Tympanomastoidectomy

At an initial consultation, your ENT specialist will take a detailed medical history, assess your symptoms, and carry out a microscopic ear examination. Scans such as CT imaging may be arranged to understand how far the disease has extended through the middle ear and mastoid.

Your procedure will take place in our dedicated Surgery Centre. When you arrive, you’ll be shown to your private patient pod, where you can change into a gown before being taken to the operating suite.

Tympanomastoidectomy is carried out under general anaesthesia, so you’ll be asleep for the surgery. During the procedure, your surgeon will make an incision just behind the ear to access the mastoid bone. Using an operating microscope and a surgical drill, they’ll remove any diseased bone in the mastoid area and open the middle ear space. The entire cholesteatoma will be carefully removed from all areas it has reached, which may include the ear canal, the eardrum, the middle ear cavity, and the hearing bones.

After removing the disease, your surgeon will reconstruct the affected structures. This may involve:

• placing cartilage to rebuild the eardrum or other damaged areas

• using a finely engineered metal prosthesis to replace a damaged hearing bone

• repairing small defects with tissue grafts, taken from cartilage or connective tissue around the ear

• using bone cement to repair partially eroded hearing bones

Surgery aims to remove all disease and stabilise the middle ear so that no further complications occur. It may also be possible to restore hearing during the procedure, but this will depend on the extent of damage before surgery.

A soft dressing or pack will be placed inside the ear canal at the end of the operation to protect the reconstruction, and a head bandage may also be applied to prevent swelling and support healing.

The length of surgery varies based on the complexity of the disease and usually takes between 1 and 4 hours. After the procedure, you’ll return to your patient pod to recover, supported by our specialist nursing team, and will be able to go home the same day. Before you leave, you’ll receive tailored aftercare advice and a follow-up plan to support your recovery. You’ll need someone to collect you, and you shouldn’t drive for 24 hours after a general anaesthetic.

Tympanomastoidectomy is a safe and commonly performed procedure, but all ear surgery carries risks because of the anatomy around the ear. Your consultant will discuss these risks fully before treatment, and will only recommend surgery when the benefits outweigh any potential risks. 

Possible risks include:

• bleeding

• infection

• ear pain

• dizziness, which may be temporary or occasionally longer lasting

• numbness or altered sensation around the ear

• reaction to the ear dressing

• tinnitus

• failure of grafts or any prosthesis placed during reconstruction

• a persistent hole in the eardrum

• scarring behind the ear

• temporary taste disturbance (around 1 in 5 patients)

• no improvement in hearing

• reduced hearing 

• need for further surgery, especially if the cholesteatoma was extensive

Rare risks include:

• facial weakness

• complete hearing loss

• permanent taste disturbance

• leakage of cerebrospinal fluid (CSF), which may require repair

Your surgeon will provide personalised preparation advice, which may include:

• avoiding smoking to improve healing

• stopping certain medications, such as blood thinners, if advised

• arranging time off work, particularly if your job involves physical activity

• avoiding colds or ear infections before surgery

• stopping eating and drinking before a general anaesthetic 

• planning for someone to take you home, as you cannot drive after a general anaesthetic

You may also be advised to avoid air travel in the weeks before surgery if you’re prone to ear pressure problems.

You’ll be able to go home on the same day as your procedure and can use over-the-counter pain relief to help manage any discomfort. Most people feel tired and slightly unsteady for the first 24 to 48 hours, especially when turning their head quickly. Resting at home and avoiding sudden movements can help.

You can usually remove your soft head bandage the following day, and a soft pack will be left inside the ear canal for around 2 weeks to protect the reconstruction. This causes temporary muffled hearing. Your surgeon may prescribe antibiotic ear drops to use on the packing for 2 weeks.

You should keep the operated ear completely dry for the first 6 weeks. Using a small piece of cotton wool coated with petroleum jelly (such as Vaseline) when showering helps prevent water from entering the canal. Avoid popping your ears, blowing your nose forcefully, or sneezing with your mouth closed, as these actions increase pressure in the middle ear.

Activities that create pressure changes, such as flying or travelling through deep overground tunnels, should be avoided for 6 weeks. If you need to fly sooner because you live abroad, please discuss this with your surgeon. Travelling on the London underground is usually fine.

Most people need around 1 to 2 weeks off work, depending on their type of job. Strenuous exercise and heavy lifting should be avoided for 2 weeks.

Your hearing may fluctuate for several weeks as your ear heals. Follow-up appointments will be arranged to remove the packing, review the reconstruction, and perform repeat hearing tests.

Please contact our Ear, Nose & Throat centre for pricing information.

At Welbeck, our ENT surgeons are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

To book a tympanomastoidectomy, you must be referred by either your GP or an ENT specialist following a consultation with them. Self-referrals are not accepted for this treatment.

If you would like to schedule a consultation with a Welbeck ENT specialist, please get in touch to make an appointment. Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.