Mastoidectomy or tympanoplasty - Dr Bridget Clancy

Fast Facts

If an infection starts within two weeks before your surgery date, contact your surgeon to have the ear cleaned and start a course of antibiotic drops and continue until the time of surgery.

Don’t pop the ear, blow the nose hard or get the ear wet until fully healed; this may take 3 months. Don’t plan to travel by plane for at least 3 months after surgery.

Take 2 weeks off to recover. This includes day-care/school/sport/work/study.

Don’t remove any dressings from the ear while recovering.

What is this for and is it effective?

This operation aims to remove chronic middle ear disease. This includes hole in the ear drum, atelectasis (retracted or sucked in ear drum) or cholesteatoma (skin growing from the ear drum into the middle ear, causing infection and erosion of bone).

Left untreated, chronic ear disease can cause frequent infection, permanent loss of hearing and balance, facial nerve palsy (paralysed muscles in the face) and meningitis (infection around the brain). Surgery for chronic ear disease can rarely cause these problems but they are much more likely to happen if chronic ear disease is not treated.

The aim of surgery is to remove disease to prevent infection and stop further damage to hearing. Surgery does not always improve hearing.

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

Temporary side effects:

The ear can become infected, needing antibiotic tablets or ear drops.
Tinnitus (noise in the ear) may be better, worse or remain the same.
The ear drum or ear canal may not heal properly, requiring procedures in the office or another operation.
Rarely, pressure areas on the skin or clots in the veins in the leg can happen because the operation takes several hours.

Permanent side effects:

1:100 adults notice permanent change in taste. This is more common in people over fifty years of age.
1:100 adults have vertigo after surgery and long term problems with balance.
Hearing may be better, worse or stay the same after surgery.
<1:1000 people have facial muscle weakness after surgery.

Could I need more surgery or treatment in the future?

Yes, it’s common for people with chronic ear disease to need more surgery. Most chronic ear disease is due to long standing eustachian tube dysfunction with inability to equalise middle ear pressure. The tube usually gets better with age and growth. If the eustachian tube is working well, the surgery is more likely to be effective. If the eustachian tube is still not working well, the surgery is less likely to be effective and more than one operation may be needed. Most people with chronic ear disease will need more than one operation.

You may need to use a hearing aid after the ear is fully healed.

There are two types of operations for chronic ear disease. Your surgeon decides on which operation you need based on how bad your ear disease is, your age and your current hearing levels.

Intact canal wall mastoidectomy: the natural shape of the ear canal is preserved. The advantages are: less risk of hearing loss, the ear looks normal on the outside and there is less need for regular cleaning of the ear by your surgeon. The disadvantages are most people need a “second look” operation in 12 months as there is an increased risk of the disease coming back. This operation is best for people who are younger, have good hearing and milder disease
Modified radical mastoidectomy: the back wall of the ear canal is removed to create a large cavity. The cavity needs to be cleaned once or twice a year by the surgeon and an ear plug must be worn for swimming. There is less risk of the disease coming back and less need for more than one operation, but for most people hearing is the same or worse after surgery. This operation is best for people who are older, already have poor hearing and have severe disease.

What are the alternatives to surgery? Are they appropriate for me?

For minor chronic ear disease, treatment with cleaning the ear regularly (by the surgeon with the microscope and suction and tear drops) or insertion of a ventilation tube (grommet) may be enough.

What if I choose not to have surgery?

For severe chronic ear disease, the risk of serious complications is high and surgery is recommended.

See should I have surgery for more information.

How should I prepare for surgery?

You will have a hearing test and CT scan of the ears.

Stop using any supplements and medications that increase bleeding (like Nurofen) one week before surgery and follow the fasting instructions provided by the hospital. For more information see preparing for surgery.

Stop smoking. Smokers are more likely to have side effects including heart and breathing complications, increased pain and bleeding and take longer to heal. The longer you have stopped smoking, the safer the surgery will be for you. If you smoke on the day of surgery, your surgery will be cancelled. Ask your surgeon for a Quit pack if needed. The nurses can help with nicotine patches while you are in hospital.

