​What kinds of symptoms do patients experience before receiving treatment?

A mastoidectomy is a surgical procedure that removes diseased mastoid air cells. A patient who needs a mastoidectomy will experience hearing loss, chronic ear infections, and possibly cholesteatoma—an abnormal skin growth in the middle ear. Cholesteatomas cause hearing loss and ear discharge. The cholesteatoma will erode bones in the middle ear and can eventually expose the brain and cause death in complicated, untreated cases.

​What is the impact on patients’ lives of living with these conditions?

Patients live with hearing loss and chronic ear infections.

What cultural or regional factors affect the treatment of these conditions?

Treated incorrectly or left untreated, an infected mastoid bone can cause hearing loss, persistent ear discharge, meningitis, temporary dizziness, and temporary loss of taste. Due to poor hygiene and limited education in rural Cambodia, patients are likely to experience complications and receive the incorrect treatment.

What does the treatment process look like?

A mastoidectomy is performed with the patient asleep under general anesthesia. Surgeons will perform one of several different types of mastoidectomy, depending on the amount of infection present. These include: • Simple (or closed) mastoidectomy: The operation is performed through the ear or through an incision behind the ear. The surgeon opens the mastoid bone and removes the infected air cells. The eardrum is incised to drain the middle ear. Topical antibiotics are placed in the ear. • Radical mastoidectomy: This procedure removes the most bone and is usually performed for extensive spread of a cholesteatoma. The eardrum and middle ear structures may be completely removed. Usually the stapes, the "stirrup"-shaped bone, is spared to preserve some hearing. • Modified radical mastoidectomy: In this procedure, some middle ear bones are left in place, and the eardrum is rebuilt by tympanoplasty. After surgery, the wound is stitched up around a drainage tube, and a dressing is applied.

What is the impact of this treatment on the patient’s life?

This treatment will relieve chronic ear infections, hearing loss, and other symptoms caused by the infected mastoid bone.

What potential side effects or risks come with this treatment?

This treatment is highly effective, but it poses risks if performed by an inexperienced surgeon. The operation is near the facial nerve and the brain, so surgeons must be careful when operating. At Children's Surgical Centre, ENT surgeons only operate on cases about which they feel confident.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Care for this condition is not easily accessible in Phnom Penh. Only one other hospital performs ENT surgery, but care at that hospital is expensive. The ENT surgeons at our medical partner have a proven record of successful cases.

What are the alternatives to this treatment?

Once the infection stops responding to antibiotics, surgery is the only option.