Mastoidectomy & Ear Infection Care in Delhi: When a Discharging Ear Needs Surgery

 Many patients who come to my clinic in Vasant Vihar tell the same story. One ear has been discharging on and off for months, sometimes for years. Drops help for a while, the ear dries up, and then the discharge returns with the next cold or after water gets in during a bath. Somewhere along the way someone mentions an operation called mastoidectomy, and the worry begins.

Chronic ear infection is common in India. A meta-analysis of Indian studies found chronic suppurative otitis media, the medical name for a long-standing discharging ear with a hole in the eardrum, in about 3.78% of children. Most of these ears can be treated without surgery. Some cannot, and leaving them untreated can cost hearing or, rarely, lead to serious complications.

This guide to mastoidectomy and ear infection care in Delhi explains how an ENT tells the two apart, what the operation actually involves, and what recovery looks like.

Why some ear infections never settle

Most ear infections clear on their own or with a short course of treatment. The ones that turn chronic usually leave behind a hole in the eardrum. Through that hole the middle ear stays open to germs and water, so it keeps getting infected again.

Doctors call this chronic suppurative otitis media: a long-standing infection of the middle ear and the mastoid air cells behind it, with discharge through a perforated eardrum. Cochrane reviewers list ear discharge and hearing loss as its two main symptoms.

Indian ENT surgeons often divide it into two kinds. In the ‘safe’ kind, the problem is a hole in the eardrum with an inflamed lining. It often settles with treatment, and the hole can be repaired later. The ‘unsafe’ kind involves cholesteatoma, a growth of skin cells that collects in the middle ear where it does not belong.

Cholesteatoma is not cancer, but it slowly erodes the bone around it. A 2026 review lists its complications as hearing loss, facial nerve paralysis and infections inside the skull. Drops cannot remove it, and it needs surgery.

Children are especially at risk. In a study of 694 schoolchildren in rural Karnataka, 5.2% had chronic suppurative otitis media. Frequent colds and a habit of cleaning the ears with various objects were both linked to it.

Warning signs that need urgent care

Most discharging ears can wait for a routine appointment, but some signs cannot. Pain, swelling or redness behind the ear, or the ear being pushed forward, can mean infection in the mastoid bone. Weakness on one side of the face, such as difficulty closing the eye, can mean the facial nerve is involved.

Giddiness with vomiting, a severe headache, high fever, a stiff neck, drowsiness or confusion can mean the infection has reached the inner ear or, rarely, the area around the brain. Any of these needs an ENT or an emergency department the same day. Caught early, these complications are treatable.

How an ENT decides whether you need surgery

The first step is a careful look at the eardrum under a microscope or an ear endoscope, after the discharge has been cleaned out. This shows whether there is a simple hole in the eardrum or signs of cholesteatoma, such as a pocket of white skin debris or eroded bone near the top of the eardrum. A swab of the discharge shows which germ is growing, which helps when the usual drops have failed.

A hearing test, called pure tone audiometry, measures how much hearing has been lost and which part of the ear is affected. A CT scan of the temporal bone is not needed for everyone. It is used when cholesteatoma or a complication is suspected, or to plan surgery, because it shows how far the disease has spread and the delicate structures around it. An MRI is sometimes added, for example to look for cholesteatoma that has come back after an operation.

Artificial intelligence is now being trained to read these CT scans. A 2025 review found models scoring over 90% accuracy on their own test data but only 78 to 88% on outside data. For now, the decision still rests with an experienced ENT surgeon.

Not every discharging ear needs surgery. A ‘safe’ ear that dries up with treatment may only need the hole in the eardrum repaired later. Cholesteatoma, or an ear that keeps discharging despite proper treatment, usually does need an operation.

Treatment before surgery

The first aim is a dry ear. Keep water out of the affected ear while bathing by plugging it with cotton wool coated in a little petroleum jelly, and avoid swimming until your ENT says it is safe. Ear cleaning by an ENT, using gentle suction under the microscope, removes the discharge so that drops can actually reach the infected lining.

Antibiotic ear drops are usually the main treatment. A Cochrane review found that drops may dry the ear better than antibiotic tablets or injections, though the evidence is limited. Some drops can harm the inner ear when there is a hole in the eardrum, so use only the drops your ENT prescribes. A blocked nose, allergies or enlarged adenoids in children can keep reinfecting the ear through the tube that connects it to the back of the nose, so these need treatment too.

Many people try home remedies first. Mustard oil, garlic oil or onion juice can make the infection worse, especially when there is a hole in the eardrum. Cleaning the ear with buds, matchsticks or hairpins can push debris deeper or scratch the canal. A discharging ear needs an examination, not more home treatment.

