully protecting the nerve to your face, the inner ear, and the bones in your middle ear. If the cholesteatoma has caused damage to these bones, a separate procedure called an ossiculoplasty may be performed to repair them. The hearing may not improve as a result of the surgery, as the primary goal is to remove the disease. Sometimes a second procedure is needed to restore the hearing. The eardrum will then be replaced, the incision closed, and the ear canal packed to allow healing. A pressure dressing will be applied to prevent bleeding underneath the incision.
Mastiodectomy patients often stay in the hospital overnight. You will be instructed to remove the dressing in 24 to 48 hours. You will be given prescriptions for antibiotics and pain medicine. If you have sutures behind your ear, they will be removed in the office in 1 week. It is important to know that because of the packing and the natural healing process, the hearing may actually seem worse in the post operative period. Close follow up in the office is important to assure proper healing.