Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction.
Summary
A tympanoplasty with mastoidectomy is a surgical procedure to remove diseased mastoid bone behind the ear and repair the eardrum (tympanic membrane). This procedure does not involve reconstruction of the hearing bones (ossicles).
Purpose
This procedure addresses chronic ear infections, cholesteatoma (a type of skin cyst in the middle ear), and damage to the mastoid bone. The primary goals are to eliminate infection, create a dry and safe ear, and repair the eardrum to improve hearing and prevent further complications.
Indications
- Chronic middle ear infections resistant to medical therapy
- Cholesteatoma
- Persistent drainage from the ear
- Significant hearing loss due to tympanic membrane perforation
- Mastoiditis (infection and inflammation of the mastoid bone)
- Patients who have not responded to conservative treatments
Preparation
- Fasting for at least 8 hours before surgery
- Current medication review and possible adjustments, particularly blood thinners
- Preoperative assessment including hearing tests, CT or MRI scans of the ear, and overall health evaluation
Procedure Description
- The patient is given general anesthesia.
- An incision is made behind the ear to access the mastoid bone and middle ear.
- Diseased mastoid bone and tissue are removed (mastoidectomy).
- The ear canal may be widened (canalplasty) to enhance access to the middle ear.
- The eardrum is repaired using a graft if necessary (tympanoplasty).
- Ossicles are inspected but not reconstructed in this procedure.
- The incision is closed with sutures, and a sterile dressing is applied.
Duration
The procedure typically lasts 2 to 4 hours.
Setting
Usually performed in a hospital or specialized surgical center.
Personnel
- ENT (Ear, Nose, and Throat) surgeon or otologist
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Dizziness or vertigo
- Facial nerve injury
- Hearing loss or no improvement in hearing
- Tinnitus (ringing in the ears)
- CSF (cerebrospinal fluid) leak
Benefits
- Resolution of chronic ear infections
- Reduced risk of serious complications like brain abscesses or meningitis
- Improved ear function and, potentially, hearing
Recovery
- Patients typically go home the same day or within 24 hours.
- Pain and dizziness might occur post-surgery, managed with prescribed medications.
- Keep the ear dry and avoid strenuous activities for several weeks.
- Follow-up appointments to monitor healing and remove packing from the ear.
- Hearing improvement can usually be assessed a few weeks after surgery.
Alternatives
- Medical management with antibiotics and ear drops
- Less extensive surgery if infection is less severe
- Observation and regular follow-ups for non-progressive conditions
- Each alternative has its own benefits and potential drawbacks compared to the described surgery.
Patient Experience
- Some discomfort and dizziness after the procedure.
- Pain is usually mild to moderate and managed with pain relief medications.
- Hearing might worsen temporarily due to postoperative swelling, gradually stabilizing as healing progresses.
- Follow care instructions meticulously to ensure proper recovery.