If an infection starts within two weeks of your surgery date, contact your surgeon to have the ear cleaned and start a course of antibiotic drops and continue until the time of surgery.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery. The operation takes 3-4 hours. You will go home the next day after surgery.

How long will I need off work/school/sport?

You need two weeks off work (or school/kinder/day-care), sport and study. You should not drive for at least 24 hours after a general anaesthetic or on any day when taking strong pain killers.

You won’t be able to swim or travel by plane until the ear is completely healed. This can take up to three months.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

Children and adults always have a general anaesthetic for this procedure. See anaesthesia for more information.

How will I feel after surgery?

You will have a bandage around your head for 24 hours. There will be a dressing like a plug in the ear canal for several weeks; this will make the ear feel blocked. You may have mild pain in the temple or with chewing. Pain lasts for a few days and is usually mild. Most patients have change in taste and numbness in the skin around the ear for a few months after surgery. You may have vertigo for a few hours after surgery.

What do I need to do to recover well?

The better you eat, the better you heal. Aim to eat as normally as possible, including vegetables and solid food as well as drinking water.

Keep the ear completely dry. Don’t blow the nose hard, pop the ear or travel by plane until the surgeon advises you the ear is fully healed.

Don’t remove any dressings from the ear canal or behind the ear. Apply ear drops twice a day to the dressings in the ear canal.

View more information on ear plugs
How to use an ear plug for swimming
How to use BluTac as an ear plug
How to use ear drops

When will I see the surgeon?

The surgeon will check on you in the recovery room and on the ward before you go home from hospital. You will see the surgeon one week after surgery then every 1-2 weeks until fully healed. You will have a hearing test 3 months after surgery. Once the ear is fully healed, you will have appointments every 6-12 months.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non emergency advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

After major ear surgery

You need one to two weeks off work (or school/kinder/day-care), sport and study. You should not drive for at least 24 hours after a general anaesthetic or on any day when taking strong pain killers. You won’t be able to swim or travel by plane until the ear is completely healed. This can take up to three months.

What do I need to do to recover well?

The better you eat, the better you heal. Aim to eat as normally as possible, including vegetables and solid food as well as drinking water.
Rest sitting up or reclining at 45 degrees to reduce pressure and swelling.
Keep the ear completely dry. Don’t insert an ear plug until the surgeon tells you it is safe to do so.
Don’t blow the nose hard, pop the ear, swim or travel by plane until the surgeon advises you the ear is fully healed.
Don’t remove any dressings from the ear canal or behind the ear. Apply Ciloxan ear drops, 5 drops twice a day onto the dressings in the ear canal.
Take Augmentin DF one tablet twice a day for 10 days or Keflex one tablet twice a day for 10 days.
For pain use paracetamol 1-2 tablets every 4-6 hours as needed (no more than 8 tablets per day). If pain persists, add Celecoxib, one capsule, 12 hourly as needed.

View more information on ear plugs
How to use an ear plug for swimming
How to use BluTac as an ear plug
How to use ear drops

What is normal? How will I feel after surgery?

You will have a bandage around your head for 24 hours. There will be a dressing like a plug in the ear canal for several weeks; this will make the ear feel blocked. There will be mild blood stained or watery discharge for 2 weeks from the ear canal.
You may have mild pain in the temple or with chewing. Pain lasts for a few days and is usually mild.
You may notice temporary change in taste on one side of the tongue.
The skin around the ear will feel numb or like pins and needles for weeks to months after surgery.
You may have nausea or vertigo for a few days after surgery. Take care to steady yourself and get up slowly.
Tinnitus (noise in the ear) may be temporarily better, worse or remain the same.

What is not normal?

Contact your surgeon if you have:

vomiting or vertigo/head spins lasting more than a few hours.
severe pain not relieved by the prescribed pain relief.
fever >38 degrees for more than 24 hours.
swelling behind the ear.
pus running out of the ear.
headache, neck stiffness, eye pain on looking at light.

In an emergency, call an ambulance or attend your nearest hospital emergency department.