Tympanomastoidectomy

A tympanomastoidectomy is a combination surgical treatment of both a tympanoplasty and a mastoidectomy.

• A tympanoplasty is the surgical reconstruction of the tympanic membrane, often referred to as the ear drum, which is located within the ear and separates the outer and inner ear regions
• A mastoidectomy is the surgical removal of the mastoid bone, which is located just behind the ear and behind the tympanic membrane

When performing a tympanomastoidectomy, the surgeon will decide which portion of the procedure to complete first. This may depend on the reason for the damage, the severity of the issue, and if an infection is currently present.

Tympanoplasty
When the tympanic membrane has been damaged, perforated, or ruptured, it is important to have the issue corrected to prevent more extensive problems from developing. While smaller areas of damage may be corrected by simple sutures, it is often necessary for the surgeon to do more extensive repairs. This can often be completed through the placement of a skin graft. A bit of the patient’s own skin is removed then attached to cover the tear in the tympanic membrane.

Mastoidectomy
The mastoid bone contains small air pockets, and its cells have the same thin lining that can be found in other cells of the middle ear. If an infection, fluid, or cells from a problem in the inner ear leak into the small spaces within the mastoid bone, this may result in the need for this small bone to be removed through a mastoidectomy. The surgeon may access this bone from within the ear before reconstructing the tympanic membrane, though it is often less invasive and preferred to access this bone through the skin behind the external ear area.

Surgical treatment is rarely the first choice when it comes to handling problems of the ear. Some typical problems that can make such a surgery necessary include:

• Chronic ear infections
• Fluid buildup within the Eustachian tube
• Cholesteatoma or other growths in the middle ear
• Rare disorders such as Wegener’s granulomatosis

A tympanomastoidectomy may be required when more conservative treatments for both the ear drum and mastoid have failed or when complications occur during other treatments. A good candidate for this combination surgery will be determined based on factors that are considered by the surgeon.

Perforation to the tympanic membrane may heal over time on its own without the need for intervention. Antimicrobial ear drops may be required to speed recovery if an infection is present. If this treatment is ineffective, a patch may be applied to the perforation with the application of special chemicals that promote cell growth. Surgical intervention with a tympanoplasty may be necessary if there is further disease within the middle ear or when other treatment methods fail.

Because the mastoid bone is located to closely to the middle ear area with very little to divide the two components, it is possible for the mastoid to incur the same diseases or growths that occur in the middle ear. If an infection does not clear up with antibiotics, the bone may need to be removed. If fluid or cells have become embedded within this bone, a mastoidectomy may be necessary to remove the infected or diseased material to promote healing.

Patients can expect to be sedated during any surgery involving the ear. The specific anesthesia used will be determined by the surgeon and the attending anesthesiologist and are often based on a patient’s medical history or the specific procedures to be completed. The surgeon will provide the patient with information on what to do, and what not to do, before the surgery.

If there is an issue within the middle ear that is causing pressure on the tympanic membrane, the surgeon may need to make an incision in the ear drum to allow fluid to drain or to remove an infection or growth of cells, such as a cyst. The perforation in the tympanic membrane will be repaired. Part or all of the mastoid bone may need to be removed. The surgeon will typically make an incision behind the ear to access and remove this bone. All incisions will be sutured. A tympanomastoidectomy is commonly performed as an outpatient procedure, allowing patients to go home for recovery on the same day. The surgeon will provide the patient with post-surgical instructions and medications, is necessary, and set up an appointment to see the patient for follow-up. The prognosis for healing following this surgical procedure is very good.