Mastoid surgery (Mastoidectomy)

What is mastoid surgery (mastoidectomy)?

Mastoid surgery is an operation on the mastoid, the honeycomb of air spaces in the bone just behind the ear. It is most often done to remove a cholesteatoma — a sac of skin cells that grows into the middle ear and mastoid, slowly eroding bone. It is also used for long-standing infection that has not settled with other treatment.

The main aim is to make the ear safe and dry, and to stop the disease spreading to nearby structures such as the balance organ, the facial nerve, the inner ear or, rarely, the lining of the brain. Improving or protecting hearing is a goal too, but it comes after safety.

Surgery is the only reliable way to remove a cholesteatoma — sprays, drops and antibiotics can settle an infection for a while but cannot clear the underlying skin sac. Even after a good operation, cholesteatoma can leave tiny fragments behind or come back, so most people need long-term follow-up and some need a planned second operation.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• See the operating surgeon, who will examine the ear and explain whether a closed or open technique is planned and why.
• Expect a hearing test beforehand, and often a CT scan to map the disease and nearby structures.
• Tell your surgeon about any previous ear surgery, dizziness, facial weakness or single-sided hearing, as these change the risk discussion.
• Mention all medicines and supplements, especially blood thinners, as some increase bleeding.
• Arrange a lift home and someone to stay with you for the first night after a general anaesthetic.
• Plan around two weeks off work or school, and keep the ear dry while it heals.
• Ask whether a planned second-look operation is likely, so you are not surprised later.

What happens

The operation is done asleep under general anaesthetic and usually takes one to three hours. The surgeon almost always works through a cut behind the ear (sometimes in front), then uses a microscope or telescope and a small drill to open the mastoid air spaces and remove the cholesteatoma or infected tissue.

Depending on the disease, the surgeon decides during the operation whether to keep the back wall of the ear canal (closed) or take it down to leave an open cavity. Where possible, the eardrum and hearing bones are repaired or reconstructed in the same sitting. A dressing or pack is usually placed in the ear canal.

Most people go home the same day or after one night. You will go home with instructions to keep the ear dry, and an outpatient appointment to remove packing and check healing.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The biggest concerns are to hearing, to taste (the chorda tympani nerve runs through the area), and to the facial nerve, which passes very close to the surgery. Serious facial weakness is rare in routine cases but is more likely in revision surgery or when disease is wrapped around the nerve. Ask your surgeon how often they do ear surgery, whether they use facial-nerve monitoring, and what the realistic outlook is for your hearing.

Published figures to discuss

Outcomes and complication rates depend heavily on how extensive the disease is, whether it is a first or revision operation, and the surgeon's experience. Most patient information describes risks in words (common, uncommon, rare) rather than precise percentages, because robust like-for-like figures are limited. Facial-nerve injury is the most feared complication and is rare in routine first operations.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from the wound itself is fairly quick — most people are back to normal life in about two weeks — but the ear is reviewed over months, and some people need a second planned operation to confirm the disease has gone.

• A sore, blocked-feeling ear and muffled hearing in the early weeks
• Some discharge, crusting or a small amount of old blood from the ear
• A change in taste or a metallic taste on one side that often improves over weeks to months
• Mild unsteadiness for a few days
• Numbness around the ear or scar that settles over time

Aftercare

• Keep the ear completely dry until your surgeon confirms it has healed — use cotton wool with petroleum jelly when washing your hair.
• Take painkillers as advised and avoid blowing your nose hard or sneezing with a closed mouth in the first days.
• Use any prescribed ear drops or ointment exactly as directed.
• Avoid swimming, flying, diving and heavy lifting until cleared.
• Attend all follow-up appointments, including any planned second-look operation or scan.
• If you have an open cavity, attend for cleaning as advised and report a smelly or persistent discharge.
• Save the clinic's contact number in case of fever, severe pain, facial weakness or vision/balance problems.

• Lift home and an adult to stay overnight after the anaesthetic
• About two weeks off work or school booked
• Painkillers and any prescribed ear drops collected
• Cotton wool and petroleum jelly to keep the ear dry when washing
• Follow-up and any second-look appointment noted
• Clinic out-of-hours number saved

Scars and how they heal

There is usually a cut behind the ear (sometimes in front), which is designed to be hidden in or behind the natural ear crease and within the hairline. It is pink and slightly firm at first and usually fades over months to become discreet. Some numbness around the scar or the outer ear is common early on and tends to improve.

