Transmastoid antrotomy (simple mastoidectomy)
CPT4 code
Name of the Procedure:
Transmastoid Antrotomy (Simple Mastoidectomy)
Summary
In simple terms, a transmastoid antrotomy, or simple mastoidectomy, is a surgical procedure where the surgeon removes infected air cells in the mastoid bone, part of the skull located just behind the ear. This procedure can help clear infections and improve ear health.
Purpose
The procedure addresses chronic ear infections or mastoiditis, where the mastoid bone has become filled with infected cells which can cause pain and hearing problems. The main goal is to remove these infected cells, relieve symptoms, and prevent further complications.
Indications
- Chronic ear infections (chronic otitis media)
- Mastoiditis (infection of the mastoid bone)
- Persistent ear pain or discharge due to infection
- Hearing loss related to chronic ear infections
- Cholesteatoma (an abnormal skin growth in the middle ear that can damage the ear structures)
Preparation
Patients may be instructed to:
- Fast for several hours before the surgery.
- Stop taking certain medications as advised by the surgeon.
- Undergo preoperative assessments like blood tests, ear examinations, and hearing tests.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made behind the ear to expose the mastoid bone.
- The surgeon uses a high-speed drill to create an opening in the mastoid bone.
- Infected air cells within the mastoid are meticulously removed.
- The surgical site is cleaned and any necessary repairs to ear structures are done.
- The incision is then closed with stitches or surgical staples, and a bandage is applied.
Duration
The procedure typically takes about 1 to 3 hours, depending on the extent of the infection and individual patient factors.
Setting
The surgery is generally performed in a hospital operating room or a specialized surgical center.
Personnel
- ENT (Ear, Nose, and Throat) surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
Common risks:
- Bleeding
- Infection at the surgical site
Rare risks:
- Hearing loss
- Dizziness or balance problems
- Facial nerve injury
- Persistent ear drainage or tinnitus
Benefits
- Relief from chronic ear infections and associated pain
- Improved hearing
- Prevention of further ear damage and complications
Benefits are typically realized soon after recovery as the infection is controlled and symptoms diminish.
Recovery
Post-procedure care includes:
- Pain management with prescribed medications
- Keeping the surgical area clean and dry
- Avoiding heavy lifting or strenuous activity for a few weeks
- Follow-up appointments to monitor healing and ensure no further issues arise
Full recovery generally takes a few weeks to a couple of months, depending on individual healing processes.
Alternatives
- Antibiotic therapy for less severe infections
- Myringotomy with tube placement (ear tubes) to drain fluid
- More extensive surgery, such as radical mastoidectomy, if needed
Each alternative has its own set of pros and cons which should be thoroughly discussed with a healthcare provider.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. After the surgery, patients may experience some pain and discomfort around the ear, which can be managed with medications. Hearing may initially seem altered but typically improves as healing progresses.