Revision mastoidectomy; resulting in tympanoplasty
CPT4 code
Name of the Procedure:
Revision Mastoidectomy; resulting in Tympanoplasty
Common name(s): Ear surgery for chronic infections or hearing restoration.
Summary
A revision mastoidectomy combined with tympanoplasty is a surgical procedure to remove infected or dead tissue from the mastoid bone behind the ear and to reconstruct the eardrum (tympanic membrane) and sometimes the small bones of the middle ear.
Purpose
This procedure is conducted to treat persistent or recurrent mastoid infections and to repair or enhance the function of the eardrum and middle ear. The goals are to eliminate infection, improve hearing, and prevent future complications.
Indications
- Chronic or recurrent ear infections (otitis media)
- Persistent fluid in the middle ear
- Hearing loss due to damaged eardrum or middle ear structures
- Tympanic membrane perforation
- Failed previous ear surgeries
Preparation
- Patients might be required to fast for 6-8 hours before surgery.
- Blood tests and imaging studies such as CT scans may be conducted preoperatively.
- Review current medications with a doctor to adjust or discontinue certain drugs before the procedure.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A behind-the-ear incision is made to access the mastoid bone.
- Mastoidectomy: Infected or diseased tissue within the mastoid bone is carefully removed using microscopic tools.
- Tympanoplasty: The eardrum is repaired with graft materials, and if necessary, the small bones of the middle ear (ossicles) are reconstructed.
- Closure: The incision is sutured, and a sterile dressing is applied.
Duration
The procedure typically lasts between 2 to 4 hours, depending on the complexity.
Setting
The procedure is performed in a hospital or an outpatient 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
- Bleeding
- Hearing loss
- Tinnitus (ringing in the ears)
- Dizziness or vertigo
- Facial nerve injury
- Failure of graft or need for additional surgery
Benefits
- Elimination of chronic infection
- Improved hearing
- Prevention of further ear damage
- Enhanced quality of life
Recovery
- Patients typically go home the same day or the next day.
- Pain and discomfort can be managed with prescribed medications.
- Keeping the ear dry and avoiding strenuous activities is crucial.
- Follow-up appointments are necessary to monitor healing and hearing improvement.
- Complete recovery may take several weeks to a few months.
Alternatives
- Medical management with antibiotics or ear drops.
- Hearing aids or other assistive listening devices.
- Observation and monitoring for less severe conditions.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain. Post-operatively, some ear and site pain, swelling, and mild dizziness are common. Pain management includes prescribed pain relievers, and most discomfort subsides within a few days. Regular follow-ups ensure proper healing and troubleshoot any complications or needs for further intervention.