From the Research
Mastoidectomy is primarily indicated for chronic ear infections that don't respond to medical therapy, particularly chronic suppurative otitis media with cholesteatoma, as well as complications of otitis media such as brain abscess or meningitis, and temporal bone trauma with CSF leakage. The decision to perform a mastoidectomy is based on the severity of the disease and the presence of complications. According to the most recent and highest quality study 1, tympanoplasty alone may be sufficient for treating chronic otitis media, even with mastoid cavity opacification, if the ear is dry for at least 3 months before surgery. However, mastoidectomy may still be necessary in cases with cholesteatoma or other complications. The extent of the procedure varies based on disease severity, ranging from simple cortical mastoidectomy to more extensive radical procedures when the disease is widespread.
Some key indications for mastoidectomy include:
- Cholesteatoma (an abnormal skin growth in the middle ear)
- Chronic mastoiditis resistant to antibiotics
- Complications of otitis media such as brain abscess or meningitis
- Temporal bone trauma with CSF leakage
- Extensive damage to the mastoid air cells from persistent infection
It's worth noting that the evidence suggests that routine mastoidectomy in conjunction with tympanoplasty in noncholesteatomatous chronic otitis media may not be beneficial 2. However, the presence of cholesteatoma or other complications may still require mastoidectomy. The timing of the procedure is crucial, with urgent intervention needed for complications like facial nerve paralysis or intracranial spread of infection.
In terms of the type of mastoidectomy, radical mastoidectomy may be unwarranted in non-cholesteatomatous ears, even with otogenic intracranial complications 3. A more conservative approach, such as cortical mastoidectomy, may be sufficient in these cases. Ultimately, the decision to perform a mastoidectomy and the extent of the procedure should be based on the individual patient's condition and the presence of complications.