Bruce Black MD
Jane Black PhD

Mastoid Cavity Repair

Rehabilitation of Radical Mastoidectomy Sites

Mastoid cavities are the outcome of radical mastoidectomy surgery (canal wall down mastoidectomy, open cavity mastoidectomy). This surgery is undertaken for cholesteatoma in the middle ear, a cyst of skin with the potential for major medical complications. The procedure essentially hollows out the middle ear to remove the threat of the disease. Although largely supplanted by more complex techniques (intact canal wall mastoidectomy), radical cavity surgery remains relatively common. Once performed, the cavities generally require subsequent care to remove debris from the cavity site to avoid infection. The cavities also incur a range of other problems, such as difficulties pursuing water sports and loss of hearing.

Healthy mastoid cavity. Debris accumulation and infection may be achieved in a majority of cases

A substantial proportion of these open cavities develop immediate or delayed complications. This is due to damage of the blood supply to the cavity and/or disruption of the normal ear’s ability to clean itself. Infection is common, sometimes severe with unremitting discharge. Dizziness and foul odour may occur. Hearing aids are commonly required, but their use may be impeded by the shape of the cavity and also by debris accumulation, discharge or discomfort. The patient may incur a lifetime of such difficulties.

Degeneration of cavity lining into the chronic infected state, due to poor blood supply and exposed respiratory epithelium
Almost all such troublesome cavities may be eliminated with current reconstructive techniques. A substantial number will recover hearing from these repair procedures. This surgery is an area of specialised skills employed in three ways: The cavity may be “filled in” (obliteration) with the patient’s tissues or with biomaterials. This method incurs a risk of lingering disease. Alternatively, the anatomy of the ear can be re-created (reconstruction). This method is more complex, but yields superior outcomes and offers the better chance of hearing restoration. Reconstructions have been researched and refined at Queensland Otology over many years. This centre remains a global leader in this field with a high success rate now expected. The third surgical method is used in severely damaged ears, usually with permanent sensorineural hearing losses. The ear canal is closed (ablation) after removal of disease. One of the modern implantable technologies may be used in these cases to recover the hearing loss.
 
Radiology of bilateral cavity repair sites. Ceramic implants and vascular flap coverage have rehabilitated the ear canals to a healthy state
For most cases, canal wall reconstruction will succeed in eliminating the symptoms that trouble many such open cavities. The reconstruction requires exact procedures, not only to recreate the new canal dimensions but also to restore the vitality of the site using new blood supply derivatives from local arterial structures. The surgery requires a limited incision behind the ear and an overnight hospital stay. Postoperative recuperation is rapid, and the aftercare limited to several visits. Professor Black works with colleagues in regional centres to minimise the necessity for protracted stays in Brisbane.

These aspects were developed by Professor Black over many years and are now a reliable treatment method that has successfully rehabilitated several hundred cases.

A healthy external canal after repair of a previous open cavity
It should be noted that there are few troublesome mastoid cavities that cannot be stabilised to eliminate ongoing problems. If this problem is present, consult your family physician with respect to seeking the above surgery.