⚠ Get urgent help if…

• New or worsening weakness or droop of the face on the operated side — seek help urgently
• Severe or increasing ear pain, fever, or spreading redness behind the ear
• Sudden severe dizziness or repeated vomiting
• A sudden drop or complete loss of hearing in the operated ear
• Clear watery fluid leaking from the ear or down the back of the throat
• A severe headache, neck stiffness or feeling very unwell (possible signs of a serious infection)
• Heavy bleeding from the ear or wound that does not stop

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means the cholesteatoma or infection has been cleared, the ear is dry and safe, and serious complications have been avoided. Hearing may be preserved, improved or, in some ears, slightly worse — your surgeon will be clearer about your likely outcome once they know what they found and what could be reconstructed.

It is important to understand that surgery makes the ear safe but does not guarantee the disease will never return. That is why follow-up, repeat hearing tests and sometimes a second operation are a normal part of the pathway rather than a sign something has gone wrong.

Making the ear safe is usually durable, but cholesteatoma has a real tendency to leave fragments behind or grow back, sometimes years later. Closed (canal wall up) techniques keep the ear's normal shape but carry a higher chance of hidden recurrence, which is why a second-look operation or scan is often planned. Open (canal wall down) cavities are easier to monitor but may need occasional cleaning for life.

Combining with other procedures

Mastoid surgery is often combined with repair of the eardrum (tympanoplasty) and, where the hearing bones are damaged, with reconstruction of those bones (ossiculoplasty) to try to preserve or improve hearing in the same operation.

Follow-up & long-term care

You will usually be seen within one to two weeks to remove packing and check the wound, then at intervals over the following months for hearing tests and to check for residual disease. If a closed technique was used, a planned second-look operation or an MRI scan is commonly arranged at around 9–18 months to confirm the cholesteatoma has not returned.

• Long-term clinic follow-up, sometimes for several years, to check for recurrence
• Occasional cleaning of an open mastoid cavity at the clinic
• Keeping water out of the ear as advised, especially for an open cavity
• Repeat hearing tests as recommended
• Prompt review of any new discharge, hearing change or dizziness

Revision and secondary surgery reality

• A planned 'second look' operation is often part of the plan after closed techniques, not a sign of failure.
• Residual or recurrent disease may need further surgery, sometimes more than once over the years.
• Revision surgery generally carries higher risk to the facial nerve and hearing than the first operation.
• An open cavity may need lifelong occasional cleaning rather than further surgery.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Clear written instructions on keeping the ear dry and on warning signs to act on.
• A named contact route and out-of-hours number for facial weakness, severe dizziness or fluid leak.
• A planned schedule of follow-up, repeat hearing tests and any second-look operation or scan.
• Prompt access to cavity cleaning and review of any new discharge.
• Honest discussion of hearing results and next steps, including hearing aids if needed.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The operating surgeon's fee and the complexity of the disease found
• Whether eardrum and hearing-bone reconstruction is needed at the same time
• General anaesthetic and the anaesthetist's fee
• Theatre and facility fees, and any overnight stay
• Pre-operative hearing tests and CT scanning
• Follow-up appointments and any planned second-look operation or MRI scan
• Cavity cleaning or revision surgery if needed later

• The surgeon's fee and what operation it covers (including any reconstruction)
• Anaesthetist's fee and the type of anaesthetic
• Theatre, facility and any overnight stay charges
• Cost of pre-operative scans and hearing tests
• Number of follow-up appointments included
• Whether a planned second-look operation or MRI is included or charged separately
• What happens, and who pays, if a complication or revision is needed

On the NHS? Mastoid surgery for cholesteatoma or unsafe ear disease is standard NHS treatment when clinically indicated; private care is mainly used for faster appointments, choice of surgeon or a second opinion.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Are you planning a closed (canal wall up) or open (canal wall down) operation, and why?
• How likely am I to need a planned second-look operation or a scan later?
• What is the realistic outlook for my hearing, and will you try to reconstruct the hearing bones?
• How do you reduce and monitor the risk to my facial nerve during surgery?
• Will my taste be affected, and how long does that usually last?
• If I end up with an open cavity, how often will it need cleaning?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for mastoid surgery

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: ENT UK — Mastoid surgery / cholesteatoma NHS — Cholesteatoma Royal Berkshire NHS — Mastoid surgery patient leaflet University Hospitals Sussex NHS — Mastoid surgery StatPearls — Mastoidectomy (NCBI Bookshelf)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.