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Canal Wall Down Mastoidectomy

Canal wall down mastoidectomy is a surgical intervention designed to effectively address persistent ear infections and cholesteatomas by removing parts of the mastoid bone. This procedure facilitates better management of chronic ear conditions, helping to prevent recurrence and improve overall ear health. If you are struggling with recurring ear problems that have not responded to conventional treatment, consider consulting with Pristyn Care's team of experienced ENT specialists. Our experts specialise in advanced mastoidectomy techniques to provide you with optimal care. Book your appointment today.

Canal wall down mastoidectomy is a surgical intervention designed to effectively address persistent ... Read More

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What Is Canal Wall Down Mastoidectomy?

A canal wall down mastoidectomy is a surgical procedure performed by an otolaryngologist, commonly known as an ENT specialist. This surgery is necessary for treating persistent infections of the ear or to address cholesteatoma, which is a growth of skin cells in the ear that can damage structures inside the ear. 

The procedure involves removing part of the bone behind the ear, the mastoid, to reach and remove the infected or problematic areas. This approach ensures a thorough clearing of the disease to prevent further complications.

The benefit of this surgery lies in its effectiveness in managing and resolving chronic ear conditions, thereby improving the patient’s quality of life.

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What Are The Types Of Canal Wall Down Mastoidectomy?

Canal wall down mastoidectomy is a key surgical option for chronic ear conditions, performed in various forms depending on the extent of the disease and the areas needing treatment. Here are the different types of this procedure:

  • Atticotomy: This type targets the upper part of the mastoid bone to remove disease while preserving as much structure as possible.
  • Atticoantrostomy: Similar to atticotomy, this surgery extends to include the antrum, a cavity in the mastoid, to ensure more extensive disease clearance.
  • Radical Mastoidectomy: This procedure involves the removal of both the mastoid bone and the middle ear structures, often necessary for extensive infections or cholesteatomas.
  • Modified Radical Mastoidectomy/Bondy’s Procedure: This type preserves the outer wall of the ear canal, which helps maintain some ear function and provides a simpler postoperative course.

Retrograde Mastoidectomy: Starting from the deepest part of the ear and moving outward, this approach is used for difficult-to-reach cholesteatomas, ensuring complete removal.

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Diagnosis Before Canal Wall Down Mastoidectomy

Before considering a canal wall down mastoidectomy, accurate diagnosis is crucial to determine the extent of the ear condition. Diagnosis usually involves several steps:

  • Clinical Examination: An ENT specialist will examine the ear using an otoscope to look for signs of infection or abnormal growths.
  • Hearing Tests: Audiometry may be conducted to assess the impact of the condition on hearing.
  • Imaging: CT scans are often necessary to view the detailed structure of the ear and the extent of the disease within the mastoid.
  • Microscopic Examination: This can help in identifying the presence and type of cholesteatoma.
  • Biopsy: In uncertain cases, a biopsy might be taken to analyse the tissue for signs of malignancy or other unusual conditions.

What Is The Procedure For Canal Wall Down Mastoidectomy?

A canal wall down mastoidectomy is a significant ear surgery aimed at addressing chronic ear infections and other severe conditions such as cholesteatoma. This procedure is designed to remove disease and prevent its recurrence effectively. Here are the steps involved:

  • Preparation: The patient undergoes general anaesthesia, and the surgical area around the ear is cleaned and prepared.
  • Incision: The surgeon makes an incision behind the ear to access the mastoid bone.
  • Removal of Bone: Using specialised surgical tools, the surgeon removes part of the mastoid bone to expose the cholesteatoma or infected areas.
  • Disease Clearance: The surgeon meticulously removes all diseased tissue, ensuring that no infected areas are left behind.
  • Reconstruction: Depending on the extent of the removal, the surgeon may need to reconstruct parts of the middle ear using artificial materials or grafts.
  • Drainage: A small tube may be inserted to help drain any fluids that accumulate post-surgery.
  • Closure: The incision is closed with stitches, and a sterile dressing is applied.

Recovery: The patient will spend time in recovery for monitoring before being allowed to go home. Instructions on care and follow-up appointments are provided.

