MASTOIDECTOMY & MYRINGOTOMY

MASTOIDECTOMY & MYRINGOTOMY

MASTOIDECTOMY: TYPES AND SURGICAL STEPS

DEFINITION

• Mastoidectomy is a surgical procedure involving the removal of infected mastoid air cells located in the mastoid bone, situated behind the ear.

• It is primarily done to manage chronic otitis media and mastoiditis.

TYPES OF MASTOIDECTOMY

1. CORTICAL MASTOIDECTOMY

   • Also known as Schwartze operation.

   • Removal of mastoid air cells while keeping the posterior wall of the external auditory canal intact.

   • Indicated in acute mastoiditis and coalescent mastoiditis.

2. MODIFIED RADICAL MASTOIDECTOMY (MRM)

   • Canal wall down procedure.

   • Disease is removed from mastoid and middle ear, preserving ossicles when possible.

   • Posterior canal wall is removed to create a common cavity.

3. RADICAL MASTOIDECTOMY

   • More extensive than MRM.

   • Removes all mastoid air cells, tympanic membrane, ossicles except stapes.

   • Indicated when hearing is already lost and extensive disease exists.

4. CANAL WALL UP MASTOIDECTOMY (CWU)

   • Posterior canal wall is preserved.

   • Requires a second look surgery to check for residual cholesteatoma.

   • Provides better cosmetic and functional results.

5. CANAL WALL DOWN MASTOIDECTOMY (CWD)

   • Posterior canal wall is removed.

   • Provides better exposure and disease clearance.

SURGICAL STEPS IN MASTOIDECTOMY

• General or local anaesthesia is administered.

• Postauricular incision is made.

• Periosteum is elevated, cortical mastoid is drilled.

• Disease is removed from mastoid air cells, antrum, aditus, epitympanum, and middle ear.

• Facial nerve and sigmoid sinus are preserved.

• In CWD procedures, canal wall is removed and cavity is exteriorized.

• Temporalis fascia graft may be used if tympanoplasty is combined.

• Closure of wound and dressing applied.

CLASSICAL AYURVEDIC PERSPECTIVE

• Karna roga mentioned in classical texts like Ashtanga Hridaya and Sushruta Samhita cover diseases like Karna srava and Karna vidradhi, which may be correlated with chronic suppurative otitis media (CSOM) and mastoid abscess.

• शोणितं पूतिमांसं च कृमिसंस्थानसंयुतम्।
  पिच्छिलं कर्णतः स्रवति स पूयकर्ण उच्यते॥
  (Ashtanga Hridaya, Uttara Tantra, 16/12)

  • This describes pus-like discharge indicative of chronic ear infection.

MYRINGOTOMY: INDICATIONS, CONTRAINDICATIONS AND SURGICAL STEPS

DEFINITION

• Myringotomy is a surgical incision made in the tympanic membrane (eardrum) to drain fluid from the middle ear, often with insertion of a ventilation tube (grommet).

INDICATIONS

• Recurrent acute otitis media.

• Otitis media with effusion (glue ear).

• Barotrauma-related middle ear effusion.

• Serous otitis media causing hearing loss or speech delay in children.

• Chronic Eustachian tube dysfunction.

CONTRAINDICATIONS

• Acute external ear infections.

• Perforated tympanic membrane.

• Coagulation disorders.

• Allergy or hypersensitivity to materials used for grommets.

SURGICAL STEPS IN MYRINGOTOMY

• Procedure done under general anaesthesia in children and local anaesthesia in adults.

• Using a microscope or endoscope, the external ear canal is cleaned and visualised.

• Incision is made in the anteroinferior quadrant of the tympanic membrane.

• Middle ear fluid is aspirated using suction.

• Ventilation tube (grommet) may be inserted.

• Patient is advised to avoid water entry into the ear post-operatively.

AYURVEDIC PARALLEL CONCEPTS

• Though Myringotomy is not directly described, conditions like Karna srava (ear discharge) and Badhirya (hearing loss) are mentioned.

• Surgical management of ear abscesses is elaborated under Karna vidradhi in Sushruta Samhita.

• कर्णविद्रधयोस्त्वेकं कर्णमूलं च मूर्छितम्।
  वेदना शोफपाकश्च पूतिकर्णनिवेदनम्॥
  (Sushruta Samhita, Uttara Tantra, 21/21)

  • Indicates abscess formation and need for surgical drainage.

MODERN ENT TEXTBOOK REFERENCES

• Logan Turner’s Diseases of the Nose, Throat and Ear

• Dhingra’s Diseases of Ear, Nose and Throat

• PL Dhingra, Essentials of ENT

• Cummings Otolaryngology: Head and Neck Surgery

POSTOPERATIVE CARE IN BOTH PROCEDURES

• Antibiotics and analgesics prescribed.

• Aural precautions: Avoid water entry into ears.

• Regular follow-up for cavity care in mastoidectomy.

• Grommet extrusion monitored in myringotomy.

PROGNOSIS

• Good if performed timely and with proper technique.

• Recurrent infections or cholesteatoma may affect outcomes in mastoidectomy.

• Myringotomy often resolves glue ear and prevents speech development issues in children.