What is Myringotomy?

Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum, so as to relieve pressure caused by the excessive buildup of fluid, or to drain pus. Myringotomy is often performed as a treatment for otitis media. Before the invention of antibiotics, myringotomy was the main treatment of severe acute otitis media.

The eardrum, also called the tympanic membrane, ordinarily heals within two weeks or so of a myringotomy – unless a tube is inserted into the opening that was made or unless the opening is made with a laser. Depending on the design of the tube, a myringotomy and tube procedure can allow external ventilation of the middle ear space for weeks, months or even years. Myringotomy with tube insertion is performed for the relief of otitis media.

Effects of Myringotomy

The purpose of myringotomy is to relieve symptoms, to restore hearing, to take a sample of the fluid to examine in the laboratory in order to identify any microorganisms present, or to insert ear tubes.

Parents often report that children talk better, hear better, are less irritable, sleep better, and behave better after myringotomy with the insertion of ear tubes.

Candidates for Myringotomy

The insertion of ear tubes may be recommended by your child’s physician and/or an ear, nose, and throat physician if several of the following conditions are present:

  • fluid in the ears for more than three or four months following an ear infection
  • fluid in the ears and more than three months of hearing loss
  • changes in the actual structure of the eardrum from ear infections
    a delay in speaking
  • repeated ear infections that do not improve with antibiotics over several months

Your Consultation

The child may not have food or water for four to six hours before anesthesia. Antibiotics are usually not needed.

The Myringotomy Procedure

The procedure is usually done in an ambulatory surgical unit under general anesthesia, although some physicians do it in the office with sedation and local anesthesia, especially in older children. The ear is washed, a small incision made in the eardrum, the fluid sucked out, a tube inserted, and the ear packed with cotton to control bleeding.

Ear tubes, or tympanostomy tubes, are small tubes, open at both ends that are inserted into the incisions in the eardrums during myringotomy. There has been an effort to design ear tubes that are easier to insert or to remove, and to design tubes that stay in place longer. They come in various shapes and sizes and are made of plastic, metal, or both. They are left in place until they fall out by themselves or until they are removed by a doctor.

Although this very brief microsurgical procedure can be performed on an outpatient basis, without the need for a general anaesthetic in co-operative adults, children require a short general anesthetic for tube insertion

Recovery

Use of antimicrobial drops is controversial. Water should be kept out of the ear canal until the eardrum is intact. A doctor should be notified if the tubes fall out.

An additional element of post-operative care is the recommendation by many doctors that the child use ear plugs to keep water out of the ear during bathing or swimming, to reduce the risk of infection and discharge.

Risks

The risks include:

  • Cutting the outer ear
  • Formation at the myringotomy site of granular nodes due to inflammation
  • Formation of a mass of skin cells and cholesterol in the middle ear that can grow and damage surrounding bone (cholesteatoma)
  • Permanent perforation of the eardrum.

The risk of persistent discharge from the ear (otorrhea) is 13%.

If the procedure is repeated, structural changes in the eardrum can occur, such as loss of tone (flaccidity), shrinkage or retraction, or hardening of a spot on the eardrum (typmanosclerosis). The risk of hardening is 51%; its effects on hearing aren’t known, but they are probably insignificant.

It is possible that the incision won’t heal properly, leaving a permanent hole in the eardrum, which can cause some hearing loss and increases the risk of infection.

It is also possible that the ear tube will move inward and get trapped in the middle ear, rather than move out into the external ear, where it either falls out on its own or can be retrieved by a doctor. The exact incidence of tubes moving inward is not known, but it could increase the risk of further episodes of middle-ear inflammation, inflammation of the eardrum or the part of the skull directly behind the ear, formation of a mass in the middle ear, or infection due to the presence of a foreign body.

The surgery may not be a permanent cure. As many as 30% of children undergoing myringotomy with insertion of ear tubes need to undergo another procedure within five years.

FAQs

What is Myringotomy with insertion of ear tubes?

Myringotomy with the insertion of ear tubes is an optional treatment for inflammation of the middle ear with fluid collection (effusion), also called glue ear that lasts more than three months (chronic otitis media with effusion) and does not respond to drug treatment. It is the recommended treatment if the condition lasts four to six months. Effusion is the collection of fluid that escapes from blood vessels or the lymphatic system. In this case, the fluid collects in the middle ear.

What are myringotomy tubes (also called ear tubes, tympanostomy tubes, or ventilation tubes)?

Myringotomy tubes are small tubes that are surgically placed into your child’s eardrum by an ear, nose, and throat surgeon. The tubes may be made of plastic, metal, or Teflon®. The tubes are placed to help drain the fluid out of the middle ear in order to reduce the risk of ear infections. During an ear infection, fluid gathers in the middle ear, which can affect your child’s hearing. Sometimes, even after the infection is gone, some fluid may remain in the ear. The tubes help drain this fluid, and prevent it from building up. The most common ages are from 1 to 3 years old. By the age of 5 years, most children have wider and longer eustachian tubes (a canal that links the middle ear with the throat area), thus, allowing better drainage of fluids from the ear.

What are the benefits of ear tubes?

The following are some of the possible benefits:

  • Ear tubes help to reduce the risk of future ear infections.
  • Hearing is restored in some children who experience hearing problems.
  • Speech development is not harmed.
  • Ear tubes allow time for the child to mature and for the eustachian tube to work more efficiently. (By the age of 5 years, the eustachian tube becomes wider and longer, thus, allowing for better drainage of fluids from the ears.)
  • Children’s behavior, sleep, and communication may be improved if ear infections were causing problems.

What are the risks of using ear tubes?

The following are some of the risks that may be discussed:

 

  • Some children with ear tubes continue to develop ear infections.
  • There may be problems with the tubes coming out.
  • The tubes usually fall out in about one year. After they fall out, if ear infections recur, they may need to be replaced.
  • If they remain in the ear too long, the surgeon may need to remove them.
  • After they come out, they may leave a small scar in the eardrum. This may cause some hearing loss.
  • Sometimes, after the tube comes out, a small hole may remain in the eardrum. This hole may need to be repaired with surgery.

 

When should a nerve block not be performed?

Patients who are on anticoagulant therapy with heparin or coumadin should not undergo a nerve block procedure. These particular medications can increase the risk of bleeding. Also, nerve blocks should not be performed on patients who have an active infection around the area of pain or on those who are allergic to local anesthetics or steroids.