Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tymorphic membrane repair); without ossicular chain reconstruction.
Summary
A tympanoplasty with antrotomy or mastoidotomy is a surgical procedure to repair the eardrum (tympanic membrane) and address issues within the middle ear and mastoid bone without reconstructing the small bones of the middle ear (ossicles). This surgery helps restore normal ear function and alleviate associated symptoms.
Purpose
This procedure is performed to:
- Treat chronic ear infections
- Repair perforated eardrums
- Remove infected tissue from the mastoid bone
- Improve hearing and prevent further complications within the ear.
Indications
- Chronic otitis media (long-term middle ear infections)
- Persistent tympanic membrane perforation
- Cholesteatoma (abnormal skin growth in the middle ear)
- Recurrent ear infections resistant to medical treatment
- Hearing loss due to structural problems in the ear.
Preparation
- Patients may be asked to fast (no food or drink) for several hours before the procedure.
- Pre-operative assessments, such as hearing tests (audiometry) and imaging studies (CT scan or MRI) of the ear, are usually required.
- Review and possibly adjust current medications with the healthcare provider.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made behind the ear or within the ear canal to access the middle ear and mastoid bone.
- The surgeon repairs the ear canal (canalplasty) and removes any infected or abnormal tissue from the mastoid (mastoidotomy) or attic (atticotomy) area.
- The tympanic membrane is repaired using a tissue graft.
- The ear is carefully packed to support healing.
Specialized tools such as microscopes, surgical drills, and fine instruments are used to ensure precision.
Duration
The procedure typically takes 2 to 3 hours.
Setting
This procedure is performed in a hospital or outpatient surgical center under sterile conditions.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Hearing loss or changes
- Dizziness or balance problems
- Facial nerve injury
- Tinnitus (ringing in the ear)
Benefits
- Improved hearing
- Resolution of chronic ear infections
- Reduced risk of recurrent ear problems
- Enhanced quality of life
Benefits are typically noticeable within a few weeks as the ear heals.
Recovery
- Patients can usually go home the same day or the next day after the procedure.
- Post-operative instructions include keeping the ear dry, avoiding strenuous activities, and following up with the surgeon.
- Full recovery may take several weeks to months, with hearing improvement typically realized within three months.
- Follow-up appointments are essential to monitor healing and ear function.
Alternatives
- Conservative treatments such as antibiotics and ear drops
- Hearing aids for hearing loss management
- Less extensive surgical procedures depending on the specific condition
Each alternative has its own benefits and limitations compared to tympanoplasty with antrotomy or mastoidotomy.
Patient Experience
- During the procedure: Patients will be under general anesthesia and will not feel pain or be aware of the surgery.
- After the procedure: Mild to moderate discomfort, ear fullness, and slight dizziness are common. Pain management includes prescribed medications.
- Patients should follow the post-operative care instructions provided by their healthcare team to ensure a smooth recovery.