CPT® Code 69604

1. Indications

The revision mastoidectomy resulting in tympanoplasty, as described by CPT® Code 69604, is indicated for several specific conditions and symptoms, including:

• Chronic Ear Infections: Persistent infections that do not respond to medical treatment may necessitate surgical intervention to remove infected tissue and improve drainage.
• Previous Mastoid Surgery Complications: Patients who have undergone prior mastoid surgeries may experience complications such as recurrent infections or incomplete removal of infected tissue, requiring a revision procedure.
• Tympanic Membrane Perforation: The presence of a hole in the tympanic membrane, which can result from infection or trauma, may require repair through tympanoplasty.
• Mastoiditis: Inflammation of the mastoid bone, often due to untreated ear infections, may lead to the need for surgical intervention to remove infected air cells.

2. Procedure

The procedure for a revision mastoidectomy resulting in tympanoplasty involves several critical steps, which are detailed as follows:

• Step 1: An incision is made behind the ear to access the mastoid bone. This incision allows the surgeon to expose the mastoid air cells and assess the condition of the surrounding tissues.
• Step 2: The remaining mastoid air cells are inspected to determine the extent of the revision procedure required. This assessment is crucial for planning the surgical approach and ensuring all infected or damaged tissue is addressed.
• Step 3: The air cell system is completely removed, along with any purulent matter, debris, and infected tissue. This step is essential to eliminate sources of infection and promote healing.
• Step 4: If necessary, the posterior and superior walls of the external auditory canal may be removed to enhance exposure of the mastoid and attic of the middle ear. This step facilitates better access for the surgeon to perform the necessary repairs.
• Step 5: In cases requiring a more extensive (radical) mastoidectomy, structures within the epitympanum, such as the head of the malleus and body of the incus, may be removed. The stapes may also be removed but is preserved if possible to maintain hearing function.
• Step 6: The removal of these structures allows for the exteriorization of the mastoid cavity and middle ear, which is important for effective drainage and healing.
• Step 7: A drain may be placed behind the ear to facilitate continued drainage of any fluids that may accumulate post-surgery.
• Step 8: The tympanic membrane is then repaired. The surgeon rims the tissue around the hole until bleeding occurs, which promotes healing by encouraging the edges to come together.
• Step 9: For larger holes in the tympanic membrane, a graft may be required. A small amount of skin, fat, tendon, or fascia is harvested to create the graft.
• Step 10: The graft is prepared and placed over the hole in the tympanic membrane. Absorbable sponge material may be positioned in the middle ear behind the hole to support the graft during the healing process.
• Step 11: An additional absorbable sponge is placed in the ear canal over the graft to hold it in place, ensuring stability as the area heals.
• Step 12: Finally, the ear is packed with gauze to provide support and protection during the recovery phase.

3. Post-Procedure

After the revision mastoidectomy and tympanoplasty, patients can expect specific post-procedure care and considerations. It is essential to monitor for any signs of infection or complications, such as increased pain, swelling, or discharge from the surgical site. Patients may be advised to keep the ear dry and avoid getting water in the ear canal during the initial healing period. Follow-up appointments will be necessary to assess the healing of the tympanic membrane and the overall success of the procedure. The physician may provide additional instructions regarding activity restrictions and the use of medications to manage pain and prevent infection. Recovery times can vary, but patients should be informed about the expected timeline for healing and any signs that would warrant immediate medical attention.