Mastoidectomy Pre-Operative Preparation: Complete Checklist and Patient Education

Pre-Operative Preparation for Mastoidectomy

A mastoidectomy removes diseased mastoid air cells. Thorough preoperative workup optimizes safety and outcomes.

Standard Pre-Op Checklist

1. Medical Evaluation: H&P, medication review, comorbidity optimization (cardiology/pulmonology clearance if indicated).
2. Focused ENT Exam: Microscopy, tuning forks, cranial nerve assessment.
3. Imaging: High-resolution temporal bone CT (axial/coronal ± 3D); MRI if intracranial extension suspected.
4. Audiometry: Pure-tone, speech, tympanometry, acoustic reflexes—baseline for hearing preservation counseling.
5. Labs: CBC, CMP, coagulation (PT/INR, aPTT), type & screen; ECG if >40 or cardiac history.
6. Medication Adjustments: Hold anticoagulants/antiplatelets per protocol (typically 5–7 days); continue essential cardiac/neuro meds.
7. Fasting & Hygiene: NPO after midnight; preoperative chlorhexidine shower (night before + morning).
8. Anesthesia Consult: General vs. monitored anesthesia care; discuss airway, positioning (supine, head turned), facial nerve monitoring.
9. Informed Consent: Procedure, risks (facial nerve injury, hearing loss, taste disturbance, CSF leak, recurrence), alternatives, expectations.
10. Post-Op Planning: Outpatient vs. overnight; pain regimen; activity restrictions; follow-up schedule.

Patient Education Points

• Expect packing in ear canal (removed 1–3 weeks).
• Hearing may be muffled initially; improves as packing dissolves/removed.
• No nose blowing, straining, heavy lifting, flying for 4–6 weeks.
• Keep water out of ear (Vaseline-coated cotton ball for showering).

Meticulous preparation reduces complications and aligns expectations.