Mastoidectomy Surgery in India & UAE — Cholesteatoma & Ear Disease Treatment
Mastoidectomy surgery in India from $2,000. Surgical treatment for cholesteatoma, chronic otitis media & mastoiditis. Expert ENT surgeons. Book with GAF Healthcare.
Estimated cost: $2,000 – $5,000 · Average stay: 2–4 days
Mastoidectomy is a surgical procedure that removes diseased mastoid air cells from the mastoid process — the bony prominence behind the ear that contains a honeycomb of air-filled cells connected to the middle ear. It is performed most commonly for cholesteatoma (a destructive collection of skin cells within the middle ear and mastoid that erodes adjacent structures if untreated), chronic suppurative otitis media (CSOM — chronic middle ear infection with a persistent perforated eardrum and purulent discharge), and acute mastoiditis (infection of the mastoid air cells, most commonly a complication of acute otitis media in children).
Cholesteatoma is the most important indication for mastoidectomy. A cholesteatoma is an epithelial cyst (skin-lined sac) that slowly expands by shedding layers of dead skin — it destroys everything in its path by enzymatic erosion: the ossicles (causing progressive conductive hearing loss), the mastoid bone, the facial nerve canal (causing facial nerve palsy), the semicircular canals (causing vertigo and sensorineural hearing loss), the tegmen (the bone separating the ear from the brain — risking intracranial complications), and the sigmoid sinus (risking dural venous sinus thrombosis). Untreated cholesteatoma inevitably leads to serious complications; surgery is the only treatment.
India and the UAE have ENT departments with consultant otologists experienced in mastoid surgery — a sub-specialty of ENT requiring specific training, high operating microscope precision, and experienced anaesthetic support.
Types of Mastoidectomy
Cortical (simple) mastoidectomy: removal of the mastoid air cells while leaving the posterior canal wall intact and the middle ear undisturbed. Used for acute mastoiditis with a subperiosteal abscess, or as a first step in cochlear implantation surgery. It does not address middle ear disease and is not used for cholesteatoma.
Canal wall up (CWU) mastoidectomy: removes mastoid disease while preserving the posterior wall of the external auditory canal. The middle ear is reconstructed (tympanoplasty with ossiculoplasty if ossicles are eroded). The advantage is a more normal-shaped ear canal (no need for a mastoid cavity to clean) and better hearing reconstruction results. The disadvantage is a higher rate of residual or recurrent cholesteatoma (because the preserved canal wall limits the surgical exposure of the posterior mesotympanum and mastoid tip, where disease can hide), requiring mandatory second-look surgery at 12–18 months.
Canal wall down (CWD) modified radical mastoidectomy: removes the posterior and superior canal walls, creating a common cavity between the mastoid and the external auditory canal. The cholesteatoma is completely removed and the ear is externalised, dramatically reducing the risk of residual disease. The trade-off is a mastoid bowl (cavity) that requires lifelong regular cleaning by an ENT specialist (every 6–12 months) and significant restrictions on water exposure (no swimming or water sports; meticulous ear protection when bathing). Hearing reconstruction is more challenging in the cavity ear.
Mastoidectomy Procedure
Mastoidectomy is performed under general anaesthesia through a post-auricular (behind the ear) incision, using an operating microscope for the middle ear portion and a drilling system for the mastoid bone work. The procedure takes 2–4 hours depending on the extent of disease.
The mastoid cortex is exposed; a burr is used to systematically drill away the mastoid air cells — removing the infected or cholesteatomatous tissue, opening the mastoid antrum, and following the disease wherever it extends (tegmen, posterior fossa plate, facial nerve canal, semicircular canals). The facial nerve is identified and protected throughout using a facial nerve monitor.
For CWU mastoidectomy, the posterior canal wall is preserved; the tympanic membrane is reconstructed with a temporalis fascia or perichondrium graft (myringoplasty); the ossicular chain is reconstructed if ossicles are damaged (ossiculoplasty). For CWD mastoidectomy, the posterior canal wall is removed, the mastoid bowl is made self-cleaning with a meatoplasty (enlarging the ear canal opening), and the cavity is lined with skin.
Facial nerve monitoring is used throughout all mastoid surgery — the facial nerve runs through the mastoid bone and is at risk during drilling; the monitor alerts the surgeon if the drill approaches the nerve.
