Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction
Summary
Tympanoplasty with mastoidectomy is a surgical procedure designed to treat and repair issues within the middle ear. This significantly includes the reconstruction of the ear drum (tympanic membrane) and ear bones (ossicular chain), and often involves clearing out infection or growths from the bone behind the ear (mastoid bone).
Purpose
This procedure addresses chronic ear infections, burst eardrums, and disordered ear bones causing hearing loss or persistent ear issues. The primary goal is to eliminate infection, repair the eardrum, and restore the ossicular chain to improve hearing and prevent future complications.
Indications
- Chronic otitis media (middle ear infection)
- Persistent perforation of the ear drum (tympanic membrane)
- Cholesteatoma (a growth in the middle ear)
- Conductive hearing loss due to ossicular damage or scarring
- Repeated ear infections not responsive to medical treatment
Preparation
- Fasting for 6-8 hours prior to surgery if general anesthesia is used
- Potential discontinuation of certain medications as advised by the doctor
- Blood tests, hearing tests, and imaging studies like CT scans may be required
Procedure Description
- Anesthesia: Generally performed under general anesthesia.
- Incision: A small incision is made either behind the ear or within the ear canal.
- Mastoidectomy: The surgeon drills into the mastoid bone to remove infected or abnormal tissue.
- Canalplasty: The ear canal may be reshaped to allow better access to the middle ear.
- Tympanoplasty: The surgeon repairs the tympanic membrane using graft tissue.
- Ossicular Chain Reconstruction: Damaged ear bones are reconstructed using prostheses or patient’s own tissues.
- Closure: The incision is closed with stitches and a sterile bandage is applied.
Tools, Equipment, and Technology
- Surgical drill system for mastoidectomy
- Microscope for visual clarity
- Fine grafting materials and prosthetic devices
Duration
Approximately 2-4 hours, depending on complexity.
Setting
Performed in a hospital or specialized surgical center.
Personnel
- Otologist or ENT surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technicians
Risks and Complications
- Infection
- Dizziness or vertigo
- Tinnitus (ringing in ears)
- Hearing loss (persistent or worsening)
- Facial nerve injury
- Bleeding or blood clots
- Risks associated with anesthesia
Benefits
- Improved hearing
- Reduced incidence of ear infections
- Closed eardrum perforation, preventing recurrent drainage
- Better overall ear health
Recovery
- Hospital stay of 1-2 days may be required
- Keep the surgical site dry and clean
- Pain management with prescribed medications
- Follow-up appointments to monitor healing
- Avoid heavy lifting, strenuous activities, and water activities for several weeks
- Full recovery might take several weeks to few months
Alternatives
- Medical management with antibiotics and ear drops
- Hearing aids for hearing loss
- Less invasive procedures if applicable
- Pros: Non-surgical, less risk
- Cons: Might not resolve the issue permanently, potential progression to surgery
Patient Experience
- Mild to moderate discomfort post-surgery, manageable with pain medication
- Temporary dizziness or balance issues
- Hearing might initially be impaired due to packing material placed in the ear, improving as healing progresses
- Regular follow-up visits to ensure proper healing and functionality