Clinical Indicators: Myringotomy and Tympanostomy Tubes

1. History (One required)
   1. Severe acute otitis media (myringotomy).
   2. Hearing loss > 30 dB in patient with otitis media with effusion (myringotomy or tube).
   3. Poor response (describe) to antibiotic for otitis media (myringotomy or tube).
   4. Impending mastoiditis or intra-cranial complication due to otitis media (myringotomy).
   5. Otitis media with effusion > 3 months (myringotomy or tympanostomy tube).
   6. Recurrent episodes of acute otitis media (more than 3 episodes in 6 months or more than 4 episodes in 12 months) (tympanostomy tube).
   7. Chronic retraction of tympanic membrane or pars flaccida (tympanostomy tube).
   8. Barotitis media control.
   9. Autophony due to patulous eustachian tube.
   10. Craniofacial anomalies that predispose to middle ear dysfunction (e.g., cleft palate).
   11. Middle ear dysfunction due to head and neck radiation and skull base surgery.
2. Physical Examination (required)
   1. Description of tympanic membrane.
   2. Description of middle ear space
3. Tests
   1. Audiometry–pure tones and/or Speech Reception Thresholds.
   2. Tympanometry.

Postoperative Observations

1. Persistent or profuse bleeding from ear?
2. Otorrhea?

Outcome Review

1. First Month
   1. Infection–Has there been any discharge from the ear requiring treatment?
   2. Tube– Check placement and patency of tube.
2. Beyond One Month
   1. Hearing–Is hearing improved? (Document with audiogram or history and physical exam.)
   2. Infection–Has there been a decrease in the number of ear infections?
   3. Tube–Is tympanostomy tube functioning?
   4. Continued follow-up at last 6 months.

Associated ICD-10-CM Diagnostic Codes

• H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
• H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
• H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
• H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
• H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left
  ear
• H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),
  recurrent, bilateral
• H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous),
  recurrent, unspecified ear
• H65.119 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), unspecified
  ear
• H65.20 Chronic serous otitis media, unspecified ear
• H65.21 Chronic serous otitis media, right ear
• H65.22 Chronic serous otitis media, left ear
• H65.23 Chronic serous otitis media, bilateral
• H65.30 Chronic mucoid otitis media, unspecified ear
• H65.31 Chronic mucoid otitis media, right ear
• H65.32 Chronic mucoid otitis media, left ear
• H65.33 Chronic mucoid otitis media, bilateral
• H65.411 Chronic allergic otitis media, right ear
• H65.412 Chronic allergic otitis media, left ear
• H65.413 Chronic allergic otitis media, bilateral
• H65.419 Chronic allergic otitis media, unspecified ear
• H65.491 Other chronic nonsuppurative otitis media, right ear
• H65.492 Other chronic nonsuppurative otitis media, left ear
• H65.493 Other chronic nonsuppurative otitis media, bilateral
• H65.499 Other chronic nonsuppurative otitis media, unspecified ear
• H69.00 Patulous Eustachian tube, unspecified ear
• H69.01 Patulous Eustachian tube, right ear
• H69.02 Patulous Eustachian tube, left ear
• H69.03 Patulous Eustachian tube, bilateral
• H69.80 Other specified disorders of Eustachian tube, unspecified ear
• H69.81 Other specified disorders of Eustachian tube, right ear
• H69.82 Other specified disorders of Eustachian tube, left ear
• H69.83 Other specified disorders of Eustachian tube, bilateral
• H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
• H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
• H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
• H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
• H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left
  ear
• H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
• H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
• H66.009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified
  ear
• H70.001 Acute mastoiditis without complications, right ear
• H70.002 Acute mastoiditis without complications, left ear
• H70.003 Acute mastoiditis without complications, bilateral
• H70.009 Acute mastoiditis without complications, unspecified ear
• H70.011 Subperiosteal abscess of mastoid, right ear
• H70.012 Subperiosteal abscess of mastoid, left ear
• H70.013 Subperiosteal abscess of mastoid, bilateral
• H70.019 Subperiosteal abscess of mastoid, unspecified ear
• H70.091 Acute mastoiditis with other complications, right ear
• H70.092 Acute mastoiditis with other complications, left ear
• H70.093 Acute mastoiditis with other complications, bilateral
• H70.099 Acute mastoiditis with other complications, unspecified ear
• H74.11 Adhesive right middle ear disease
• H74.12 Adhesive left middle ear disease
• H74.13 Adhesive middle ear disease, bilateral
• H74.19 Adhesive middle ear disease, unspecified ear
• Q35.1 Cleft hard palate
• Q35.3 Cleft soft palate
• Q35.5 Cleft hard palate with cleft soft palate
• Q35.9 Cleft palate, unspecified
• Q35.7 Cleft uvula
• Q37.0 Cleft hard palate with bilateral cleft lip
• Q37.1 Cleft hard palate with unilateral cleft lip
• Q37.2 Cleft soft palate with bilateral cleft lip
• Q37.3 Cleft soft palate with unilateral cleft lip
• Q37.4 Cleft hard and soft palate with bilateral cleft lip
• Q37.5 Cleft hard and soft palate with unilateral cleft lip
• Q37.8 Unspecified cleft palate with bilateral cleft lip
• Q37.9 Unspecified cleft palate with unilateral cleft lip
• Q67.0 Congenital facial asymmetry
• Q67.1 Congenital compression facies
• Q67.2 Dolichocephaly
• Q67.3 Plagiocephaly
• Q67.4 Other congenital deformities of skull, face and jaw
• Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction)
• Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction)
• Q90.2 Trisomy 21, translocation
• Q90.9 Down syndrome, unspecified

Additional Information

Assistant Surgeon — N
Supply Charges — not allowed
Prior Approval — N
Anesthesia Code(s)– 00126

Patient Information

Myringotomy with or without tympanostomy tube insertion is the most commonly performed ear
operation. It is extremely safe and effective. Complications are minor and usually in the form of
infection, which may be treated with antibiotics. The tube usually remains in place for 6 to 12
months, although it may be rejected sooner or remain in place for years. Post-op care including
water precautions are individualized and will be discussed by your physician. Occasionally the
tympanic membrane fails to heal after tubes have been removed, and the resulting perforation
may require surgical repair. In some cases, tympanostomy tubes may need to be replaced.
Hearing improvement is usually immediate after fluid has been removed from the ear. Failure to
improve hearing may indicate a second problem in the middle or inner ear.

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.

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