CPT® Code 69643

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction

A tympanoplasty with mastoidectomy is a surgical procedure that combines the repair of the tympanic membrane (eardrum) with the removal of infected or diseased mastoid bone. This specific procedure, identified by CPT® Code 69643, is performed when the wall of the ear canal is either intact or has been reconstructed. The surgery may involve several components, including canalplasty, which is the widening of the ear canal, middle ear surgery, and the repair of the tympanic membrane itself. Tympanoplasties are categorized based on the extent of the repair needed; they can involve only the tympanic membrane or may also require the repair of the ossicular chain, which consists of the small bones in the middle ear. In this case, the procedure is conducted without any reconstruction of the ossicular chain. During the surgery, an incision is typically made behind the ear to access the mastoid bone, allowing the surgeon to inspect the mastoid air cells and determine the necessary extent of the procedure. The mastoid air cells are carefully removed along with any infected tissue, debris, or purulent matter. If the external auditory canal's posterior and superior walls are removed to facilitate access to the mastoid and attic of the middle ear, these walls are reconstructed afterward. A drain may be placed behind the ear to assist with fluid management post-surgery. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to enlarge the canal. The tympanic membrane is then inspected, and any scar tissue in the middle ear is excised. The repair of the tympanic membrane involves techniques such as rimming the edges of the hole to promote healing or using a graft if the hole is larger. The grafting material, which may include skin, fat, tendon, or fascia, is prepared and placed over the tympanic membrane defect, with absorbable materials used to support the graft. This comprehensive approach aims to restore hearing and prevent further infections while ensuring the structural integrity of the ear.