Mastoid operation

Risks of the surgery are the same as if the cholesteatoma is not removed, but occur less frequently.  Hearing loss and dizziness may occur along with injury to the lining or dura of the brain.  The VII Nerve runs through the center of the middle ear and mastoid cavity and can be injured during surgery.  This may cause a facial paralysis.  However, from the picture on the right, one can see how this nerve can be easily damaged by the cholesteatoma .  Thus, once diagnosed, most cholesteatoma should be surgically removed.  Kos et al. reported on the results for canal wall down mastoidectomies .  He found the average pre-operative hearing loss was 52 dB.  Post-operatively the hearing was unchanged in 41%, improved in 31% and worse in 28%.  Other complications were persistent vertigo and one case of facial paralysis.  View Abstract

A long standing cholesteatoma can erode through the dura and into the brain or into the inner ear.  The horizontal semicircular canal is the inner ear structure most prone to damage.  Below is a link to a CT Scan of a cholesteatoma which produced a fistula of the horizontal semicircular canal.  The patient had a chronic history of hearing loss and ear drainage.  He recently, experienced a severe episode of vertigo from labyrinthitis .  

Birds have a diapsid skull, as in reptiles, with a pre-lacrymal fossa (present in some reptiles). The skull has a single occipital condyle. [24] The skull consists of five major bones: the frontal (top of head), parietal (back of head), premaxillary and nasal (top beak), and the mandible (bottom beak). The skull of a normal bird usually weighs about 1% of the bird's total bodyweight. The eye occupies a considerable amount of the skull and is surrounded by a sclerotic eye-ring, a ring of tiny bones. This characteristic is also seen in reptiles.

According to the American Society for Microbiology, middle ear infections increased in the United States from approximately three million cases in 1975 to over nine million in 1997. Middle ear infections are now the second leading cause of office visits to physicians, and this diagnosis accounts for over 40% of all outpatient antibiotic use. Ear infections are also very common in children between the ages of six months and two years. Most children have at least one ear infection before their eighth birthday.


Teaching mastoid surgery with binocular operating microscope and KTP LASER Before antibiotics, mastoid surgery was commonly done in desperate circumstances for acute infection, a mastoid abscess. Our predecessors had nothing better than a hammer and gouge, and no magnification other than some spectacle loupes. It was counted a success if the patient – usually a young child – survived. No delicate work could be done, and most survivors were deafened. It was only after the introduction of the binocular operating microscope in the 1950’s that modern delicate controlled microsurgery of the ear became possible. Even with all the latest high powered microscopes, lasers and modern anaesthetics, mastoid surgery is very difficult. Surgeons have to train for years to get good at it. Like all ear surgeons trained since the 1960’s I did my basic training (in the 1980’s) on temporal bones from cadavers (dead bodies). Although some might find that macabre, I’d prefer the learning curve to be on my dead granny, rather than on my live child. The margin of error in mastoid surgery is measured in fractions of a millimetre. Anatomy varies considerably, and a surgeon needs to practice on lots of bones before embarking on live patients. Simulators and plastic bones just aren’t up to it. Unfortunately, in the UK, a public attitude has become established against the use of post-mortem tissues, which has led to a severe shortage of temporal bones for the next generation of ear surgeons to train on. I teach trainee surgeons ear surgery on live patients every week, sometimes two or three cases. The operations take anywhere between one to six hours. The average is around three hours.

Mastoid operation

mastoid operation


Teaching mastoid surgery with binocular operating microscope and KTP LASER Before antibiotics, mastoid surgery was commonly done in desperate circumstances for acute infection, a mastoid abscess. Our predecessors had nothing better than a hammer and gouge, and no magnification other than some spectacle loupes. It was counted a success if the patient – usually a young child – survived. No delicate work could be done, and most survivors were deafened. It was only after the introduction of the binocular operating microscope in the 1950’s that modern delicate controlled microsurgery of the ear became possible. Even with all the latest high powered microscopes, lasers and modern anaesthetics, mastoid surgery is very difficult. Surgeons have to train for years to get good at it. Like all ear surgeons trained since the 1960’s I did my basic training (in the 1980’s) on temporal bones from cadavers (dead bodies). Although some might find that macabre, I’d prefer the learning curve to be on my dead granny, rather than on my live child. The margin of error in mastoid surgery is measured in fractions of a millimetre. Anatomy varies considerably, and a surgeon needs to practice on lots of bones before embarking on live patients. Simulators and plastic bones just aren’t up to it. Unfortunately, in the UK, a public attitude has become established against the use of post-mortem tissues, which has led to a severe shortage of temporal bones for the next generation of ear surgeons to train on. I teach trainee surgeons ear surgery on live patients every week, sometimes two or three cases. The operations take anywhere between one to six hours. The average is around three hours.

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