Ear care through Delhi’s seasons

Delhi’s winter smog season brings a wave of colds and blocked noses, and in children these often spread to the ears through the tube that links each ear to the back of the nose. Delhi averaged 82.2 µg/m³ of PM2.5 in 2025, the highest of any capital in IQAir’s report. A systematic review of 24 studies found growing evidence that higher air pollution goes with more ear infections in children. Treating a blocked nose early, and getting a child with ear pain or discharge examined, can stop a simple infection from turning chronic.

The monsoon brings a different problem. Hot, humid weather favours fungal ear infections, and a study from north-eastern Haryana found them most often in the rainy season. They cause itching, a blocked feeling and discharge, and are easily mistaken for a bacterial infection that is not responding to drops. In summer, swimming pools are the main risk, so anyone with a hole in the eardrum should keep that ear dry or ask their ENT about a well-fitting ear plug.

If you live in Delhi and an ear keeps discharging through any of these seasons, an ENT specialist in Delhi can examine it under the microscope and tell you whether it needs drops, a repair or surgery.

What a mastoidectomy actually involves

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A mastoidectomy removes infected air cells and any cholesteatoma from the mastoid, the honeycomb of bone you can feel behind your ear. The goals, in order, are a safe ear free of disease, then a dry ear, and then the best hearing possible.

It is usually done under general anaesthesia, through a small cut behind the ear. The eardrum is often repaired in the same sitting, an operation called tympanoplasty, and damaged hearing bones may be rebuilt. Most patients go home within a day or two.

There are two main approaches. In a canal wall up mastoidectomy, the bony wall of the ear canal is kept, so the ear looks and works normally afterwards. Cholesteatoma can hide and come back, though, so a second look may be needed. In a canal wall down mastoidectomy, that wall is taken down to open the area fully. This lowers the chance of disease being left behind, but leaves a cavity that needs cleaning at regular check-ups, often for life.

Some surgeons fill, or ‘obliterate’, that cavity. A 2022 meta-analysis of 2,379 patients found obliteration had lower recurrence than canal wall up and less discharge than an open cavity. Its authors stress that the choice depends on the surgeon’s experience and the individual patient. If you are considering mastoidectomy in Delhi, ask your surgeon which approach they recommend for your ear, and why.

Recovery and aftercare at home

Most people feel sore behind the ear for a few days, and simple painkillers usually control it. A head bandage is often kept on for the first day. The ear canal may be packed for a couple of weeks, so hearing in that ear will seem muffled until the packing comes out. Stitches behind the ear are usually removed after about a week.

Keep the ear completely dry until your surgeon says otherwise. Cover it while bathing, avoid swimming, and do not blow your nose hard, because the pressure can travel up to the ear. Sneeze with your mouth open. Mild giddiness, ringing in the ear or a slight change in taste on one side of the tongue can happen for a while and usually settles.

Most people with desk jobs return to work in one to two weeks, but heavy lifting and hard exercise should wait longer. Do not miss the follow-up visits. The surgeon cleans the ear under the microscope and checks how it is healing, and after a canal wall down operation these check-ups continue long term.

Honest risks, recurrence and hearing

Like any operation, a mastoidectomy has risks, and you should hear them before you agree to it. The facial nerve runs through the bone close to the middle ear, so facial weakness is a known but uncommon risk in experienced hands. Hearing can stay the same, improve, or occasionally get worse. Giddiness, ringing in the ear, a change in taste and wound infection are other possible problems, and most are temporary.

Cholesteatoma can come back, which is why follow-up matters. It tends to be more aggressive in children. A 2023 meta-analysis quotes recurrence rates of 16 to 54% after surgery in children. It found similar rates whether the canal wall was kept or taken down, with better hearing when it was kept. Regular check-ups, and sometimes an MRI or a planned second operation, catch any return early.

If hearing is still poor once the ear has healed, it can often be helped. The hearing bones can sometimes be rebuilt in a later operation, and a well-fitted hearing aid helps many people. At MedFirst ENT Centre, hearing tests and hearing aid fitting are done in the same clinic.

About the author

Dr. (Major) Rajesh Kumar Bhardwaj is a senior ENT surgeon with more than 35 years of clinical and surgical experience. He earned his MS in ENT at AFMC Pune with a silver medal and also holds a DNB. He served 15 years in the Indian Army Medical Corps and is Professor Emeritus at TMU, Moradabad.

He leads MedFirst ENT Centre in Vasant Vihar, South Delhi. The centre covers ENT surgery including mastoidectomy, general ENT care, an allergy clinic, a vertigo clinic with specialised vestibular testing, and hearing aid fitting with audiometry. To book an ear check, visit entdelhi.com.