Mastoid obliteration (separate procedure)
CPT4 code
Name of the Procedure:
Mastoid Obliteration
- Common names: Mastoid packing, Mastoid cavity closure
- Medical term: Mastoid obliteration surgery
Summary
Mastoid obliteration is a surgical procedure where the mastoid cavity, a part of the ear located behind the ear canal, is filled with soft tissue or bone to eliminate a cavity that may lead to infections or other complications.
Purpose
Medical conditions addressed:
- Chronic ear infections (chronic otitis media)
- Recurrent or persistent mastoiditis
- Cholesteatoma
Goals/Expected outcomes:
- Elimination of chronic infection
- Rendering the mastoid cavity self-cleaning and dry
- Prevention of recurrent disease
- Improvement in hearing
Indications
Symptoms/Conditions warranting the procedure:
- Persistent ear drainage despite medical treatment
- Chronic ear infections not responsive to antibiotics
- Persistent or problematic mastoid cavity after previous surgeries
- Presence of cholesteatoma (abnormal skin growth in the middle ear)
Patient criteria:
- Patients with chronic ear conditions not responding to less invasive treatments
- Patients with complications from previous mastoid surgeries
Preparation
Pre-procedure instructions:
- Fasting typically 6-8 hours before surgery
Medication adjustments as directed by your surgeon (e.g., stopping blood-thinning meds)
Diagnostic tests/assessments:
- Hearing tests
- CT or MRI scan of the ear
- Blood work to assess overall health
Procedure Description
Step-by-step explanation:
- Anesthesia is administered (usually general anesthesia).
- An incision is made behind the ear.
- The mastoid bone is accessed, and the infected or diseased tissue is removed.
- The mastoid cavity is then filled with tissue or material from the patient (e.g., bone graft or muscle flap), or occasionally synthetic materials.
- The incision is closed with stitches or surgical staples.
Tools/Equipment used:
- Surgical microscope
- Micro-drills
- Bone curettes
- Grafting materials (bone, muscle tissue)
Anesthesia/Sedation details:
- General anesthesia to ensure the patient is asleep and pain-free during the procedure.
Duration
The procedure typically takes 2-3 hours.
Setting
Performed in a hospital operating room or specialized surgical center.
Personnel
- Ear, Nose, and Throat (ENT) surgeon or otologist
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
Common risks:
- Infection
- Bleeding
- Temporary dizziness or imbalance
Rare risks:
- Facial nerve injury
- Hearing loss
- Failure of the graft to integrate
Management of complications:
- Antibiotics for infections
- Close monitoring and additional interventions if bleeding occurs
- Physical therapy for balance issues
- Additional surgeries if necessary
Benefits
Expected benefits:
- Relief from chronic ear infections and drainage
- Improved hearing in some cases
- Reduction in the need for ongoing ear care and cleanings
Timeframe for realization:
- Immediate relief from symptoms, with full benefits realized over a few weeks to months as tissues heal.
Recovery
Post-procedure care:
- Dressing and wound care
- Pain management with prescribed medications
- Keeping the ear dry and avoiding water exposure
Expected recovery time:
- 2-4 weeks for initial recovery
- Full recovery and return to normal activities within a few months
Restrictions and follow-up:
- Avoid heavy lifting or strenuous activities
- Follow-up appointments to monitor healing and success of the graft
Alternatives
Other treatment options:
- Conservative treatments (antibiotics, ear cleaning)
- Revisions of previous surgeries
- Tympanomastoidectomy
Pros and cons of alternatives:
- Conservative treatments may not be effective for severe cases, but they are less invasive.
- Revision surgeries may be necessary but involve similar risks.
Patient Experience
During the procedure:
- The patient will be under general anesthesia and will not feel or remember the procedure.
After the procedure:
- Pain and discomfort managed with medications
- Possible temporary dizziness or imbalance
- Follow-up visits for removal of dressings and stitches, and to monitor healing
Pain management and comfort measures:
- Prescription pain medications
- Rest and limited activity to aid in recovery