Definition of Mastoidectomy : 

Mastoidectomy : It is an operation to eradicate disease in the mastoid and middle ear cavity.

Types of mastoidectomy :

1. Cortical mastoidectomy.
2. Radical mastoidectomy.
3. Modified radical mastoidectomy

Indications of mastoidectomy :

1.  Acute coalescent mastoiditis.
2. Incompletely resolved acute otitis media with reservoir sign
3. Masked mastoiditis
4. As in initial step to perform

• Endolymphatic ear surgery.
• Decompression of facial nerve.
• Translabyrinthine or retrolabyrinthine procedures for acoustic neuroma.

Aims of mastoidectomy :

1. To open up the mastoid cavity.
2. To cleans up the infected air cells.
3. To improves middle ear ventilation by widening of the aditus.

Cortical mastoidectomy :

Synonyms of cortical mastoidectomy :

• Simple mastoidectomy.
• Complete mastoidectomy.
• Schwartz operation.

Definition of cortical mastoidectomy : 

Definition : Complete exenteration of all accessible mastoid air cells & converting them into a single cavity preserving the posterior meatal wall is called cortical mastoidectomy.

Indications of cortical mastoidectomy :

1.  Acute coalescent mastoiditis.
2. Incompletely resolved acute otitis media with reservoir sign
3. Masked mastoiditis
4. As in initial step to perform

• Endolymphatic ear surgery.
• Decompression of facial nerve.
• Translabyrinthine or retrolabyrinthine procedures for acoustic neuroma.

Complications of Cortical mastoidectomy :

1. Injury to lacial nerve.
2. Dislocation of incus
3. Injury to horizontal semicircular canal Patient will have postoperative giddiness and nystagmus.
4. Injury to sigmoid sinus with profuse bleeding
5. Injury to dura of middle cranial fossa.
6. Postoperative wound infection and wound breakdown.

Radical mastoidectomy:

Definition: Radical mastoidectomy is a procedure to eradicate disease from the middle ear and without any attempt to reconstruct hearing.

Indications of Radical mastoidectomy :

1. When all cholesteatoma cannot be safely removed, e.g. that invading eustachian tube, round window niche, perilabyrinthine or hypotympanic cells.
2. If previous attempts to eradicate chronic inflammatory disease or cholesteatoma have failed.
3. As an approach to petrous apex
4. Removal of glomas tumour
5. Carcinoma middle ear.

Complications of radical mastoidectomy :

1. Facial paralysis.
2. Perichondritis of pinna,
3. Injury to dura or sigmoid sinus
4. Labyrinthitis, if stapes gets dislocated.
5. Severe conductive deafness of 50 dB or more.
6. This is due to removal of all ossicles and tympanic membrane.
7. Cavity problems.

Modified radical mastoidectomy

Definition : It is a modification of radical mastoidectomy where as much of the hearing mechanism as possible is preserved.

Indications of modified radical mastoidectomy :

1. Cholesteatoma confined to the attic & antrum
2. Localized chronic otitis media.
3. CSOM (atticoantral) with extracranial complications.

Aims of modified radical mastoidectomy :

1. To eliminate the disease.
2. To produce a safe and dry ear which is self-cleansing,
3. To modify the anatomy of the tympanomastoid compartment so as to prevent recurrent disease an wherever possible to reconstruct the hearing mechanism.

Steps of modified radical mastoidectomy (MRM) :

1. Incision, post aural or endaural.
2. Retraction of soft tissues and exposure of mastoid area.
3. Removal of cortical bone and exposure of antrum and attic.
4. Removal of diseased tissue.
5. Facial ridge is lowered.
6. Mastoid cavity is smoothened with polishing burr, removing any overhangs and then irrigated w normal saline.
7. Reconstruction of hearing mechanism.
8. Meatoplasty and closure of wound is same as in radical mastoidectomy.

Canal wall up mastoidectomy : 

1. Here posterior canal wall is kept intact if the disease is limited & an open cavity is avoided.
2. Here the ossicles are left intact, if found healthy.
3. This operation is done in simple mastoidectomy & if limited disease tympanoplasty is performed.
4. Chance of recurrence is more
5. Deafness remains unchanged or improves with subsequent tympanoplasty
6. No inspection cavity
7. No such problem.