Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular repl
CPT4 code
Name of the Procedure:
Tympanoplasty without Mastoidectomy (including Canalplasty, Atticotomy, and/or Middle Ear Surgery), Initial or Revision; with Ossicular Chain Reconstruction and Synthetic Prosthesis (e.g., Partial Ossicular Replacement Prosthesis [PORP], Total Ossicular Replacement Prosthesis [TORP]).
Summary
This surgical procedure repairs a perforated eardrum and reconstructs the bones of the middle ear using synthetic prostheses. It does not involve any work on the mastoid bone but may include other enhancements such as canalplasty (widening of the ear canal), atticotomy (removal of part of the attic in the middle ear), or other middle ear surgeries.
Purpose
The procedure is intended to restore the normal function of the middle ear in individuals with damaged eardrums or ossicles (small bones in the ear), improving hearing and reducing infections. The main goal is to enhance hearing quality and resolve any issues related to chronic ear conditions.
Indications
- Persistent perforation of the eardrum.
- Conductive hearing loss due to ossicular chain disruption.
- Chronic otitis media (middle ear infections).
- Prior unsuccessful ear surgeries.
- Symptoms such as hearing loss, ear pain, or frequent ear infections.
Preparation
- Patients may need to fast for several hours before the procedure.
- Medications, such as blood thinners, may need to be adjusted or stopped.
- Pre-operative diagnostic tests, such as hearing tests and imaging scans, are often required.
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free.
- An incision is made in the ear canal or behind the ear to access the middle ear.
- The eardrum perforation is repaired using graft material.
- The ossicular chain is reconstructed with a synthetic prosthesis (PORP or TORP) to restore the transmission of sound to the inner ear.
- Additional procedures, such as canalplasty or atticotomy, are performed if needed.
- The incision is closed, and sterile dressings are applied.
Duration
The procedure typically takes between 2 to 4 hours.
Setting
The surgery is conducted in a hospital or specialized surgical center.
Personnel
- Otolaryngologist (Ear, Nose, and Throat surgeon)
- Anesthesiologist
- Surgical nurses
- Surgical technologists
Risks and Complications
- Infection
- Bleeding
- Dizziness or balance issues
- Tinnitus (ringing in the ear)
- Facial nerve injury
- Prosthesis displacement or failure
- Sensory hearing loss
Benefits
- Improved or restored hearing.
- Reduced frequency of ear infections.
- Enhanced overall ear function.
- Benefits are typically noticed several weeks to months post-surgery.
Recovery
- Patients may need to rest and avoid strenuous activities for several weeks.
- Follow-up appointments are necessary to monitor healing and prosthesis function.
- Antibiotics and pain medications may be prescribed.
- Avoid getting water in the ear until cleared by the surgeon.
Alternatives
- Hearing aids or other non-surgical hearing devices.
- Conservative management of ear infections and perforations.
- Different surgical approaches, including mastoidectomy if needed.
Patient Experience
- Patients typically experience some discomfort and mild pain post-operation, managed with prescribed medications.
- Might feel dizzy or off-balance temporarily.
- There will be a period of adjustment as hearing improves and the ear heals.
- Comfort measures include keeping the head elevated and avoiding nose-blowing to reduce pressure on the healing ear.