Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with Mastoidectomy (including Canalplasty, Middle Ear Surgery, Tympanic Membrane Repair); with Ossicular Chain Reconstruction
Summary
Tympanoplasty with mastoidectomy is a surgical procedure that involves the repair of a damaged eardrum (tympanic membrane) and the reconstruction of the ossicular chain (small bones in the middle ear). This procedure often includes canalplasty (reshaping the ear canal) and surgery to address issues in the middle ear and mastoid bone.
Purpose
This procedure addresses chronic ear infections, cholesteatoma (a destructive ear cyst), and hearing loss due to damaged ossicles or eardrum. The goals are to eliminate infection, restore hearing, and improve ear canal and eardrum structure.
Indications
- Chronic otitis media (long-term middle ear infection)
- Cholesteatoma
- Perforated eardrum
- Hearing loss due to ossicular chain damage
- Eustachian tube dysfunction leading to recurrent infections
Preparation
- Fasting for at least 6-8 hours before surgery
- Medication adjustments (e.g., stopping blood thinners)
- Pre-operative hearing tests and imaging studies (e.g., CT scans)
- Discussing allergies, current medications, and medical history with the surgeon
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made behind the ear or within the ear canal.
- Mastoidectomy: The mastoid bone is accessed and infected tissue is removed.
- Canalplasty: The ear canal is reshaped to improve access and drainage.
- Tympanoplasty: The eardrum is repaired using a graft.
- Ossicular Chain Reconstruction: Damaged ossicles are repaired or replaced with prosthetic materials.
- Closure: The incisions are closed with sutures, and a sterile dressing is applied.
Tools used include surgical microscopes, drills for mastoid bone removal, and micro-instruments for delicate ear work.
Duration
The procedure typically lasts 2 to 4 hours.
Setting
Performed in a hospital or surgical center under general anesthesia.
Personnel
- ENT surgeon (otolaryngologist)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Dizziness or imbalance
- Tinnitus (ringing in ears)
- Taste disturbance
- Partial or total hearing loss
- Facial nerve injury
Benefits
- Improved hearing
- Reduced infections
- Prevention of further ear damage
- Enhanced quality of life
Recovery
- Post-operative antibiotics and pain management
- Keep the ear dry and clean
- Avoid heavy lifting or straining for several weeks
- Follow-up appointments to monitor healing and remove stitches
- Full recovery in 6 to 12 weeks
Alternatives
- Hearing aids or other assistive devices for hearing loss
- Medical management of infections (antibiotics)
- Less invasive ear surgeries if applicable
Patient Experience
- During the procedure: Patient is under general anesthesia and will not feel pain.
- After the procedure: Mild to moderate pain managed by prescribed medications, a feeling of fullness in the ear, and possible temporary dizziness.
- Pain management with prescribed medications and measures to ensure comfort during recovery.