| Mastoidectomy | |
|---|---|
 Coronal section of right temporal bone with mastoid cells labeled in bottom left | |
| Specialty | Otolaryngology |
A mastoidectomy is a procedure performed to remove the mastoid air cells [1] near the middle ear. The procedure is part of the treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. [2] Additionally, it is sometimes performed as part of other procedures, such as cochlear implants, [3] or to access the middle ear.
Historically, trephination was used to potentially relieve intracranial pressures or build-up of pus, with records dating back to pre-historic times. [4] Over time, these became formalized as mastoidectomies. Mastoidectomies were used to treat infections such as otitis media, or abnormal skin cell growth near the middle ear. [2] Over time, they were adapted to help treat hearing issues such as tinnitus. [5]
Mastoidectomies have also been used in the modern practice of placing cochlear implants. [6] Additionally, mastoidectomies are occasionally performed with tympanoplasties to fix the tympanic membrane. [7]
The following are possible complications from mastoidectomy procedures: [8]
In 2018, the International Otology Outcome Group agreed on guidelines defining different mastoidectomies. [8] Before this, there was discourse on the proper classifications of the procedure. [11]
Under the 2018 guidelines, there are the following types of mastoidectomy: [12]
Also known as schwartze procedure or cortical mastoidectomy or canal wall up
Also known as canal wall down
Used for
Additionally, there are mixed categories, such as M1a+2a and M1b+2a. There is a slight distinction between M2c and M3a in that M3a removes the eardrum before pre auricular pit and cavity closure and blocks the tympanic opening of the Eustachian tube. [12]
After the invention of endoscopic transcanal ear surgery by Muaaz Tarabichi, the usage of this procedure has decreased significantly. [14]
Greek physician Galen (AD 129-217) was the first to write in his treatise Hygiene (Italian: De Sanitate Tuenda, English: On the Preservation of Health) about ear discharge being a natural secretion form the brain, and the importance of permitting drainage of such fluid. [15]
The first potential documented case of a mastoidectomy procedure was recorded in 1524 by Lucas van Leyden as an incision behind the right ear. Abscess drainage was popularized by Adam Politzer, considered to be one of the founders of otology and initially interpreted Galen's writings on ear discharge to mean that Galen removed infected mastoid regions. [16] However, this may have been deliberately misrepresented to justify mastoidectomy procedures to more conservative audiences. [17]
Additionally, there is controversy whether French physician Ambroise Paré was the first to describe a surgical procedure draining an infected ear of Francis II of France in 1560. [18] Recent studies have shown how there is lack of documentation of this event by French historian Louis Régnier de la Planch, and also lack of mention in Paré's own writings. [17]
Credit for the first mastoidectomy to remove abscesses is attributed to Jean-Louis Petit in the 18th century. [19] However soon after this, the procedure fell out of popularity in the 18th century after the death of Justus von Berger in 1791. [20] von Berger, the court physician of Christian VII, died 13 days after a mastoidectomy attempt to fix his right-sided deafness.
The mastoidectomy was revitalized in 1873 following the publication, Ueber die künstliche Eröffnung des Warzenfortsatzes (English: “On the artificial opening of the mastoid process”), written by Hermann Schwartze and his assistant Adolf Eysell. [21] In the publication, Schwartze made several recommendations on modernizing the procedure, including replacing older instruments and a new surgical technique. This procedure, using a chisel and gouge, [4] is now credited as the "modern mastoid operation" or Schwartze operation. [22] Published in the oldest and most known otolaryngology journal of the time, Archiv für Ohrenheilkunde, the publication became widely disseminated and referenced. [23]
Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties. This can result in the destruction of the bones of the middle ear (ossicles), as well as growth through the base of the skull into the brain. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal.
The stapes or stirrup is a bone in the middle ear of humans and other tetrapods which is involved in the conduction of sound vibrations to the inner ear. This bone is connected to the oval window by its annular ligament, which allows the footplate to transmit sound energy through the oval window into the inner ear. The stapes is the smallest and lightest bone in the human body, and is so-called because of its resemblance to a stirrup.
Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present.
A cochlear implant (CI) is a surgically implanted neuroprosthesis that provides a person who has moderate-to-profound sensorineural hearing loss with sound perception. With the help of therapy, cochlear implants may allow for improved speech understanding in both quiet and noisy environments. A CI bypasses acoustic hearing by direct electrical stimulation of the auditory nerve. Through everyday listening and auditory training, cochlear implants allow both children and adults to learn to interpret those signals as speech and sound.
