Mastoidectomy

A mastoidectomy is a type of ear surgery in which a surgeon removes diseased or infected bone from the mastoid, the area of the skull located just behind the ear. The mastoid contains small air spaces that can become infected, often as a result of ongoing or severe ear infections. When these infections do not respond to medication, they can cause persistent ear problems and lead to serious complications. A mastoidectomy helps remove the source of infection and protect important ear structures involved in hearing and balance.

There are several types of mastoidectomy, and the type used depends on how much of the mastoid bone is affected by disease. The goal of each approach is to remove disease while protecting hearing and other important ear structures as much as possible

• A simple (or cortical) mastoidectomy removes only the infected air cells within the mastoid while leaving the ear canal and eardrum intact.

• In more advanced cases, a canal wall up or canal wall down mastoidectomy may be performed. These describe whether part of the ear canal wall is preserved or removed during surgery, based on the extent of the infection or damage.

A child may need a mastoidectomy when an ear infection or related condition does not improve with standard treatments and begins to cause complications. One common reason is a chronic ear infection that has not responded to antibiotics or ear tubes.

A mastoidectomy may also be needed if a child develops a cholesteatoma, which is an abnormal growth of skin in the middle ear that can damage nearby bone and other important ear structures. In some cases, the surgery is recommended to treat complications from an ear infection, such as the spread of infection into the mastoid bone or surrounding tissues. Performing a mastoidectomy helps remove the source of infection and protect a child’s hearing, balance and overall ear health.

A mastoidectomy offers several important benefits for children with serious or ongoing ear conditions. One of the main benefits is removing the source of a chronic infection when other treatments have not worked. By clearing infected or diseased bone from the mastoid, the surgery helps protect hearing and prevent damage to delicate ear structures involved in hearing and balance.

A mastoidectomy can also reduce the risk of serious complications, such as the infection spreading to nearby tissues or the brain, helping preserve long‑term ear health and overall well‑being.

Like any surgical procedure, a mastoidectomy has potential risks, though it is generally safe. Possible risks include:

• Temporary or permanent changes in hearing
• Dizziness or balance problems, which usually improve over time
• Tinnitus (ringing in the ear)
• Facial weakness, which is very rare
• Recurrence of infection or cholesteatoma, which may require further treatment

During a mastoidectomy, the procedure typically involves the following steps:

• Your child is given general anesthesia, so they are fully asleep and do not feel pain during surgery
• The surgeon makes a small incision behind the ear and uses a specialized drill to remove infected or damaged bone from the mastoid area
• If necessary, repairs to the eardrum or the small bones of the middle ear may be performed at the same time
• Once the procedure is complete, the incision is closed using dissolvable stitches or surgical skin glue

The surgical team monitors your child closely throughout the procedure to ensure safety and comfort.

• Your child may go home the same day or stay overnight in the hospital, depending on the type and extent of surgery
• A dressing or bandage is placed over the ear to protect the surgical area
• Some drainage from the ear canal is normal for a few days as the ear heals
• Your child may be prescribed ear drops or antibiotics to help prevent infection
• Follow‑up visits are important and may include examining the ear, removing any packing, and possibly repeating hearing tests to monitor recovery

Hearing outcomes after a mastoidectomy can vary depending on your child’s condition and the reason for surgery. In some cases, hearing may improve, especially if chronic infection, fluid or blockage was interfering with how the ear works. In other situations, the primary goal of a mastoidectomy is to stop the spread of infection and prevent further hearing loss, rather than restore lost hearing. Your child’s surgeon can explain what hearing changes, if any, are expected based on your child’s specific ear condition and surgical plan.

In some cases, the problem can come back after a mastoidectomy. This is more likely when the surgery is done to treat a cholesteatoma, which can sometimes recur even after careful removal. If the condition does return, additional monitoring or another surgery may be needed. Regular follow‑up visits help your child’s care team catch any recurrence early and manage it promptly to protect hearing and overall ear health.

Swimming is usually not allowed right after a mastoidectomy. In most cases, your child will need to avoid swimming until the ear is fully healed, as water exposure can increase the risk of infection. Healing time can vary depending on the type of surgery and how your child is recovering. Your child’s surgeon will provide specific guidance on when it is safe to swim again and whether ear protection will be needed.