Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction
CPT4 code
Name of the Procedure:
Tympanoplasty with Mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); Radical or Complete, with Ossicular Chain Reconstruction
Summary
Tympanoplasty with mastoidectomy is a surgical procedure performed to repair damage to the eardrum, remove infection or disease from the mastoid bone, and reconstruct the small bones in the middle ear for improved hearing. It is an intricate surgery aimed at addressing chronic ear infections and hearing loss.
Purpose
The procedure addresses chronic otitis media (chronic ear infections), perforated eardrums, cholesteatoma, or other conditions causing conductive hearing loss. The goal is to eradicate infection, repair the eardrum, and restore the sound conduction mechanism for better hearing.
Indications
- Chronic ear infections unresponsive to medical treatment
- Perforated eardrum
- Cholesteatoma (abnormal skin growth in the middle ear)
- Conductive hearing loss due to ossicular chain issues
- Persistent ear drainage
Preparation
- Preoperative fasting as instructed (usually 6-8 hours before surgery)
- Blood tests, hearing tests (audiometry), and imaging studies (CT scan of the ear)
- Review and adjustment of medications, especially blood thinners
- Informing the surgeon of any allergies or medical conditions
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: An incision is made either behind the ear or within the ear canal.
- Mastoidectomy: The diseased mastoid bone is accessed and removed.
- Canalplasty: The ear canal is widened if necessary to improve access and drainage.
- Middle Ear Surgery: Diseased tissues in the middle ear are cleaned out.
- Tympanic Membrane Repair: The eardrum (tympanic membrane) is repaired using graft tissue.
- Ossicular Chain Reconstruction: Damaged small bones in the middle ear (ossicles) are reconstructed or replaced to restore hearing.
Duration
The procedure typically takes 2 to 4 hours, depending on the extent of the disease and the reconstruction required.
Setting
The surgery is performed in a hospital setting, often in the outpatient surgery department or a specialized otologic surgical center.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurses
- Scrub techs and surgical assistants
Risks and Complications
- Infection
- Bleeding
- Dizziness or balance problems
- Hearing loss
- Tinnitus (ringing in the ear)
- Facial nerve injury
- Graft failure or eardrum perforation
Benefits
- Elimination of chronic ear infections
- Repair of the eardrum and middle ear structures
- Improved hearing
- Prevention of further complications related to chronic ear disease
Patients may begin to realize the benefits within a few weeks, with full hearing improvement assessed after the ear has healed.
Recovery
- Pain management with prescribed medications
- Avoid heavy lifting and straining
- Keep the ear dry and avoid water exposure
- Follow-up visits to monitor healing and hearing improvement
- Possible need for audiometry to assess hearing outcomes
Recovery can vary but typically takes several weeks, with most patients resuming normal activities within a few days to a week.
Alternatives
- Medical management with antibiotics and ear drops for minor cases
- Hearing aids for conductive hearing loss
- Less invasive ear tube placement for drainage and pressure relief
Each alternative has its own benefits and limitations compared to surgical intervention documented here.
Patient Experience
Patients will be unconscious during the procedure due to general anesthesia. Post-procedure, they might experience some pain, dizziness, and mild discomfort. Pain management includes prescribed analgesics and comfort measures such as head elevation. Full recovery and resumption of daily activities is expected within a few weeks, though hearing improvement may take a bit longer to assess thoroughly.