Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction
Summary
Tympanoplasty with antrotomy or mastoidotomy is a surgical procedure to repair the eardrum (tympanic membrane) and the bones in the middle ear (ossicular chain). This surgery may involve canalplasty (reshaping the ear canal), atticotomy (removal of the attic portion of the ear), and mastoidectomy (removal of diseased mastoid bone). It aims to improve hearing and eliminate infection.
Purpose
The procedure addresses chronic ear infections, hearing loss due to ossicular chain damage, and eardrum perforations. The goals are to restore hearing, eradicate infection, and reconstruct damaged ear structures to improve overall ear function.
Indications
- Persistent ear infections not responsive to medical treatment
- Perforated eardrum causing hearing loss
- Cholesteatoma (an abnormal skin growth in the middle ear)
- Conductive hearing loss due to ossicular chain disruption
- Ear drainage lasting more than six weeks
Preparation
- Fasting for 6-8 hours before surgery
- Adjustment of medications as per doctor's advice (e.g., stopping blood thinners)
- Preoperative hearing tests and imaging studies (CT or MRI scans)
- Blood tests to check general health status
Procedure Description
- Anesthesia: The patient is given general anesthesia for comfort and to ensure they are asleep during the procedure.
- Incision: An incision is made behind the ear to gain access to the middle ear and mastoid bone.
- Antrotomy/Mastoidotomy: Diseased tissue and parts of the mastoid bone are removed.
- Canalplasty and Atticotomy: The ear canal is reshaped, and the attic portion may be removed to clear the disease.
- Tympanoplasty: The eardrum is repaired using grafts taken from the patient's tissue.
- Ossicular Chain Reconstruction: Damaged bones in the middle ear are repaired or replaced with prosthetic devices to improve hearing.
- Closure: The incision is closed with sutures, and a sterile dressing is applied.
Duration
The procedure typically takes 2-4 hours, depending on the extent of the surgery needed.
Setting
Performed in a hospital or surgical center equipped with specialized ENT (Ear, Nose, and Throat) facilities.
Personnel
- ENT Surgeon (Otolaryngologist)
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or blood clots
- Persistent hearing loss or changes in hearing
- Dizziness or balance problems
- Facial nerve injury
- Tinnitus (ringing in the ears)
Benefits
- Improved hearing
- Elimination of chronic infections
- Improved quality of life and daily functioning
- Reduced ear discharge
- Enhanced structural integrity of the ear
Recovery
- Pain management with prescribed medications
- Keeping the ear dry and avoiding water exposure
- Follow-up appointments for hearing tests and to check the surgical site
- Return to daily activities within a few weeks, with full recovery in several months
- Avoiding strenuous activities and heavy lifting during the initial recovery period
Alternatives
- Watchful waiting and medical management
- Hearing aids for hearing loss
- Simple tympanoplasty (repairing only the eardrum without addressing mastoid disease)
- Regular ear cleaning and antibiotic treatments for recurrent infections
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. After surgery, mild pain and discomfort in the ear are expected, managed with pain relievers. Patients might feel dizzy or have temporary taste changes. Proper post-operative care helps ensure a smooth recovery.