CPT® Code 69636

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction

A tympanoplasty with antrotomy or mastoidotomy is a surgical procedure aimed at repairing the tympanic membrane (eardrum) and addressing issues within the middle ear. This procedure is particularly complex as it may involve additional techniques such as canalplasty, atticotomy, and middle ear surgery, along with the repair of the tympanic membrane itself. Tympanoplasties are categorized based on the extent of the repair needed; they can be classified as simple, where only the tympanic membrane is repaired, or more complex, where the ossicular chain, which consists of small bones in the middle ear, also requires reconstruction. The procedure typically involves creating an osseous channel into the temporal bone, referred to as an antrotomy, or into the mastoid bone, known as a mastoidotomy, to facilitate drainage of any accumulated fluid or infection. The surgical approach may be through the ear canal or via a post-auricular incision, depending on the specific case and the surgeon's preference. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to widen it. During the procedure, the surgeon inspects the tympanic membrane and middle ear structures, removes any scar tissue, and may perform an atticotomy to access the tympanic attic. The tympanic membrane is then repaired, which may involve rimming the edges of the perforation to promote healing or using a graft if the hole is larger. In cases where ossicular chain reconstruction is necessary, the surgeon evaluates the ossicles and may reconstruct them using harvested tissue grafts or synthetic prostheses, depending on the specific requirements of the case.