Cholesteatoma/ Mastoid Operations

What is a cholesteatoma?

A cholesteatoma is a cyst or sac of skin that is growing backwards behind your eardrum into the middle ear and mastoid. It results in a chronic, smelly discharge, and the longer it remains the more damage it can do to the delicate structures of the ear.

Why have an operation?

If left untreated, after many years it could destroy your hearing, destroy your balance organ and damage your facial nerve which would give you a paralysed side of your face. It can also cause brain infections, because the ear is so close to the brain. It is therefore necessary to remove it, before it is able to cause such damage.

By removing the cholesteatoma, you should no longer be at risk of these complications. It may also be possible to improve your hearing in that ear.

What does the operation involve?

It is almost always done under general anaesthetic. You will have a cut either behind your ear, or just in front and above your ear. The extent of the operation depends on the extent of the disease. The aim is to remove all the disease but preserve as much of the workings of your ear as possible.

The mastoid bone is like a bony sponge, full of little pockets that can harbour the cholesteatoma, so these will need to be removed and smoothed out. If the disease is surrounding the ossicles, these little bones will also have to be removed.

The facial nerve, which supplies the muscles in your face, runs in a bony canal through your ear. Sometimes the bone overlying the nerve has been destroyed by the disease, but at all care is taken to avoid damaging this nerve (see risks).

After the disease has been removed, a graft will be used to seal up any hole in the eardrum, and packing placed in the ear canal.

There are multiple variations of the mastoid operation, so your surgeon will explain the details which apply to you.

What happens after the operation

You will stay in hospital at least one night after the operation. If the stitches are not dissolvable, they will be removed after one or two weeks, either by the hospital or your practice nurse. The packing will be removed from your ear after 1 to 3 weeks.
If you have a mastoid cavity after the operation, it will need regular care in the ear nose and throat outpatients department until it is entirely healed.

What are the risks of the operation?

The risks of a general anaesthetic.

The risks of the operation are similar to those of leaving the cholesteatoma in your ear, only more controlled and much rarer. There is a risk of reduced hearing after the operation but this is often able to be improved by an operation at a later date once the cholesteatoma has been controlled.

There is a rare risk to the facial nerve resulting in a weakness of the side of the face.

Sometimes a second operation is planned about one year after the original operation to check for recurrence of the cholesteatoma. There is also a risk of taste disturbance on one side of your tongue.

When can I wash my hair/swim/fly?

If you are careful about keeping water away from your operated ear, you can wash your hair after a week.

You should be able to swim about four to six weeks after the operation, depending on how well the operation has healed, and so you should ask your surgeon at your postoperative outpatients appointment.

You should be able to fly at any time after the operation unless you have also had an operation to improve your hearing at the same time as the mastoid operation - again, check with your surgeon.

By R Lloyd Faulconbridge and D Bowdler, University Hospital Lewisham

The details in this section are for general information only. Always check with your own surgeon.