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Otorhinolaryngology focuses on the ear, nose, and throat. Learn about the diagnosis and treatment of hearing loss, sinusitis, tonsillitis, and voice disorders.
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The mastoid is a part of the skull located just behind the ear. While many people have never heard of it until they experience a problem, it plays a significant role in the health and function of the ear system. When you touch the large, bony bump behind your earlobe, you are feeling the mastoid bone. Inside, this bone is not solid like a rock; instead, it looks more like a rigid sponge or a honeycomb. It is filled with many small, air-filled spaces called air cells. These cells are connected to the middle ear, which means that the health of your mastoid is directly tied to the health of your ear.
A mastoidectomy is a surgical procedure performed to remove diseased cells from this honeycomb bone. It is a common and highly effective surgery used to treat severe ear infections that have spread beyond the middle ear or to remove growths that can damage hearing and balance. For patients facing this surgery, it often marks the end of a long struggle with chronic ear pain, drainage, or hearing loss. The procedure is performed by an ear, nose, and throat (ENT) specialist and is designed to make the ear safe, dry, and healthy again. This section covers mastoid anatomy, causes of disease, and the surgery used to fix it.
The mastoid bone is technically part of the temporal bone, which is one of the major bones forming the side of the skull. Its unique honeycomb structure is evolutionary and functional. The air pockets inside help to reduce the overall weight of the heavy human skull. More importantly, these air cells act as a buffer and a ventilation system for the middle ear. The middle ear needs air to function properly, and the mastoid air cells provide a reservoir of air that helps maintain stable pressure.
The connection between the mastoid and the middle ear is seamless. They are lined with the same type of mucous membrane, similar to the lining of your nose. This means that when the middle ear gets infected (otitis media), the infection can easily travel backward into the mastoid air cells. In most simple ear infections, the mastoid gets a little inflamed but heals when the ear heals. However, if an infection is aggressive or chronic, the mastoid can become filled with pus, infected fluid, or abnormal skin growth. Because the bone structure is like a maze, antibiotics sometimes cannot reach deep enough to clear the infection, necessitating surgical intervention.
The mastoid bone is not just empty space; it houses and protects very important structures. The facial nerve, which controls your ability to smile and close your eye, runs through this bone. The large veins that drain blood from the brain are also nearby, as is the inner ear organ responsible for hearing and balance. When surgeons operate on the mastoid, they are navigating a complex landscape. The goal is to clean out the disease while leaving these vital structures perfectly intact. This aspect is why mastoid surgery is considered a microsurgery, requiring high-powered microscopes and extreme precision.
Mastoiditis is the medical term for infection of the mastoid bone. It is the most common reason for emergency mastoid surgery, especially in children. It occurs when a middle ear infection spreads and essentially becomes trapped in the honeycomb bone. The bone itself becomes infected and can begin to break down.
This condition comes on quickly. The patient, often a child, will have a fever and severe ear pain. The area behind the ear becomes red, swollen, and tender to the touch. It may push the ear forward so it looks like it is sticking out. This is a serious condition because, if left untreated, the infection can erode through the bone and spread to the brain or cause meningitis. In the era before antibiotics, mastoiditis was a leading cause of death in children. Today, it is treatable, but it still requires prompt medical attention and often surgery to drain the infection.
Chronic mastoiditis is a slower, smoldering process. It is often associated with a long-standing hole in the eardrum or chronic drainage from the ear. The patient might lack a fever or severe pain, but they have a persistent, foul-smelling discharge from the ear that antibiotics do not cure. The mastoid bone becomes hardened, and the air cells fill with scar tissue and infection. Surgery is a planned procedure to clean out the chronic infection and stop the drainage.
One of the most frequent reasons for performing a mastoidectomy in adults is a condition called cholesteatoma. This is a non-cancerous skin cyst that grows into the middle ear and mastoid. It usually starts when the eardrum is retracted or sucked inwards due to poor pressure regulation.
Skin from the ear canal becomes trapped in the middle ear. Skin cells are constantly shedding, and normally this dead skin falls out of the ear. But in a cholesteatoma, the skin forms a sac or a ball. As the dead skin accumulates inside the sac, it gets larger. It acts like a slow-motion tumor. It can erode the tiny hearing bones, damage the balance organ, and eat into the mastoid bone. It is not a tumor, but it behaves destructively.
Cholesteatomas do not go away on their own. There is no pill or ear drop that can dissolve them. They must be physically removed. Since they often grow into the mastoid air cells, a mastoidectomy is needed to remove the bone and make sure every tiny piece of the skin cyst is taken out. If any piece is left behind, the cholesteatoma will grow back. The surgery creates a safe, open cavity so the doctor can monitor the ear and clean it in the future.
The primary goal of any mastoid surgery is safety. The surgeon wants to remove the disease—whether it is an infection or a cholesteatoma—to prevent it from causing dangerous complications like meningitis or facial paralysis. A “safe ear” is one that is not at risk of spreading infection to the brain.
The second goal is a “dry ear.” Patients with mastoid disease often suffer from years of smelly, wet ears that ruin their clothes and pillows. Surgery aims to remove the source of the drainage so the ear becomes dry and waterproof again. Only after achieving safety and dryness do surgeons pursue the third goal, which is hearing preservation or restoration. While removing the disease is the priority, surgeons use advanced techniques to rebuild the hearing mechanism whenever possible. Since they often grow into the mastoid air cells, a mastoidectomy is needed to remove the bone and make sure every tiny piece of the skin cyst is taken out
For a patient, being told they need “bone surgery” behind the ear can be frightening. It helps to understand that this is a routine procedure for ENT specialists. The incision is usually hidden behind the ear, so it is not visible to others. The surgery effectively turns a complex, infected maze into a simple, clean bowl.
Most patients report a feeling of immense relief after recovery. Patients no longer experience constant pressure, unpleasant odors, or worry about infection. While the idea of drilling bone sounds painful, the mastoid bone itself has very few pain receptors. The discomfort is usually manageable and is often described as soreness rather than sharp pain. The journey through surgery is a trade-off: trading weeks of recovery for a lifetime of safety from chronic ear disease.
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The surgeon removes the infected air cells and the thin bony partitions inside the mastoid bone. They drill away the diseased “honeycomb” until only a smooth, rigid shell remains.
No, the mastoid bone is covered by skin and muscle. You can feel it as the solid lump behind your ear, but you cannot see the bone itself.
Usually, no. The surgeon drills out the inside of the bone. The outer shell is often preserved, or the area is filled with tissue, so the shape of the head looks normal.
No, mastoidectomy is commonly performed on children, especially those with acute mastoiditis or congenital cholesteatoma. It is safe for pediatric patients.
Not necessarily. The goal is to save hearing. While the surgery involves the hearing organs, surgeons take extreme care to protect them. In many cases, hearing can be reconstructed and improved.
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