Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with Mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
Summary
Tympanoplasty with mastoidectomy is a surgical procedure aiming to treat chronic ear infections and repair the eardrum (tympanic membrane). This procedure does not involve reconstruction of the small bones in the middle ear (ossicular chain).
Purpose
This procedure addresses chronic otitis media (chronic middle ear infections) and perforations of the eardrum. The primary goals are to remove the infected tissue, prevent further infection, and restore the integrity of the eardrum for improved hearing and ear health.
Indications
- Chronic ear infections not responding to medical treatments.
- Persistent perforations of the eardrum.
- Cholesteatoma (abnormal skin growth in the middle ear).
- Hearing loss due to perforation or chronic infection. Patients indicated for this procedure often experience continuous ear drainage, discomfort, and hearing impairment.
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Certain medications, particularly blood thinners, may need to be adjusted or stopped temporarily.
- Preoperative hearing tests and imaging studies like CT scans of the mastoid bone may be required.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made either behind the ear or within the ear canal.
- Canalplasty: The ear canal is widened if necessary.
- Mastoidectomy: Infected mastoid bone air cells are removed.
- Tympanoplasty: Diseased tissue is excised from the middle ear, and the eardrum is repaired using graft material.
- Closure: The incisions are closed with sutures.
Tools used include microsurgical instruments, drills for the mastoidectomy, and graft materials for tympanic membrane repair.
Duration
The procedure typically takes 2 to 4 hours, depending on the extent of the disease and anatomical considerations.
Setting
Tympanoplasty with mastoidectomy is typically performed in a hospital or specialized surgical center.
Personnel
- ENT Surgeon (Otolaryngologist)
- Anesthesiologist
- Surgical Nurse
- Audiologist (may be involved pre- and post-operatively)
Risks and Complications
- Bleeding
- Infection
- Dizziness or vertigo
- Hearing loss
- Facial nerve injury
- Persistent perforation Complications are managed through medical or surgical intervention as needed.
Benefits
- Resolution of chronic ear infections
- Improved hearing
- Elimination of ear drainage and discomfort Benefits are often realized within several weeks to months post-procedure, as healing progresses.
Recovery
- Patients may need to stay in the hospital overnight.
- Avoid water exposure to the ear.
- Follow-up appointments are necessary for monitoring healing and removing any packing or stitches.
- Complete recovery typically ranges from 4 to 8 weeks, with specific instructions on activity restrictions and ear care.
Alternatives
- Conservative management with antibiotics and ear drops.
- Hearing aids if hearing loss is the primary issue.
- Less invasive procedures if only minor repairs are needed.
Compared to tympanoplasty with mastoidectomy, alternative treatments may have limitations in managing extensive infections or providing a long-term solution.
Patient Experience
During the procedure, patients are under general anesthesia and remain unconscious. Post-procedure, mild to moderate pain, swelling, and a sense of fullness in the ear are common. Pain management includes prescribed analgesics and rest. Some dizziness may occur but typically resolves within a few days.