Tympanoplasty and Mastoidectomy

Procedures & Operations

What are Tympanoplasty and Mastoidectomy and Why Might You Need Them

The temporal bone is part of the skull base and houses the organs of hearing (cochlea) and balance (saccule, utricle, and semicircular canals). The mastoid and ear canal label and help to define the basic surgical approach for chronic mastoiditis, cholesteatoma surgery, cochlear implant surgery, labyrinthectomy for severe Meniere’s disease, placement of an implantable hearing aid, or translabyrinthine approach to acoustic neuroma (vestibular schwannoma) resection.

The Surgery Explained

In some types of ear surgery, the approach is through the ear canal (external auditory canal) and this is called an endaural approach. Stapedotomy for otosclerosis, middle ear reconstruction (ossiculoplasty), and basic repairs of the ear drum (tympanoplasty) can be performed using an endaural approach (through the ear canal).

In chronic ear disease surgery with a large eardrum defect (tympanic membrane perforation), damaged or absent ear bones (ossicles), cholesteatoma, and mastoid disease, a combined approach with both a tympanoplasty and mastoidectomy is required.

Unless the surgery is being performed for a severely diseased ear, a large cholesteatoma, a cerebrospinal fluid leak (CSF leak), or acoustic neuroma surgery, the posterior canal wall of the ear canal (external auditory canal) is general saved, hence the term “canal wall up” mastoidectomy.

What to Expect Following Your Surgery

You will be given post-operative instructions along the following guidelines:

  1. Adults: No heavy lifting or strenuous activity for 1 week and no contact sports for 4 weeks following the surgery.
    Children and Infants: No heavy lifting, strenuous activity, contact sports, or gym classes for 4 weeks following the surgery.
  2. Head should be elevated on 1-2 pillows when lying down for 1 week following surgery.
  3. Remove the entire ear bandage 48 hours after the surgery.   You may have an incision behind your ear – the sutures will dissolve on their own though occasionally sutures that require removing may have been used.  Oozing from the ear canal and ear incision (if you have one) is normal and will decrease with time.
  4. Showering and bathing is allowed after the ear bandage has been removed (48 hours after the operation).
  5. Begin using the ear drops as prescribed twice a day to the operated ear AFTER the ear bandage is removed and you can see the ear canal.
  6. AFTER the bandages are removed, clean the incision with half-strength hydrogen peroxide (1/2 water, 1/2 20 volume hydrogen peroxide) to remove any old blood clots or crusting on the wound with Q-tips. DO NOT replace the bandage – leave the incision open to air.  If there is any oozing, you may use a small sterile adhesive bandage temporarily.
  7. Apply Vaseline to the incision after cleansing with hydrogen peroxide. Do not use ointment that contains neomycin or Bacitracin as a growing number of patients are developing allergies to these ointments.
  8. Keep your operated ear dry with an ear plug or a cotton wool ball and Vaseline – if there is excessive drainage from the ear you may leave the cotton wool ball in the ear.
  9. You may be given an antibiotic to take by mouth following surgery. Please ensure the medication is finished as prescribed; do no stop early even if feeling well. If you think that you may be developing an allergic reaction to the antibiotic, a yeast infection, excessive diarrhoea or loose stools, or have severe abdominal cramping, please call your doctor’s office. Contact us as soon as possible for any high fevers, severe headaches, or unusual neck stiffness.
  10. The first post-operative clinic visit is 3 weeks after the surgery.

Following your operation, you may suffer from:

Pain: Adults will be given pain medication to be taken for the first few days following surgery. Infants should be given paediatric-dosed paracetamol (over the counter) every six hours or so for the first 2 days following surgery. Older children will be given a pain medication to be taken for the first several days after surgery. Mild, intermittent ear pain is not unusual during the first two weeks after surgery. Pain above or in front of the ear is common when chewing and is temporary.

Swelling: Swelling is expected following surgery. The swelling can occur behind the ear, in front of the ear, around the eye, or around the mouth. Some bruising may also occur. The ear may appear to stick out or appear to be higher or lower than the other ear. This is normal and will gradually improve over the weeks following surgery. However, if a golf ball sized swelling develops, please contact us as soon as possible.

Drainage or discharge: A bloody or watery discharge is expected during the healing process. Call your doctor’s office for a yellow or green discharge with a foul odour. Continue to use your ear drops twice a day as prescribed for at least 2 months following surgery. Some patients notice a nosebleed or spit up blood – this is common and results from the blood that accumulates in the middle ear during surgery, and drains into the back of the nose. This is not a cause for concern.

Ear numbness: Your ear may feel numb – this is temporary and will improve over several weeks or months. Be careful when using a hair dryer on a hot setting to avoid injury to the skin until sensation returns.

Ear fullness or popping: You may experience fullness of the ear or hear popping, crackling, or other sounds in the ear. This is usually temporary and is often due to the blood, fluid and dissolvable packing in the ear canal and middle ear (behind the eardrum).

Ringing (Tinnitus), hearing loss, or increased hearing sensitivity: Patients may notice ringing in their ear after surgery – this can be high-pitched, low-pitched, constant or intermittent – and is often temporary or decreases with time. You may feel that the hearing is worse and this is due to the dissolvable packing and blood from surgery – this improves with time. Some patients experience sensitivity to loud sounds in the operated ear and this is usually temporary.

Dizziness: Dizziness may occur following surgery. Avoid sudden movements; stand up slowly. Dizziness is usually temporary and will improve with time. Gradually increase your activity levels.

If you had a CANAL WALL DOWN mastoidectomy, you will notice that the opening to the ear cavity is larger and is filled with a gauze and cotton packing – leave this undisturbed, continue the ear drops to keep the packing moist and your consultant will remove it when you see him for your first post-operative visit.

Taste disturbance and dry mouth: This is common after ear surgery and results from irritation of the taste nerve (chorda tympani nerve) during the surgical approach to safely protect the facial nerve and expose the cochlea. This is a temporary sensation for the majority of patients. In some patients, this can last a few months or more.

Bruising around the eye or corner of the mouth: You may have some slight bruising around the eye or corner of the mouth – this occasionally occurs because of the facial nerve monitor electrodes and is temporary.

Sore throat or hoarse voice: You may have a sore throat or hoarse voice and this occasionally occurs because of the breathing tube (endotracheal tube) that is used if you received general anaesthesia. This will usually improve over time.

To view and/or download further information relating to these procedures, please go to the Patient Information Leaflets section of this website.