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Who Is The Right Candidate For Canal Wall Down Mastoidectomy?

Determining the right candidate for a canal wall down mastoidectomy is crucial for effective treatment. This surgery is typically recommended for patients who meet specific criteria:

  • Chronic Infection: Individuals who suffer from persistent ear infections that have not responded to other treatments may be candidates.
  • Presence of Cholesteatoma: Patients diagnosed with a cholesteatoma, especially those where it has expanded and caused significant damage or infection, are ideal candidates.
  • Recurrent Issues: Those who have recurring problems despite previous surgeries might require this more radical approach.
  • Significant Hearing Loss: If the condition has led to significant hearing impairment, this procedure can help to address the cause and potentially improve hearing capabilities.

Poor Eustachian Tube Function: Patients with poor eustachian tube function that contributes to chronic infections and fluid build-up may benefit from this surgery.

What Are The Benefits Of Canal Wall Down Mastoidectomy?

A canal wall down mastoidectomy offers several benefits for patients suffering from chronic ear conditions. Here are the main advantages:

  • Effective Disease Management: This surgery excels in removing cholesteatoma and infected tissue, reducing the risk of further complications and the recurrence of the disease.
  • Improved Hearing: Although hearing loss can be a concern, many patients experience stabilisation or improvement in their hearing levels post-surgery, depending on the extent of the damage and the reconstruction done.
  • Reduced Pain and Discomfort: Chronic infections often cause significant pain and discomfort, which this surgery addresses by removing the source of infection.
  • Decreased Discharge: Patients typically see a reduction in the discharge from the ear as the infection is cleared, leading to a cleaner ear and less maintenance.
  • Enhanced Quality of Life: By addressing and managing the underlying chronic conditions, patients often report an improved overall quality of life without the constant concern of ear infections.

Simplified Follow-Up Care: The surgical approach makes the ear easier to examine and clean, which simplifies ongoing care and monitoring by healthcare providers.

How To Prepare For Canal Wall Down Mastoidectomy?

Preparing for a canal wall down mastoidectomy is crucial for ensuring the best outcomes. Here’s how to get ready for the procedure:

  • Medical Evaluation: Undergo a thorough medical evaluation to assess your general health and the specifics of your ear condition.
  • Medication Review: Discuss your current medications with your doctor as some may need to be paused or adjusted before surgery.
  • Preoperative Tests: Complete any tests, such as blood work or imaging studies, prescribed by your surgeon.
  • Fasting: Follow the fasting instructions for eating and drinking before surgery to prepare for anaesthesia.
  • Arrange Transportation: Since you’ll be under anaesthesia, arrange for someone to drive you home post-surgery.

Prepare Your Home: Set up a comfortable recovery area in your home with all necessities within easy reach.

What Are The Recovery Tips and Precautions To Follow After Canal Wall Down Mastoidectomy?

Recovering from a canal wall down mastoidectomy involves careful management to ensure healing and prevent complications. Here’s what to expect and some tips:

  • Rest: Allow your body to rest in the days following surgery to help the healing process.
  • Ear Care: Keep the surgical area clean and dry. Follow your surgeon’s instructions on how to care for your ear.
  • Medication Adherence: Take prescribed medications, including antibiotics and pain relief, as directed to manage discomfort and prevent infection.
  • Avoid Straining: Refrain from strenuous activities and heavy lifting to prevent pressure on the surgical site.
  • Follow-Up Appointments: Attend all scheduled follow-up appointments to monitor your recovery and address any concerns.
  • Hearing Protection: Protect your ear from loud noises and avoid using earphones until your doctor approves.

Notice Symptoms: Watch for signs of infection like increased pain, swelling, or discharge, and contact your doctor if these occur.

