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H72.1 – Attico-antral Tympanic Membrane Perforation
H72.1 is the ICD-10 code for attico-antral perforation of the tympanic membrane – a defect in the upper posterior area of the eardrum often linked to cholesteatoma.
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H72.1 is the ICD-10 code for attico-antral perforation of the tympanic membrane – a defect in the upper posterior area of the eardrum often linked to cholesteatoma.
What is H72.1?
The ICD-10 code H72.1 refers to attico-antral perforation of the tympanic membrane (eardrum). This is a hole or defect located in the posterior superior region of the eardrum, involving the attic (epitympanum) and the antrum mastoideum of the middle ear. Compared to central perforations, this type is clinically more significant because it is frequently associated with cholesteatoma – an abnormal growth of skin cells within the middle ear – and carries a higher risk of serious complications.
Causes
Attico-antral tympanic membrane perforations typically arise from the following causes:
- Chronic otitis media: Persistent middle ear infections gradually erode the eardrum tissue.
- Cholesteatoma: Ingrowth of squamous epithelium (skin cells) into the middle ear that destroys surrounding tissue and causes perforation.
- Trauma: Injury from pressure waves (e.g., explosions), direct trauma, or foreign objects inserted into the ear canal.
- Eustachian tube dysfunction: Chronic ventilation problems of the Eustachian tube can lead to retraction pockets and eventual perforation.
Symptoms
Patients with this condition commonly report:
- Hearing loss: Conductive hearing loss due to the eardrum defect and possible middle ear involvement.
- Ear discharge (otorrhoea): Often foul-smelling, particularly when associated with cholesteatoma.
- Ear pain (otalgia): Occasionally present, especially during acute flare-ups.
- Dizziness or vertigo: If the inner ear structures become involved.
- Tinnitus: Ringing or buzzing sounds in the ear.
Diagnosis
Diagnosis is typically made by an ENT (ear, nose, and throat) specialist using:
- Otoscopy / Otomicroscopy: Direct examination of the eardrum. The attico-antral perforation is typically visible in the postero-superior quadrant or in the pars flaccida region.
- Audiometry: Hearing tests to assess the degree and type of hearing loss.
- CT scan of the temporal bone: Computed tomography imaging to evaluate bone erosion, extent of cholesteatoma, and potential complications.
- Microbiological swab: Taken in cases of discharge to identify causative bacteria and guide antibiotic therapy.
Treatment
Treatment depends on the severity of the perforation and its underlying cause:
Conservative Management
- Local and systemic antibiotics to treat acute bacterial superinfection.
- Regular ear cleaning and monitoring by an ENT specialist (aural toilet).
- Keeping the ear dry, especially during bathing or swimming.
Surgical Treatment
- Tympanoplasty: Surgical repair of the perforated eardrum using the patient's own tissue (typically temporalis fascia), aiming to restore hearing and prevent recurrent infections.
- Mastoidectomy: Surgical removal of diseased tissue from the mastoid process, particularly when cholesteatoma or extensive disease is present.
- Ossiculoplasty: Reconstruction of the ossicular chain (the tiny bones of the middle ear) if they have been damaged by infection or cholesteatoma.
Complications
If left untreated, attico-antral perforation can lead to serious complications:
- Progression of cholesteatoma with bone destruction
- Intracranial complications such as meningitis or brain abscess (rare but life-threatening)
- Damage to the facial nerve (cranial nerve VII)
- Inner ear involvement causing sensorineural hearing loss or vestibular disturbance
References
- World Health Organization (WHO): International Classification of Diseases, 10th Revision (ICD-10), Chapter VIII – Diseases of the Ear and Mastoid Process (H60–H95). Geneva, 2019.
- Gleeson M. et al. (eds.): Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 7th Edition. Hodder Arnold, London, 2008.
- Bluestone C.D., Klein J.O.: Otitis Media in Infants and Children, 4th Edition. BC Decker Inc., Hamilton, 2007.
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