Stapedectomy is a surgical procedure in which the stapes bone is removed from the middle ear and replaced with a prosthesis.
Bone conduction is the conduction of sound to the inner ear primarily through the bones of the skull, allowing the hearer to perceive audio content even if the ear canal is blocked. Bone conduction transmission occurs constantly as sound waves vibrate bone, specifically the bones in the skull, although it is hard for the average individual to distinguish sound being conveyed through the bone as opposed to the sound being conveyed through the air via the ear canal. Intentional transmission of sound through bone can be used with individuals with normal hearing—as with bone-conduction headphones—or as a treatment option for certain types of hearing impairment. Bones are generally more effective at transmitting lower-frequency sounds compared to higher-frequency sounds.
Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear.
Unilateral hearing loss (UHL) is a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear.
Otology is a branch of medicine which studies normal, pathological anatomy and physiology of the ear (hearing). Otology also studies vestibular sensory systems, related structures and functions, as well as their diseases, diagnosis and treatment. Otologic surgery generally refers to surgery of the middle ear and mastoid related to chronic otitis media, such as tympanoplasty, ossiculoplasty and mastoidectomy. Otology also includes surgical treatment of conductive hearing loss, such as stapedectomy surgery for otosclerosis.
A bone-anchored hearing aid (BAHA) is a type of hearing aid based on bone conduction. It is primarily suited for people who have conductive hearing losses, unilateral hearing loss, single-sided deafness and people with mixed hearing losses who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids. They are more expensive than conventional hearing aids, and their placement involves invasive surgery which carries a risk of complications, although when complications do occur, they are usually minor.
The House Institute Foundation (HIF), formerly the House Ear Institute, is a non-profit 501(c)(3) organization, based in Los Angeles, California, and dedicated to advancing hearing science through research, education, and global hearing health to improve quality of life.
Surfer's ear is the common name for an exostosis or abnormal bone growth within the ear canal. They are otherwise benign hyperplasias (growths) of the tympanic bone thought to be caused by frequent cold-water exposure. Cases are often asymptomatic. Surfer's ear is not the same as swimmer's ear, although infection can result as a side effect.
Neurotology or neuro-otology is a subspecialty of otolaryngology—head and neck surgery, also known as ENT medicine. Neuro-otology is closely related to otology, clinical neurology and neurosurgery.
Tympanosclerosis is a condition caused by hyalinization and subsequent calcification of subepithelial connective tissue of the tympanic membrane and middle ear, sometimes resulting in a detrimental effect to hearing.
William Fouts House was an American otologist, physician and medical researcher who developed and invented the cochlear implant. The cochlear implant is considered to be the first invention to restore not just the sense of hearing, but any of the absent five senses in humans. Dr. House also pioneered approaches to the lateral skull base for removal of tumors, and is considered "the Father of Neurotology".
A persistent stapedial artery (PSA) is a rare anomaly in human anatomy where the stapedial branch of posterior auricular artery, or simply stapedial artery, remains within the ear of a fetus after the first ten weeks of pregnancy. Whilst not problematic for the majority of people with the anomaly, it can cause difficulties with hearing.
Endoscopic ear surgery (EES) is a minimally invasive alternative to traditional ear surgery and is defined as the use of the rigid endoscope, as opposed to a surgical microscope, to visualize the middle and inner ear during otologic surgery. During endoscopic ear surgery the surgeon holds the endoscope in one hand while working in the ear with the other. To allow this kind of single-handed surgery, different surgical instruments have to be used. Endoscopic visualization has improved due to high-definition video imaging and wide-field endoscopy, and being less invasive, EES is gaining importance as an adjunct to microscopic ear surgery.
John K. Niparko was an American surgeon, scientist and otolaryngologist who specialized in cochlear implants. Niparko edited and wrote several chapters of Cochlear Implants: Principles & Practices.
Nicholas John Frootko is a retired South African / British Otolaryngologist / Head and Neck Surgeon with a special interest and expertise in Ear Surgery.
Muaaz Tarabichi is a Syrian otolaryngologist, lecturer, researcher, and author. He is recognized around the world as the father of endoscopic ear surgery. He is the co-founder of Tarabichi Stammberger Ear and Sinus Institute. He was elected as the chairman of the International Advisory Board of the American Academy of Otolaryngology–Head and Neck Surgery.
{{cite journal}}: CS1 maint: multiple names: authors list (link)