CPT® Code 69637

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

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 performed solely to repair the tympanic membrane or may also involve the reconstruction of the ossicular chain, which consists of small bones in the middle ear that are crucial for hearing. The procedure includes creating an osseous channel into the temporal bone (antrotomy) or the mastoid bone (mastoidotomy) to facilitate drainage, which is essential in cases of chronic ear infections or other middle ear pathologies. The surgical approach can be through the ear canal or via a post-auricular incision, depending on the specific circumstances of the patient's condition. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to widen it. The surgeon inspects the tympanic membrane and middle ear structures, removing any scar tissue that may impede function. The tympanic attic may be accessed through an atticotomy, which involves removing a thin bony plate or drilling into the ear canal. The tympanic membrane is then repaired, which may involve techniques such as rimming the edges of the perforation or using grafts to cover larger defects. The use of synthetic prostheses, such as partial or total ossicular replacement prostheses, is integral to this procedure when reconstruction of the ossicular chain is necessary, ensuring improved hearing outcomes for the patient.