CPT® Code 69646

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with 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 operation is particularly significant in cases where chronic ear infections have led to complications affecting both the middle ear and the mastoid process, which is the bony structure located behind the ear. The procedure may involve additional techniques such as canalplasty, which is the widening of the ear canal, and middle ear surgery to address any abnormalities or damage within the ear. 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—comprising the malleus, incus, and stapes—also requires reconstruction. In the case of CPT® Code 69646, a radical or complete mastoidectomy is performed using a wall down technique, which entails the removal of bone from the back of the ear canal to create a single cavity that encompasses both the mastoid and the ear canal. During the procedure, an incision is typically made behind the ear to expose the mastoid bone. The surgeon inspects the mastoid air cells and determines the extent of the disease, removing any infected tissue, debris, and purulent matter. The procedure may also involve the removal of the posterior and superior walls of the external auditory canal to facilitate access to the mastoid and attic of the middle ear. If a radical mastoidectomy is necessary, structures within the epitympanum, including parts of the ossicular chain, may be excised to allow for proper drainage and healing. 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. The use of absorbable materials to support the graft and packing the ear with gauze are common practices to ensure stability during the healing process. Overall, this procedure aims to restore hearing, eliminate infection, and prevent future complications associated with chronic ear disease.