Is Modified Radical Mastoidectomy A Permanent Cure "blocked Aditus" ?

Brief Answer: Descriptive answer Detailed Answer: Hi, Thanks for the query. Modified radical mastoidectomy opens up the aditus permanently as the middle ear, mastoid antrum and air cell system is converted in to single cavity. Not all but most of the air cells are removed, most means all those which are necessary so as to remove diseased mucosa from the mastoid. If trigeminal nerve neuralgia is suspected, the mastoidectomy is unlikely to cure this problem. Mastoidectomy is unlikely to cure trigeminal neuralgia. Mastoidectomy and petrosectomy have different indications and retained infection especially osteomyelitis of petrous bone can be an indication of petrosectomy. But if previous two surgeries were cortical mastoidectomies, then it is unlikely that the next surgery will be a petrosectomy. Trigeminal nerve does not pass through mastoid. Ear drum bulging with burping is indicative of a patent and may be patulous Eustachian tube. The sound you hear is known as tinnitus and the cause can be related to middle ear (eustachain tube dysfunction or increased vascularity of middle ear mucosa/edema because of infection) or inner ear (which can be because of some damage to inner ear (may be because of long standing disease or due to previous surgeries). If the infection from mastoid is not going with two cortical, the next option is usually modified radical mastoidectomy or an intact canal wall mastoidectomy but the final call can be taken by the doctor who is actually examining the case. Feel free to ask another query. Regards

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Brief Answer: Descriptive answer Detailed Answer: Hi, No, there is practically no way to know from outside whether aditus is blocked or not. Trans eustachian or trans tympanic endoscopy is an option but is not usually practically employed. Bone biopsy report is not going to alter the current line of management. Feeling of ear blockade is not due to aditus blockade. Aditus blockade prevents ventilation of mastoid air cell system and thus prevents the complete resolution of infection from the mastoid and thus the waxing and waning course. Presently either your middle ear is open, that is the graft has not fully taken up or the neo tympanic membrane is retracted markedly and giving the adhesive change appearance. Both the conditions warrant a surgery. Very unlikely from your history. Your modified radical mastoidectomy may or may not relieve your pain in the regions other than mastoid. If a low grade simmering infection is there in the bone, the culture during surgery and then specific antibiotic post surgery will be more effective. Long term low dose antibiotics help in such situations. Please discuss with your doctor. Modified radical mastoidectomy (MRM) provides a better ventilation of the mastoid and is independent of the aditus patency. So, there is better chance of it making your problem resolve. MRM has its own problems with the cavity, so please discus with your doctor regarding cavity problems and understand well before going for MRM. Trigeminal neuralgia, if it is there, can many a times be there without any finding in MRI. Your mastoid infection is unlikely to lead to a continuously raised CRP. But a sustained infection in bone like an osteomyelitis in the region can be a cause for this. As your ear is giving you lot of problems, and two conservative surgeries have not helped much, a little radical approach is the next option available. Feel free to ask another query. Regards

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Brief Answer: Descriptive. Detailed Answer: Hi, Ventilating the area with MRM helps in resolving the low grade infection even if the culture is negative. Culture may not reveal anything but 3rd surgery is MRM which makes a permanent pathway for drainage of infection from mastoid and helps. No, there is usually no spread of infection through blood in mastoid surgery. Making a cavity and wide meatoplasty is part of MRM and wide meatoplasty helps in ventilating the area and drainage of infection even after the surgery is over. Repeated scarring can make the membrane thick and this can give blocked feeling but the thickening partially resolves with time. If your doctor says that there are no changes of attico antral disease with chances of bony erosion in attic or postero superior bony wall of external auditory canal, you can wait for some time but that call needs to be taken by the doctor who has physically examined the ear. After MRM minimal blood accumulates in the middle ear and this gets resorbed or may be drained via Eustachian tube but this is not usually an issue at all. Ventilation of the region is the basic purpose of MRM apart from removing the infected or dead bone and the ventilation helps in healing in the infected bone also. So more or less the lining over the mastoid bone develops which is healthy and makes the ear dry and helps in resolving the multiple problems you are facing. Only thing I am cautioning you about is the non resolution of facial pain which may or may not occur. Feel free to ask another query. Regards

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Brief Answer: Descriptive Detailed Answer: Hi, Tympanoplasty is usually combined with mastoidectomy as surgeon inspects the ossicular chain integrity. From your history it appears that you have been operated for coalescent mastoiditis as you have not given any history of ear discharge pre-operatively. A grommet must have been inserted to provide ventilation to the middle ear and to make the retracted ear drum (if it was) normal. Open middle ear means a perforation in the ear drum and it is open to the outside. If so it needs a graft to patch that area. Post MRM ear needs to kept dry and there is need to get ear examined and if need be cleaned once or twice a year. There will be some hearing loss post surgery depending upon the type of tympanoplasty done. White ear drum post grommet can be because of scarring or because of sclerotic patch. Both can give a blocked feeling. Petrosectomy is usually done for tumours involving that region and for complications of chronic suppurative otitis media when there is evidence of infection going to the tip of petrous bone. Your CT scan report is not indicating that. MRM clears cell tracts in the mastoid, attic/antrum and we do not go till petrous apex during MRM. Feel free to ask another query. Regards

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Brief Answer: Descriptive Detailed Answer: Thanks for the query. No. The other way round is usually not true. Infection in the petrous apex is visible on CT and you have not stated that your CT report is suggesting that. Headache can have many reasons but believing petrous infection to be a cause of that needs some evidence on CT. Yes everything can be cleaned from front and no need of cutting. You can take some more time if you feel like. Otherwise 8 months s sufficient time. To be on more safer side, you can wait for 4 more months. That is a bigger surgery and can do more damage to hearing. No fixed period but Six weeks to three months should be sufficient. Feel free to ask another query.

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Brief Answer: Descriptive Detailed Answer: Thanks for the query. MRM is required for osteomyelitis if it involves mastoid only. There is nothing like strong or weak antibiotics, culture tells about the need. If culture is not yielding anything, these two should be sufficient. Osteomyelitis can cause pain in head. Insignificant report. Management is not going to change with report. Inflamed bone, soft tissue inflammation and nerves passing through such area can lead to neuralgic pain. Vascular cause is not there always. Unlikely Let the MRM with meatoplasty drain that infection out post surgery. Drainage and ventilation of the area helps cure it. Usually not fatal with the extent you have described. Yes very true. Feel free to ask another query. Regards

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