69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction

Name of the Procedure:

Tympanoplasty with Mastoidectomy
Common names: Tympanoplasty, Mastoidectomy, Canalplasty, Middle Ear Surgery, Tympanic Membrane Repair, with Intact or Reconstructed Wall.

Summary

Tympanoplasty with mastoidectomy is a surgical procedure designed to repair the eardrum (tympanic membrane) and clean out infection or growth from the mastoid bone (the bone behind the ear). It is performed with the goal of restoring hearing and stopping chronic ear infections without involving the ossicular chain (the tiny bones in the ear).

Purpose

This procedure is used to:

• Address chronic ear infections that do not respond to medical treatment.
• Repair a perforation or hole in the eardrum.
• Remove diseased tissue from the mastoid bone. The expected outcomes include improved hearing and the elimination of ear infections.

Indications

• Persistent ear infections (chronic otitis media).
• Perforated eardrum.
• Cholesteatoma (a growth of skin cells in the middle ear).

Preparation

• Patients may be instructed to fast after midnight the night before the procedure.
• Certain medications may need to be adjusted or stopped temporarily.
• Preoperative hearing tests and imaging studies (like a CT scan) are often required.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision is made behind the ear to access the mastoid bone.
3. Canalplasty: The ear canal is widened if necessary.
4. Mastoidectomy: Infected or diseased bone and tissue from the mastoid are removed.
5. Tympanoplasty: The eardrum is repaired using a graft, commonly taken from the patient’s own tissue.
6. Closure: The incision is closed, and the ear canal is packed with sterile material to protect the repair.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeons: An ear, nose, and throat (ENT) specialist or an otologist.
• Nurses: Assist in the operating room and postoperative care.
• Anesthesiologists: Manage anesthesia and patient comfort.

Risks and Complications

• Common risks: Bleeding, infection, dizziness, or temporary hearing loss.
• Rare complications: Facial nerve injury, permanent hearing loss, persistent dizziness, or cerebrospinal fluid leak.

Benefits

• Improved hearing.
• Relief from chronic ear infections.
• Reduced ear discharge and overall better ear health. Benefits are generally realized shortly after recovery, but full healing can take several weeks.

Recovery

• Patients typically go home the same day or the next day.
• Instructions include keeping the ear dry, avoiding nose blowing, and possible use of antibiotics.
• Follow-up appointments are needed to monitor healing.
• Recovery time can be around 4 to 6 weeks, with restrictions on heavy lifting or strenuous physical activities.

Alternatives

• Conservative management with antibiotics and ear drops.
• Hearing aids for those primarily concerned with hearing loss.
• Less invasive surgeries, if appropriate for the condition. The choice of alternatives depends on the severity of the condition, patient's overall health, and specific needs.

Patient Experience

• During the procedure: Patients are under general anesthesia and will not feel any pain.
• After the procedure: Mild to moderate pain, managed with prescribed pain medications.
• Some dizziness and ear drainage may occur but typically resolve within a few days. Comfort measures include rest, head elevation, and avoiding sudden head movements.