Potential Risks Or Complications Associated With Canal Wall Down Mastoidectomy

While canal wall down mastoidectomy is a proven treatment for chronic ear conditions, like all surgical procedures, it carries potential risks and complications. It’s important for patients to be aware of these risks to make informed decisions:

  • Hearing Loss: There is a risk of partial or complete hearing loss in the operated ear, depending on the extent of the disease and the surgery required.
  • Facial Nerve Injury: The facial nerve, which runs close to the surgical site, may be damaged during the procedure. This can lead to temporary or permanent weakness of the facial muscles.
  • Dizziness: Patients may experience dizziness or balance problems immediately after the surgery, which typically improves over time but can occasionally be long-lasting.
  • Tinnitus: Some patients may develop tinnitus (ringing in the ears) or find that it worsens if they already experienced it before surgery.
  • Infection: Post-surgical infections are a risk, despite preventive measures. These may require further treatment with antibiotics or additional surgeries.
  • Cholesteatoma Recurrence: Even after successful surgery, there is a chance that cholesteatoma can recur, necessitating further intervention.
  • Taste Disturbance: Damage to the chorda tympani nerve during surgery can lead to changes in taste perception, usually temporary but sometimes longer lasting.

FAQs

What is the canal wall down mastoidectomy?

Canal wall down mastoidectomy is a surgical procedure that treats chronic ear infections and cholesteatomas. The surgery involves removing part of the bone behind the ear (mastoid) and the canal wall to expose and clear the infected areas. This approach helps prevent the recurrence of infection by creating a cavity that can be easily cleaned and monitored.

What are the indications for canal wall down mastoidectomy?

The primary indications for a canal wall down mastoidectomy include recurring ear infections that don’t respond to other treatments, the presence of cholesteatoma, and complications from chronic ear diseases. This surgery is recommended when less invasive procedures fail to resolve these issues effectively.

Is canal wall down mastoidectomy a major surgery?

Yes, canal wall down mastoidectomy is considered a major surgery. It involves extensive alteration of the ear’s structure to remove infected tissue and ensure thorough cleaning of the area. The procedure is performed under general anaesthesia and requires careful post-operative care to manage recovery and prevent complications.

What are the disadvantages of canal wall down mastoidectomy?

The disadvantages of canal wall down mastoidectomy include a higher risk of hearing loss, possible damage to the facial nerve, visible scarring behind the ear, and a longer recovery period compared to less extensive surgeries. There is also a potential need for more follow-up surgeries if the cholesteatoma recurs.

What is the difference between canal wall down and canal wall up?

The main difference between canal wall down and canal wall up mastoidectomy lies in the preservation of the ear canal’s wall. In canal wall up, the wall is left intact, which helps preserve the ear’s natural structure and potentially better hearing outcome. In canal wall down, the wall is removed to better access and clean the infected area, which may lead to a more open cavity and easier post-operative care.

What is the recovery time for canal wall down mastoidectomy?

Recovery time for canal wall down mastoidectomy can vary but typically lasts several weeks. Patients may experience some pain and discomfort, and it’s crucial to avoid strenuous activities and follow the surgeon’s advice on ear care. Complete healing and final assessment of the surgical outcome may take several months

How much does the canal wall down mastoidectomy cost in India?

The cost of canal wall down mastoidectomy in India varies widely depending on the hospital and the surgeon’s expertise but typically ranges from INR 50,000 to INR 1,50,000. Costs may be higher in private hospitals or metropolitan areas. It’s advisable to check with specific hospitals for the most accurate pricing.

How to sleep after the canal wall down mastoidectomy?

After a canal wall down mastoidectomy, it is best to sleep with your head elevated to reduce swelling and discomfort. Use extra pillows to keep your head raised above your chest. Avoid sleeping on the operated side to prevent putting pressure on the surgical site and disrupting the healing process.

What is the success rate of canal wall down mastoidectomy?

The success rate of canal wall down mastoidectomy is generally high, with most patients experiencing significant relief from infections and other symptoms. Success largely depends on the extent of the disease and the patient’s adherence to post-operative care, but overall, this surgery effectively manages and resolves chronic ear conditions.

Can you eat after the canal wall down mastoidectomy?

Yes, you can eat after the canal wall down mastoidectomy, but it’s best to start with light, soft foods and liquids to avoid discomfort. Chewing may be temporarily challenging if there is any swelling or pain near the jaw. Gradually return to a normal diet as comfort permits.

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Medically Reviewed By
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Dr. Divya Badanidiyur
16 Years Experience Overall
Last Updated : April 12, 2025