Whether the bony partition between the external ear canal and mastoid is removed or not depends on the extent of disease. The term modified radical mastoidectomy refers to an operation where this bony partition is removed and the eardrum and ossicles are reconstructed. A radical mastoidectomy is an operation where this bony partition is removed and the eardrum, malleus and incus bones are permanently removed so that the inner lining of the large cholesteatoma sac can be safely cleaned in the office. This operation is done when an extensive cholesteatoma is encountered or one that is adherent to the inner ear or facial nerve. Experienced surgeons can usually perform this type of surgery in about two hours.
Some sensation returns several months later but return is usually incomplete.
Most patients do not find this troublesome. Shortly after surgery the ear may protrude slightly. The ear almost always returns to normal as the wound behind the ear heals. Risks of the surgery include taste disturbance, facial paralysis, recurrence of cholesteatoma, hearing loss and dysequilibrium. The facial nerve courses through the middle ear on its way to the muscles of the face.