CPT® Code 69632

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)

A tympanoplasty without mastoidectomy is a surgical procedure aimed at repairing the tympanic membrane (eardrum) and, in some cases, reconstructing the ossicular chain, which consists of the small bones in the middle ear. This procedure can be performed as an initial surgery or as a revision of a previous tympanoplasty. The surgery may involve additional techniques such as canalplasty, which is the widening of the ear canal, and atticotomy, which is the surgical opening of the attic of the middle ear. The classification of tympanoplasties is based on whether the repair is limited to the tympanic membrane alone or if it also includes the ossicles, which are critical for sound transmission. In this procedure, the surgeon may access the middle ear through the ear canal or via a post-auricular incision, which is made behind the ear. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to enlarge it. The surgeon inspects the tympanic membrane and the middle ear structures, removing any scar tissue that may be present. If necessary, the attic of the middle ear is accessed through an atticotomy, which may involve removing a thin layer of bone known as the scutum or drilling into the bony ear canal for a larger access. The surgical technique includes preparing the edges of the tympanic membrane hole to promote healing, which may involve rimming the edges until bleeding occurs. Depending on the size and location of the perforation, a patch may be required. Tissue grafts, which can be made from skin, fat, tendon, or fascia, are harvested and prepared for placement over the perforation. An absorbable sponge may be used to support the graft in the middle ear. If canalplasty is performed, skin grafts are also placed over the exposed bone in the ear canal. Finally, the ear is packed with gauze to support the surgical site during the healing process. In cases where ossicular chain reconstruction is indicated, the surgeon inspects the ossicles and reconstructs them using harvested tissue grafts, ensuring proper function of the middle ear. This comprehensive approach aims to restore hearing and prevent further complications associated with ear conditions.