Complications of Mastoidectomy

🦻 Complications of Mastoidectomy

Complications of mastoidectomy are grouped as:

• Intra-operative complications — problems that occur during surgery.
• Post-operative complications — subdivided into early and late.

🛠 Intra-operative complications of Mastoidectomy

1- Bleeding

• Causes: injury to emissary veins, sigmoid sinus, dural venous channels, middle meningeal artery, posterior auricular/occipital branches, or from granulations/cholesteatoma bed.

• Prevention: meticulous anatomy knowledge, careful drilling, good hemostasis.

How to manage intra operative bleeding during Mastoidectomy?

Why is Sigmoid sinus injury dangerous?

2- Facial nerve injury

• Common sites: tympanic segment, second genu, vertical segment.

• Management:

  • Transection → repair/graft.
  • Partial → decompression + steroids, eye care, physiotherapy.

What is the most common site of facial nerve injury in Mastoidetomy?

What are the risk factors which increase the risk of facial nerve injury?

What measures can you take to prevent facial nerve injury?

3- Chorda tympani injury

• Presentation: altered taste (metallic/bitter), reduced salivation.
• Prognosis: usually transient (neural adaptation).
• Management: reassurance, symptomatic care.

4- Labyrinthine injury (Lateral SCC fistula)

• Cause: cholesteatoma erosion, surgical trauma.
• Presentation: perilymph leak, vertigo, SNHL.
• Management:
  • If matrix intact → preserve.
  • If exposed → seal with bone dust + fascia/fat.

5- Dural plate/tegmen injury & CSF leak

• Risks: CSF leak, meningitis, brain herniation.
• Management:
  • Small exposure → cover with fascia.
  • Leak → watertight fascia/cartilage closure, acetazolamide, bed rest, lumbar drain if needed.

6- Sigmoid sinus injury

• Presentation: massive hemorrhage, risk of air embolism.
• Management: pressure, bone wax, Surgicel, muscle packing, IV fluids.

7- Ossicular chain injury

• Effect: conductive hearing loss.
• Management: ossiculoplasty.

What is the most common ossicle to be injured?

8- Stapedial muscle injury

• Effect: hyperacusis (loss of stapedius reflex).
• Prognosis: often asymptomatic, compensated by tensor tympani.
• Management: reassurance, rarely sound therapy/hearing aids.

⏱ Early Post-operative Complications of Mastoidectomy

1- Hematoma

• Site: post-auricular incision region.
• Management: evacuate clot, cauterize bleeder, compressive dressing.

2- Wound infection / abscess

• Features: swelling, discharge, fever.
• Management: IV antibiotics, drainage if abscess, wound care.

3- Vertigo

• Cause: labyrinthine irritation (suction, drill heat, labyrinthitis).
• Management: bed rest, vestibular sedatives.

4- Sensorineural hearing loss / Dead ear

• Cause: drill/suction trauma, labyrinth damage.
• Management: steroids, hyperbaric oxygen if available.
• Dead ear: rare, severe SNHL — poor prognosis.

5- Persistent CSF leak

• Cause: missed/poorly repaired tegmen breach.
• Presentation: watery otorrhea, meningitis risk.
• Management: surgical repair, lumbar drain, antibiotics.

6- Delayed facial nerve palsy

• Cause: thermal trauma, edema, tight packing, viral reactivation.
• Management: remove tight pack, steroids, eye care, physiotherapy.

🕰 Late Post-operative Complications of Mastoidectomy

1- Residual/recurrent cholesteatoma

• Cause: incomplete clearance or retraction pocket.
• Management: revision mastoidectomy.

2- Persistently discharging cavity

• Causes: high facial ridge, poor meatoplasty, residual sac.
• Management: revision mastoidectomy, cavity obliteration, aural toileting.

3- Meatal stenosis

• Cause: poor meatoplasty, canal skin loss.
• Management: revision meatoplasty, skin grafting.

4- Tympanic membrane issues

• Problems: graft failure, reperforation, atelectasis.
• Management: revision tympanoplasty.

5- Ossiculoplasty failure

• Causes: extrusion, resorption, ET dysfunction.
• Presentation: persistent CHL.
• Management: revision ossiculoplasty.

6- Caloric vertigo

• Cause: cold air/water stimulates labyrinth in open cavity.
• Management: cavity obliteration, water precautions.

7- Cosmetic deformity

• Cause: excessive bone removal, post-auricular depression.
• Management: obliteration with fat/cartilage, local flaps.