The treatment of an inflammation of the air-filled ( pneumatized ) bone cells of the mastoid (a bone that is located behind the ear) which one can imagine as a sponge or Swiss cheese, always takes place surgically, ie with the help of surgery. The goal here is that the pus can be removed by drainage tubes.
As part of the operative therapy, a so-called mastoidectomy is performed, a (partial) removal of the mastoid process ( mastoid process ), as can also be seen from the ending " ectomy ". There are two different surgical procedures to choose from, both of which are associated with an estimated one-week hospitalization in a hospital. Regardless of surgical procedures, additional calculated antibiotic therapy is appropriate. Although an antibiotic is given untargeted and without knowledge of the causative agent of mastoiditis, it is chosen so that it has an effect against the most commonly expected bacteria. The combination of surgery and antibiotic therapy is the best method of treating mastoiditis.
Only in this way can mastoiditis be adequately treated and serious consequences avoided. A complication-free operation as a therapy of mastoiditis is not a serious operation and leads within a short time to an improvement. A complete recovery is expected within a few weeks.
In the course of a mastoidectomy, the air-filled bone cells of the mastoid are removed under general anesthesia. In addition, an opening of the Antrum mastoideum, a cavity inside the mastoid process, is also performed. A so-called retroauricular approach, ie a cut behind the ear, provides access to the structures. This will be sewn again after the operation is completed. In a mastoidectomy, the posterior wall of the ear canal is preserved.
If a radical mastoidectomy is performed as a therapy instead of a mastoidectomy, significantly more structures are eliminated. These include the posterior wall of the ear canal and the lateral wall of the tympanum dome ( epitympanon ), ie the upper part of the tympanic cavity in the middle ear. As part of the radical operation, a large cavity ( radical cavity ) is created between the ear canal and the mastoid, facilitating care and control. This type of surgery is indicated for extensive bone conduction.
Like any surgical procedure, mastoidectomy also carries risks and can rarely lead to complications. In the operating area, the facial nerve ( facial nerve ) runs.
Although surgery is performed with a microscope and the facial nerve is consulted during the operation in order to prevent accidental injury.
Nevertheless, damage can not be completely ruled out. If, despite the protection of the facial nerve, there is an injury to it, this may cause a so-called peripheral facial palsy, that is, a dysfunction of the facial nerve, with a resulting unilateral facial paralysis. For example, the symptoms that appear then include a one-sided loss of facial muscle function ( facial muscles ) and an inability to frown on the affected side. Oral closure may be compromised and a drooping corner of the mouth can be seen on one side. If an operation is selected as a treatment for mastoiditis, it may in very rare cases also lead to a subsequent obstruction of the hearing. In exceptional cases, dizziness and deafness were also observed as complications.
The inflammation usually heals within a few weeks. During this time the ear must be protected from water as much as possible. Thanks to swimming caps or so-called Schwimmotoplastiken that can be purchased in a hearing aid business, swimming or swimming fun, however, must not be waived. Even conditions where pressure fluctuations are to be expected, such as traveling by plane should be avoided at first.
Surgery on the ear inevitably increases the sensitivity of the inner ear. Some substances that are not beneficial to the human inner ear under normal conditions are particularly harmful after an operation has taken place. These substances include, for example, nicotine. Therefore smoking should be avoided as much as possible after mastoidectomy.
Only at the beginning of a mastoiditis with still small symptoms, alternatively, an antibiotic can be given high-dose in a vein ( intravenous antibiotic therapy ) and in addition a tympanic membrane ( paracentesis ) are performed.