Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total
CPT4 code
Name of the Procedure:
Tympanoplasty with Antrotomy or Mastoidotomy (including Canalplasty, Atticotomy, Middle Ear Surgery, and/or Tympanic Membrane Repair); with Ossicular Chain Reconstruction and Synthetic Prosthesis (e.g., Partial Ossicular Replacement Prosthesis [PORP] or Total Ossicular Replacement Prosthesis [TORP])
Summary
This procedure is a type of ear surgery that repairs or reconstructs the middle ear and its structures, including the ear canal and eardrum. It may also involve reconstructing the small bones of hearing (ossicles) using synthetic prostheses.
Purpose
The aim of this procedure is to repair damage within the middle ear, restore hearing function, and prevent further ear infections or complications. It is typically employed to address chronic ear infections, tympanic membrane perforations, or ossicular chain abnormalities.
Indications
- Chronic otitis media (middle ear infections)
- Perforated tympanic membrane (eardrum)
- Cholesteatoma (abnormal skin growth in the middle ear)
- Ossicular chain disruption or erosion
- Conductive hearing loss due to middle ear pathologies
Preparation
- Fasting: Patients may be required to fast for several hours before surgery.
- Medication Adjustments: Certain medications might need to be stopped or adjusted.
- Diagnostic Tests: Pre-operative hearing tests, imaging studies (e.g., CT scan), and blood work.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision and Access: An incision is made behind the ear or within the ear canal.
- Antrotomy/Mastoidotomy: Removal or reshaping of the ear canal or mastoid bone to gain access to the middle ear.
- Middle Ear Surgery: Removal of diseased tissue, reshaping the canal, and any atticotomy (removal of part of middle ear structure).
- Tympanic Membrane Repair: Repair or replacement of the eardrum.
- Ossicular Chain Reconstruction: Reconstruction of the ossicles using synthetic prostheses (PORP/TORP).
- Closure: Incisions are closed with sutures or other surgical closure methods.
Duration
The procedure typically lasts between 2 to 4 hours.
Setting
The surgery is usually performed in a hospital or a specialized surgical center equipped with the necessary surgical facilities.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Hearing loss (temporary or permanent)
- Dizziness or balance issues
- Facial nerve injury
- Tinnitus (ringing in the ears)
Benefits
- Improved hearing and ear function
- Reduced risk of recurrent ear infections
- Enhanced quality of life
- Prevention of further ear damage or complications
Recovery
- Post-surgery: A bandage or ear packing may be placed in the ear.
- Instructions: Patients may need to keep the ear dry, avoid blowing the nose hard, and refrain from heavy lifting.
- Follow-up: Regular follow-up appointments to check healing and hearing tests.
- Recovery Time: Most patients recover within a few weeks, although complete healing may take several months.
Alternatives
- Hearing aids
- Antibiotic therapy for infection management
- Watchful waiting for non-severe cases
- Less invasive ear surgeries, depending on the condition
Patient Experience
- During Procedure: Patients will be under general anesthesia and won’t feel anything.
- After Procedure: Some pain and discomfort are expected, managed with prescribed pain medications.
- Sensations: Possible temporary dizziness and ear fullness.
- Comfort Measures: Pain management strategies and safe sleeping positions.