Auditory System. Chaos Healthcare

Transcription

1 Medical Coding Auditory System Chaos Healthcare

2 AUDITORY SYSTEM: Anatomy

3 AUDITORY SYSTEM: Physiology

4 AUDITORY SYSTEM MYRINGOPLASTY: Myringoplasty is an operative procedure used in the reconstruction of a perforation of the tympanic membrane. This assumes that the middle ear space, its mucosa, and the ossicular chain are free of active infection. There is no direct inspection of the middle ear during this procedure. TYMPANOPLASTY: Tympanoplasty, also called eardrum repair, implies reconstruction of the tympanic membrane but also deals with pathology within the middle ear cleft, such as chronic infection, cholesteatoma, or an ossicular chain problem. Eardrum perforation may result from chronic infection or, less commonly, from trauma to the eardrum.

5 AUDITORY SYSTEM TREATMENT: Overlay technique: This is a difficult technique to master. Graft material is inserted under the squamous(skin layer) of the eardrum. It is a difficult task peeling only the skin layer away from the tympanic membrane, placing the graft over the perforation and redraping the skin layer. Underlay technique: This is a simpler and commonly used technique. Graft is placed under the tympanomeatal flap which has been elevated hence the name underlay. The major advantage of this procedure is that it is easy to perform with a good success rate.

6 TYMPANOPLASTY There are five basic types of tympanoplasty procedures: Type I : Tympanoplasty is called myringoplasty, and only involves the restoration of the perforated eardrum by grafting. Type II : Tympanoplasty is used for tympanic membrane perforations with erosion of the malleus. It involves grafting onto the incus or the remains of the malleus.

7 TYMPANOPLASTY There are five basic types of tympanoplasty procedures.. Type III : Tympanoplasty is indicated for destruction of two ossicles, with the stapes still intact and mobile. It involves placing a graft onto the stapes, and providing protection for the assembly. Type IV : Tympanoplasty is used for ossicular destruction, which includes all or part of the stapes arch. It involves placing a graft onto or around a mobile stapes footplate. Type V : Tympanoplasty is used when the footplate of the stapes is fixed.

8 TYMPANOPLASTY TYMPANOPLASTY WITHOUT MASTOIDECTOMY WITH MASTOIDECTOMY WITH MASTOIDOTOMY WITHOUT OSSICULAR RECONSTRUCTION WITH OSSICULAR RECONSTRUCTION WITHOUT OSSICULAR RECONSTRUCTION WITH OSSICULAR RECONSTRUCTION WITH OCR, WITH PROSTHESIS WITHOUT OSSICULAR RECONSTRUCTION WITH OSSICULAR RECONSTRUCTION WITH OCR, WITH PROSTHESIS WITH INTACT OR RECONSTRUCRED CANAL WALL RADICAL OR COMPLETE WITH INTACT OR RECONSTRUCRED CANAL WALL RADICAL OR COMPLETE

9 69620-Myringoplasty (surgery confined to the drumhead and donor area) Tympanic membrane is visualized through the external ear the edges of the perforation are roughened. Packing may be paced. A fat graft plug is placed in the perforation or a piece of fascia may be placed. A tympanomeatalflap may be raised. The middle ear is not exploredor visualizedin this case. This is also known as Type I tympanoplasty. GUIDELINE: The harvesting of graft is inclusive to the procedure.

10 TYMPANOPLASTY: Codes range Codes capture the complex tympanoplasty.

11 Tympanoplasty includes canalplasty, atticotomy and or middle ear surgery. The edges of the tympanic membrane are roughened. The eardrum is reflected forward. Adhesions are lysedif any, debris or middle ear cholesteatomais removed. Graft or packing may be placed.

12 Ossicular Chain (Malleus) (Incus) (Stapes)

13 Tympanoplasty without mastoidectomy: Initial or revision-incision is made in the ear canal skin through postauricular or transcanal approach, Ossicles are not reconstructed This procedure usually involves the use of an operating microscope with Ossicular reconstruction (OCR). Packing may be used assign, if prosthesis is used with the above procedure. Prosthesis can be PORP or TORP.

14 Tympanoplasty with mastoidotomy: Through postauricularincision, the mastoid cortex is removed and air cells are drilled out to enter the antrum. Graft or packing may be placed w/o OCR w OCR prosthesis is used with OCR

15 Tympanoplasty with mastoidectomy: mastoid cortex drilled out through a postauralor endauralincision. Posterior bony canal wall is taken down to the level of facial nerve, middle ear is explored.graft or packing may be placed. Posterior skin flap and reconstructed eardrum are repositioned, meatoplasty is done w/o OCR w OCR with intact or reconstructed wall w/o OCR

16 Tympanoplasty with mastoidectomy: Contd with intact or reconstructed wall w OCR radical or complete, w/o OCR radical or complete, w OCR

17 STAPES MOBILIZATION: Incision is made in the posterior inner canal through the external ear canal. Incus and stapes are visualized, stapes is mobilized if fixated by applying pressure with delicate instrument.

18 STAPEDECTOMY/STAPEDOTOMY with reestablishment of ossicular continuity, with or without use of foreign material with reestablishment of ossicular continuity, with or without use of foreign material; with footplate drill out Revision of stapedectomyor stapedotomy

19 69666-Repair of oval window fistula Incision through external ear canal opening or postauricular. Using microscope, oval window area inspected for fluid leak from inner lining around oval window roughened. Area packed with fat fascia or muscle tissue.

20 OPERATING MICROSCOPE Microsurgical techniques, requiring use of operating microscope Note-Do not assign in Note-Do not assign in addition to procedure(s) where use or operating microscope is an inclusive component.

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