Procedure Steps
- Audiogram (pure tone and tympanometry); CT temporal bone (defines extent of cholesteatoma or disease)
- General anaesthesia; facial nerve monitor; post-auricular incision; periosteum elevated
- Mastoid drilling: cortical mastoidectomy; antrum opened; sinodural angle identified
- Disease removed systematically: cholesteatoma sac excised; infected bone removed
- Decision CWU or CWD based on extent of disease
- Tympanoplasty and ossiculoplasty if indicated (CWU); meatoplasty (CWD)
- Wound closure; mastoid dressing; overnight admission; audiogram at 6 weeks
Cost Comparison Worldwide
Country — Range — Savings
--- — --- — ---
USA — $8,000 – $20,000 — Save up to 80%
UK — £4,000 – £10,000 (private) — Save up to 75%
UAE — $6,000 – $14,000 — Save up to 72%
India — $2,000 – $5,000 — Best value
Mastoidectomy with tympanoplasty in the USA costs $8,000–$20,000. In India, CWU mastoidectomy with myringoplasty costs $2,000–$4,000; CWD (modified radical) mastoidectomy costs $2,500–$5,000 all-inclusive. The operating microscope, facial nerve monitor, and ossiculoplasty implants used at India's partner centres are equivalent to those at leading UK and USA otology centres.
Recovery & Follow-up
Post-operative hospital stay 1–3 days. Mastoid pack removed at 5–7 days. Ear dressings changed at 2 weeks; sutures removed at 10–14 days. No water in the ear for 6 weeks (waterproof ear protection when bathing). Full hearing assessment (audiogram) at 6 weeks to assess tympanoplasty and ossiculoplasty outcomes. CWU patients require second-look mastoidectomy at 12–18 months to exclude residual cholesteatoma. CWD patients require 6-monthly outpatient mastoid cavity cleaning.
Recovery Tips
- Keep the ear dry for 6 weeks — use a cotton wool ball with petroleum jelly over the ear when showering
- Do not blow your nose forcefully for 4 weeks — sniff instead, to prevent air from entering the middle ear through the Eustachian tube
- Report any facial weakness (drooping of one side of the face) immediately — this may indicate facial nerve swelling
- Attend the 6-week audiogram — this documents hearing improvement from the ossiculoplasty
- CWU patients: attend the 12–18 month second-look surgery — this is non-optional for safety
Risks & Complications
Mastoidectomy risks include: hearing deterioration (sensorineural hearing loss from drill vibration near the ossicular chain — rare with careful technique); facial nerve palsy (the most feared complication — transient palsy from retraction or heat in approximately 1%; permanent palsy rare, < 0.5%); tinnitus; vertigo (from proximity to the semicircular canals); CSF leak (from breaching the tegmen or posterior fossa dural plate); infection; and recurrence of cholesteatoma (CWU: 20–30% residual/recurrence requiring second-look; CWD: 3–8%).
Why GAF Healthcare
GAF Healthcare connects cholesteatoma and chronic ear disease patients with India's consultant otologists — surgeons who sub-specialise in middle ear and mastoid surgery with high operative volumes. CT temporal bone imaging is reviewed before travel, and the surgical approach (CWU vs CWD) is confirmed in the pre-operative plan. For CWU patients, the mandatory second-look surgery is coordinated as a scheduled return visit.
Frequently Asked Questions
What happens if cholesteatoma is not treated?
Untreated cholesteatoma expands progressively, eroding everything around it. Serious complications include: complete ossicular destruction (total conductive hearing loss); labyrinthine fistula (erosion into the inner ear causing permanent sensorineural hearing loss and severe vertigo); facial nerve palsy (pressure on or erosion of the facial nerve canal); meningitis (erosion through the tegmen allowing infection to reach the brain); intracranial abscess; and sigmoid sinus thrombosis. These are life-threatening complications — cholesteatoma must be surgically removed once diagnosed.
Can hearing be restored after mastoidectomy?
Conductive hearing loss from ossicular erosion by cholesteatoma can often be partially or fully restored with ossiculoplasty — reconstruction of the ossicular chain using titanium prostheses (TORP or PORP) or cartilage. Hearing improvement is typically assessed 6 months after surgery when post-operative inflammation has resolved. Most patients achieve a significant improvement in air-bone gap. Sensorineural hearing loss from labyrinthine involvement of cholesteatoma cannot be restored surgically.
Do I need surgery if my ear just has a perforation (hole in the eardrum)?
A simple eardrum perforation without cholesteatoma or chronic middle ear disease can sometimes be managed conservatively — particularly small perforations in a non-draining ear. Surgical repair (myringoplasty) is offered for perforations that cause recurrent wet ear episodes, hearing loss, or quality-of-life impairment. Myringoplasty (repairing the perforation with a temporalis fascia graft) is a simpler, shorter procedure than mastoidectomy and achieves perforation closure in approximately 85–90% of cases.