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Clinical Indicators: Tympanoplasty

Clinical Indicators: Tympanoplasty
Approach ProcedureCPTRBRVS Global Days
Confined to drum head (myringoplasty)6962090
Tympanoplasty Type V (fenestration) 6982090
Tympanoplasty revision6984090
Without mastoidectomy or ossiculoplasty6963190
Without mastoidectomy or ossiculoplasty, ossiculoplasty (homograft)6963290
Without mastoidectomy or ossiculoplasty, ossiculoplasty (prosthesis)6963390
Without mastoidectomy or ossiculoplasty, mastoidectomy or antrostomy6963590

Rarely if ever performed.

  1. History (one required)
    1. Conductive hearing loss due to TM perforation.
    2. Conductive hearing loss due to ossicular continuity or necrosis.
    3. Conductive hearing loss due to ossicular ankylosis.
    4. Chronic or recurrent otitis media.
    5. Recurrent middle ear infections due to contamination through perforation of TM.
    6. Progressive hearing loss due to chronic middle ear pathology.
    7. Perforation or hearing loss persistent for more than three months due to trauma, infection, or prior surgery.
    8. Inability to safely bathe or participate in water activities due to perforation of TM with or without hearing loss.
    9. Create a safe ear.
  2. Physical Examination (required)
    1. Description of complete ear examination, including both normal and abnormal findings.
  3. Tests (required & dated within 3 months of surgery)
    1. Air and bone-pure tone audiogram.
    2. 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
    1. Incision and ear canal–Signs of infection?
    2. Inner ear-Complaint of vertigo?
  2. Beyond One Month
    a) Hearing result–document with audiogram.
    b) Tympanic membrane–Is it intact?

Associated ICD-10-CM Diagnostic Codes (Representative, but not all-inclusive codes)

  • H66.019 Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear
  • H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
  • H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
  • H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
  • H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
  • H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
  • H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral H66.017 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear
  • H66.13 Chronic tubotympanic suppurative otitis media, bilateral
  • H66.10 Chronic tubotympanic suppurative otitis media, unspecified
  • H66.11 Chronic tubotympanic suppurative otitis media, right ear
  • H66.12 Chronic tubotympanic suppurative otitis media, left ear
  • H66.3X9 Other chronic suppurative otitis media, unspecified ear
  • H66.3X1 Other chronic suppurative otitis media, right ear
  • H66.3X2 Other chronic suppurative otitis media, left ear
  • H66.3X3 Other chronic suppurative otitis media, bilateral
  • H72.90 Unspecified perforation of tympanic membrane, unspecified ear
  • H72.91 Unspecified perforation of tympanic membrane, right ear
  • H72.92 Unspecified perforation of tympanic membrane, left ear
  • H72.93 Unspecified perforation of tympanic membrane, bilateral
  • H72.00 Central perforation of tympanic membrane, unspecified ear
  • H72.01 Central perforation of tympanic membrane, right ear
  • H72.02 Central perforation of tympanic membrane, left ear
  • H72.03 Central perforation of tympanic membrane, bilateral
  • H72.819 Multiple perforations of tympanic membrane, unspecified ear
  • H72.811 Multiple perforations of tympanic membrane, right ear
  • H72.812 Multiple perforations of tympanic membrane, left ear
  • H72.813 Multiple perforations of tympanic membrane, bilateral
  • H72.819 Multiple perforations of tympanic membrane, unspecified ear
  • H72.811 Multiple perforations of tympanic membrane, right ear
  • H72.812 Multiple perforations of tympanic membrane, left ear
  • H72.813 Multiple perforations of tympanic membrane, bilateral
  • H90.2 Conductive hearing loss, unspecified
  • H90.0 Conductive hearing loss, bilateral
  • H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
  • H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
  • S09.20XA Traumatic rupture of unspecified ear drum, initial encounter
  • S09.21XA Traumatic rupture of right ear drum, initial encounter
  • S09.22XA Traumatic rupture of left ear drum, initial encounter

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 Disclaimer Notice (Updated 8/7/14)

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical indicators will not ensure successful treatment in every situation. The AAO-HNS/F 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. The AAO-HNS/F is not responsible for treatment decisions or care provided by individual
physicians. Clinical indicators are not intended to and should not be treated as legal, medical, or
business advice.

CPT five-digit codes, nomenclature and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.


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