Mastoidectomy: Treating Infection Behind the Ear

Tucked behind your ear is the mastoid bone, a honeycomb of tiny air cells connected to the middle ear. When infection or abnormal skin growth takes hold there, a mastoidectomy clears it out and protects your hearing and balance from further damage.

What Is a Mastoidectomy?

The mastoid bone is the bony bump you can feel just behind your ear, made up of small, air-filled honeycomb-like cells connected to the middle ear space. A mastoidectomy is a surgical procedure to remove infected or diseased mastoid air cells, usually to clear out a chronic infection or an abnormal skin growth called a cholesteatoma that has spread into this area.

What Leads to Mastoid Surgery?

• Chronic suppurative otitis media — long-standing, recurring middle ear infection with persistent drainage
• Cholesteatoma — an abnormal collection of skin cells that grows in the middle ear and mastoid, gradually eroding surrounding bone if untreated
• Acute mastoiditis — a serious infection that spreads from the middle ear into the mastoid bone itself, sometimes causing swelling behind the ear
• Complications from chronic ear disease, including hearing loss or, rarely, spread of infection toward the inner ear or skull base

The mastoid bone sits directly behind the ear canal and middle ear

Signs and Symptoms

• Persistent or foul-smelling ear discharge
• Ear pain, particularly deep or throbbing pain behind the ear
• Progressive hearing loss in the affected ear
• Swelling, redness, or tenderness behind the ear
• Dizziness or balance problems in more advanced cases
• Fever, in cases of acute mastoiditis

How the Surgery Works

1. Anesthesia. Mastoidectomy is performed under general anesthesia.
2. Incision. An incision is typically made behind or above the ear to access the mastoid bone.
3. Removing diseased tissue. Using precision drills under microscope or endoscope guidance, the surgeon opens the mastoid air cells and removes infected tissue, cholesteatoma, or damaged bone.
4. Preserving key structures. Great care is taken around the facial nerve, inner ear structures, and hearing bones, which run close to the surgical field.
5. Reconstruction. Depending on the extent of disease, the eardrum and hearing bones may be reconstructed in the same operation (a combined tympanomastoidectomy).
6. Closing up. The incision is closed, and the ear canal may be packed to support healing.

Recovery

• First 1–2 weeks: Mild pain, swelling behind the ear, and temporary changes in hearing or balance are common; stitches are typically removed within 7–10 days.
• Water precautions: Keeping the ear dry is essential for several weeks; swimming and submerging the head are typically restricted until cleared.
• Follow-up: Regular ENT visits are needed to monitor healing and check for any recurrence, particularly with cholesteatoma, which can sometimes regrow.

Risks and Considerations

• Temporary or, rarely, permanent hearing changes
• Dizziness or balance disturbance
• Facial nerve weakness (rare, given the nerve's close proximity)
• Recurrence of cholesteatoma, requiring monitoring or a second-look surgery
• Infection or delayed healing

The mastoid air cells connect to the middle ear space

The Takeaway

Mastoidectomy sounds intimidating, but it's a well-established procedure for stopping chronic ear infections and cholesteatoma from causing lasting damage to hearing and, in rare advanced cases, more serious complications. If you have long-term ear drainage, pain, or hearing loss that hasn't resolved with medication, prompt ENT evaluation can prevent the disease from progressing further.