Why you might need? Tympanomastoidectomy
Tympanomastoidectomy, sometimes referred to as combined approach tympanoplasty, is a surgery undertaken for chronic middle ear disease and most commonly for a condition called cholesteatoma.
Cholesteatoma is a benign but expanding cyst made up of skin cells. If left untreated the cyst will continue to grow and may damage surrounding structures such as the bones of hearing, the balance organ, the nerves of taste and facial movement on that side of the face. Additionally, there is a small but serious risk that it can grow towards the brain and cause meningitis or seizures. The only successful treatment for this condition is a surgical strategy. It sometimes takes more than one operation to clear the cyst completely and restore some functioning to the affected ear. You can read more about this condition on our Cholesteatoma page.
Surgery involves removing the cyst from all the areas that it has involved, which may include the ear canal, ear drum, middle ear and bones of hearing, mastoid bone (bone behind your ear). The second part of the procedure involves repairing any damage that the cyst has already done by placing cartilage where bone has been eroded and a metal prosthesis when the bones of hearing have been damaged.
The aim of the surgery is to remove the Cholesteatoma and prevent any further damage being caused to your ear and surrounding structures. A secondary aim may be to improve hearing, depending on the type of damage that has been caused.
The operation is performed under a general anaesthetic via an incision placed behind the ear. Surgery involves drilling the bone behind your ear to access the middle ear space. After carefully removing the disease using instruments under the microscope, the middle ear is reconstructed using a graft (taken from the cartilage or other tissues around your ear). Additionally, if one of the 3 bones of hearing has been damaged by the disease we will endeavour to reconstruct this mechanism to improve your hearing. This is typically done using a metal prosthesis purposefully engineered for this condition and specifically chosen to fit onto one of your 3 bones of hearing. Sometimes it is possible to use special bone cement to repair damaged bones.
After surgery you must keep your operated ear dry for the first 6 weeks. The best way to avoid water getting into the operated ear canal is with a clean piece of cotton wool moulded with Vaseline that can be replaced daily. You must also avoid rapid air pressure changes and anything that ‘pops’ your ears for the first 6 weeks. Flying and some overground train tunnels induce pressure changes and so are to be avoided (travelling on the London underground is fine). If you do need to fly sooner than 6 weeks after surgery (for example if you live abroad), please discuss this with us. Please avoid nose-blowing during this time, and sneeze through your mouth whenever possible. We usually recommend that you take 1-2 weeks off from work and strenuous exercise.
Tympanomastoidectomy is a safe procedure performed frequently without any problems. The nature of surgery and the anatomy involved means there are rare but documented risks of this kind of surgery. We will only ever offer an operation when we feel the benefits of surgery outweigh the risks but it is important that you know and fully understand all these risks ahead of surgery:
Bleeding, Tinnitus, Infection, Dizziness, Pain, Numbness of ear, Ear dressing reaction, Graft failure, Failure or displacement of any prosthesis, Residual ear drum perforation, Scar, Facial weakness (a rare but important risk to understand), Altered taste (1 in 5 temporary, permanent change very rare), No hearing improvement, Reduced hearing, Complete loss of hearing (rare), leakage of brain fluid (CSF) requiring repair to avoid meningitis, the need for further surgery.
Surgery typically takes 1-4 hours depending on the extent of the problem. You can usually go home on the same day, using routine pain relief medications. You will usually have a head bandage which can be taken off the next day at home. A pack is left in the operated ear for around 2 weeks to reduce the risk of postoperative infections. Depending on the type of packing chosen on the day you may be asked to place antibiotics drops on this for two weeks. Due to the ear packing you will usually have reduced hearing until it is removed in the clinic.