Clinical Indicators
Tympanoplasty

Procedure CPT FUD
Confined to drum head (myringoplasty) 69620 90
Tympanoplasty Type V (fenestration) 69820 90
Tympanoplasty revision 90
Without mastoidectomy or ossiculoplasty 69631 90
  • ossiculoplasty (homograft)
 69632 90
  • ossiculoplasty (prosthesis)
 69633 90
  • mastoidectomy or antrostomy
 69635 90
*Rarely if ever performed.

Indications

1. History... one required

a) Conductive hearing loss due to TM perforation.
b) Conductive hearing loss due to ossicular continuity or necrosis.
c) Conductive hearing loss due to ossicular ankylosis.
d) Chronic or recurrent otitis media.
e) Recurrent middle ear infections due to contamination through perforation of TM.
f) Progressive hearing loss due to chronic middle ear pathology.
g) Perforation or hearing loss persistent for more than three months due to trauma, infection, or prior surgery.
h) Inability to safely bathe or participate in water activities due to perforation of TM with or without hearing loss.
i) Create a safe ear.

2. Physical Examination... required

a) Description of complete ear examination, including both normal and abnormal findings.

3. Tests... required & dated within 3 months of surgery

a) Air and bone-pure tone audiogram.
b) SRT and discrimination.

Postoperative Observations

1.  Vertigo and nystagmus--appropriate medication. If severe, notify surgeon.
2.  Drainage--reinforce or change dressing.
3.  Jaw pain--reassure.
4.  Facial motion--notify surgeon of weakness or paralysis.
5.  Moderate tinnitus--reassure. Notify surgeon.
6.  Change or loss of sense of taste (usually will resolve over weeks to months).

Outcome Review
1. One Week

a) Incision and ear canal--Signs of infection?
b) Inner ear-Complaint of vertigo?

2. Beyond One Month

a) Hearing result--document with audiogram.
b) Tympanic membrane--Is it intact?

Associated ICD-9 Diagnostic Codes

382.01   Acute suppurative otitis media with spontaneous rupture of tympanic membrane
382.1 Chronic tubotympanic suppurative otitis media
382.3 Unspecified chronic suppurative otitis media
384.20 Perforation of tympanic membrane, unspecified
384.21 Central perforation of tympanic membrane
84.24 Multiple perforations of tympanic membrane
389.02 Conductive hearing loss, tympanic membrane
872.61 Open wound of tympanic membrane, uncomplicated

Additional Information
Assistant Surgeon -- N
Supply Charges -- not allowed

Anesthesia Code(s)
00120     00124     00126

Patient Information

Tympanoplasty or reconstruction of the middle ear hearing mechanism serves the purpose of rebuilding the tympanic membrane and/or middle ear bones. An excellent result may be expected in 80-90% of cases, failure to improve is not a complication. Success depends almost as much on the ability of the body to heal and preserve the reconstruction as it does on the surgeon's skill. Fortunately, even those cases that fail may be revised and have the same high degree of expected good result. There are, nevertheless, some complications that do occasionally occur. Further hearing loss (rarely total) happens less than 10% of the time when the middle ear bones are rebuilt, and for that reason ossiculoplasty is not advised unless hearing is poor. Hearing loss is uncommon if the operation is limited to repairing the typmanic membrane. Injury to the facial nerve as a result of this surgery is rare. There is a slightly greater risk when mastoidectomy is also performed, but once again, the most experienced surgeons may only encounter this complication once or twice in a career. As a general statement, complete success in restoring hearing without complication is related to the severity of the disease present before surgery, and those are the cases that have the highest priority for surgical management. Loss of sense of taste on the side of the tongue may occur. It is usually only a minor inconvenience for a few weeks. Persistent post operative dizziness is almost unheard of after surgery limited to the repair of a tympanic membrane perforation and uncommon after rebuilding the ear bones. Unless control of infection or concern of cholesteatoma (as skin in the middle ear exists) is the reason for surgery, tympanoplasty is an elective procedure. Use of a hearing aid may be an alternative to reconstructive surgery. If the typmanic membrane perforation is not repaired, ear plugs are recommended to protect the middle ear from contamination when bathing. This may help to prevent infection and its complications.

Important Notice

The Clinical Indicators for Otolaryngology--Head and Neck Surgery are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that these clinical indicators should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results

© 2000 American Academy of Otolaryngology-Head and Neck Surgery. One Prince Street, Alexandria, VA 22314.