Introduction

Mastoidectomy surgery is a specialized ear procedure performed to remove infected air cells within the mastoid bone located just behind the ear. This surgery becomes necessary when infections or complications do not respond to medical treatment and begin to pose risks to hearing, balance, or overall health. Understanding the causes of mastoidectomy surgery helps patients identify symptoms early, seek timely medical care, and prevent further complications. In

What Is Mastoidectomy?

A mastoidectomy is a surgical procedure designed to remove diseased mastoid air cells caused by chronic ear infections or other conditions affecting the middle ear. The mastoid bone contains small, honeycomb-like spaces that can trap bacteria or debris leading to severe infection. When medication fails to clear the infection, surgeons perform a mastoidectomy to prevent the spread of disease to nearby structures such as the inner ear, facial nerve, or even the brain.

Common Causes of Mastoidectomy Surgery

Below are the leading medical conditions that often lead to mastoidectomy surgery:

Chronic Suppurative Otitis Media (CSOM) :- Chronic ear infection is one of the most common reasons for mastoidectomy. When middle ear infections persist for months or years, they can spread to the mastoid bone. CSOM leads to continuous ear discharge, hearing loss, and damage to the ear structures. If left untreated, the infection burrows deeper into the mastoid cells, making surgery the only long-term solution. A mastoidectomy helps remove infected tissue, allowing the ear to heal and preventing further complications.
Cholesteatoma :- A cholesteatoma is a noncancerous but aggressively growing skin cyst that forms behind the eardrum. It often develops due to repeated infections or poor Eustachian tube function. Over time, the cyst expands, eroding the bones of the middle ear and mastoid. This can cause hearing loss, dizziness, facial nerve weakness, and in severe cases, life-threatening infections. Mastoidectomy is performed to remove the cyst and prevent it from damaging vital ear structures.
Acute Mastoiditis :- Acute mastoiditis is a painful and potentially dangerous infection of the mastoid bone that usually occurs as a complication of untreated or severe middle ear infections. Symptoms include swelling behind the ear, redness, fever, ear pain, and pus discharge. Although antibiotics are the first line of treatment, surgery becomes necessary if the infection does not respond or spreads rapidly. Mastoidectomy eliminates infected cells, helping control the infection quickly and safely.
Ear Trauma or Injury :- In rare cases, ear trauma can cause damage to the mastoid bone, leading to fluid build-up, infection, or inflammation. Fractures in the temporal bone or deep injuries to the ear canal may introduce bacteria into the mastoid air cells. When conservative treatment fails to repair structural damage, mastoidectomy may be recommended to prevent chronic infections and restore normal ear function.
Complications of Previous Ear Surgeries :- Some individuals require mastoidectomy due to complications from earlier ear surgeries such as tympanoplasty or ossiculoplasty. When scar tissue or recurrent infections develop, the mastoid bone may become involved. Surgeons may perform a revision mastoidectomy to clear infected areas, stabilize middle ear structures, and reduce the risk of recurring disease.
Spread of Infection to Nearby Structures :- If ear infections spread beyond the middle ear, they can affect the inner ear, facial nerve, or even brain membranes. In such cases, mastoidectomy becomes urgent. Some severe complications include:

Labyrinthitis (inner ear infection)
Facial nerve paralysis due to pressure or inflammation
Meningitis or brain abscess

These conditions require immediate surgical intervention to remove infection, relieve pressure, and prevent lasting nerve or brain damage.

Symptoms That Indicate the Need for Mastoidectomy

Here are some signs that may suggest a serious infection requiring surgical evaluation:

Persistent ear discharge
Hearing loss or muffled hearing
Pain behind the ear
Foul-smelling ear fluid
Swelling or redness around the ear
Fever or headaches
Dizziness or balance problems

If you experience these symptoms, especially for more than a week, consult an ENT specialist immediately.

How Mastoidectomy Helps

The primary goal of mastoidectomy is to create a safe, infection-free ear. The surgery:

Removes infected or dead tissue
Restores the structural integrity of the middle ear
Prevents further complications
Reduces recurrence of infections
Protects hearing and balance functions

Depending on the extent of the infection, surgeons may choose between simple mastoidectomy, canal wall up mastoidectomy, canal wall down mastoidectomy, or radical mastoidectomy.

Prevention Tips

While not all causes of mastoidectomy can be prevented, following these steps can reduce the risk of severe ear infections:

Seek early treatment for ear infections
Keep ears dry and avoid inserting objects
Practice good hygiene
Manage allergies and sinus issues
Follow your ENT doctor’s advice strictly
Attend follow-up appointments after ear surgeries

Conclusion

Mastoidectomy surgery is typically recommended when infections or complications in the middle ear spread to the mastoid bone and cannot be managed with medication alone. Chronic infections, cholesteatoma, acute mastoiditis, trauma, and surgical complications are among the top causes leading to this procedure. Early diagnosis and timely treatment can help prevent serious complications and protect long-term ear health. If you suspect persistent ear issues, consulting an ENT specialist can help you determine whether mastoidectomy is necessary and ensure proper treatment.