Cholesteatoma of attic, left ear
ICD-10 H71.02 is a billable code used to indicate a diagnosis of cholesteatoma of attic, left ear.
Cholesteatoma of the attic in the left ear is a destructive and expanding growth of skin cells in the middle ear and/or mastoid process. It often arises from chronic otitis media or eustachian tube dysfunction, leading to the accumulation of skin debris and infection. Patients may present with symptoms such as hearing loss, ear fullness, tinnitus, and sometimes discharge from the ear. The condition can lead to complications, including erosion of surrounding structures, mastoiditis, and even intracranial infections if left untreated. Diagnosis is typically made through otoscopic examination, imaging studies like CT scans, and audiometric testing to assess hearing loss. Management often involves surgical intervention to remove the cholesteatoma and reconstruct the tympanic membrane, with follow-up care to monitor for recurrence. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.
Detailed history of ear symptoms, audiometric results, imaging studies, and surgical notes.
Patients presenting with chronic ear infections, hearing loss, or post-operative follow-ups.
Ensure clear documentation of the extent of cholesteatoma and any complications.
Audiometric evaluations, patient history regarding hearing loss, and any referrals for surgical intervention.
Assessment of hearing loss in patients with known cholesteatoma.
Document the impact of cholesteatoma on hearing and any recommendations for management.
Used for surgical intervention in cholesteatoma cases.
Surgical notes detailing the procedure and findings.
Otolaryngologists must ensure comprehensive documentation of the surgical approach.
Common symptoms include hearing loss, ear fullness, tinnitus, and discharge from the ear. Patients may also experience pain or pressure in the affected ear.
