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Myringotomy
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Myringotomy

(Tympanostomy; Tympanotomy; Ear Tubes Surgery)

En Español (Spanish Version)

Definition

A surgical procedure to open the tympanic membrane (eardrum) and remove fluid, such as blood, pus, and/or water, from the middle ear. The fluid is typically caused by infection or allergy. In many cases, a small tube is also inserted in the middle ear to maintain drainage. This surgery is most often performed on children, but is sometimes performed on adults.

Parts of the Body Involved

  • Eardrum
  • Middle ear
  • External ear canal

Reasons for Procedure

  • To relieve symptoms caused by pressure due to chronic fluid buildup in the middle ear that lasts 3 to 6 months and does not respond to nonsurgical treatments.
  • To relieve pain in case of severe otitis media not responding to medical treatment.
  • To restore hearing loss caused by fluid build-up and to prevent delayed speech development caused by hearing loss in children.
  • To take sample fluid from the middle ear to examine in the lab for the presence of microorganisms.
  • To place tympanostomy tubes, which help to equalize pressure, in an attempt to prevent recurrent ear infections and the accumulation of fluid behind the ear drum.

Risk Factors for Complications During the Procedure

Complications during myringotomy are rare, and there are no significant risk factors for myringotomy when it is done without general anesthesia. When performed under general anesthesia, myringotomy carries the same risks as any other surgical procedure that requires a patient to be put to sleep.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Blood tests
  • Hearing test
  • Tympanogram—a test that measures how well the eardrum responds to changes in pressure. A machine called a tympanometer, which is attached to a small, soft tip that fits snugly into the ear canal, records eardrum movement, and the results are displayed on a graph.
  • Examine the external ear and the ear drum with a special instrument called an otoscope

In the days leading up to your procedure:

  • Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure.
  • Arrange for a ride to and from the procedure.
  • Do not eat or drink anything for at least 8 hours before the procedure.

During Procedure

Anesthesia will be administered.

Anesthesia

General anesthesia is typically used. In some cases a local anesthetic, applied topically, will be used.

Description of the Procedure

An instrument called a speculum is placed in the external ear canal, and an operative microscope is placed in position. Taking care not to injure the small bones in the middle ear, a tiny incision is made in the eardrum. Fluid built up in the middle ear is then drained, and in most cases, an ear tube to continue drainage is inserted and left in place.

No stitches are used to close the incision; generally, the incision will heal itself. The procedure is often performed on both ears. Some surgeons may use a laser beam to make the opening in the ear drum.

Myringotomy

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© 2008 Nucleus Medical Art, Inc.

After Procedure

You will be taken to the postoperative area, watched for complications, and given liquids. Once your vital signs are normal (usually within 2 to 3 hours) you will be moved to a hospital room, or you may be sent home.

How Long Will It Take?

The surgery lasts 15 to 20 minutes, but the overall duration including anesthesia may last 60 to 90 minutes.

Will It Hurt?

Anesthesia prevents pain during surgery. However, you may have minor pain after surgery, and your doctor can give you pain medication or recommend a nonprescription pain reliever to manage this discomfort. Also, lidocaine eardrops may be administered to decrease pain.

If ear tubes are inserted, you may feel popping, pulsation, clicking, or minor pain when burping, chewing, or yawning until the ear heals around the tubes.

Possible Complications

Complications from myringotomy are rare. They include:

  • Excessive bleeding
  • Infection
  • Failure of the myringotomy incision in the ear drum to heal as expected
  • Hearing loss
  • Injury to ear structures other than the ear drum
  • Formation of a benign middle ear cholesteatoma , which may damage surrounding bone and require significant surgery
  • Need for repeat surgery

Average Hospital Stay

In the absence of any other surgical or medical problems, the procedure is performed as an out patient.

Postoperative Care

  • If cotton was placed in the ear canal to absorb postsurgical drainage, change it regularly. (Drainage should end or reduce to a minimal amount within 2 to 3 days.)
  • If you are given eardrops, use as directed, usually 3 drops in each ear 3 times a day for 3 days after surgery.
  • If water gets in the ear after surgery, monitor for drainage. If drainage begins, use eardrops if directed by your physician, and if drainage continues for 3 days (or as directed), call your doctor.
  • To speed healing, resume normal activities as soon as possible; within 2 days after surgery.
  • Take any medications as prescribed by your doctor.
  • Use earplugs prescribed by your doctor while swimming or bathing, and avoid underwater swimming and diving unless instructed otherwise.
  • Do not drive for at least 3 to 4 days after surgery.
  • See your doctor for any needed tests.
  • Do not clean your ear after surgery or place anything other than eardrops, cotton, or ear plugs into the ear unless instructed otherwise by your doctor.

Outcome

Complete healing without complications should occur within four weeks. Pain and/or pressure in the ear due to fluid build-up should be alleviated, and hearing loss due to fluid build-up should improve as well.

If ear tubes were inserted, they should fall out within 6 to 12 months. In some cases, surgery to remove the ear tubes may be necessary. Most ear drums heal normally after tubes come out, but visible scarring is not unusual.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the ear
  • Pain in the ear increases after surgery
  • Drainage from ear continues for more than four days after surgery
  • Headaches, muscle aches, dizziness, or general ill feeling
  • Constipation or abdominal swelling
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

National Institute on Deafness and Other Communication Disorders, NIH
http://www.nidcd.nih.gov

CANADIAN RESOURCES:

Canadian Society of Otolaryngology
www.entcanada.org/public2/patient10

Hospital for Sick Children
www.sickkids.ca

References:

Baylor College of Medicine Department of Otorhinolaryngology and Communicative Sciences website. Available at: http://www.bcm.edu/oto/ .

The University of Chicago Children's Hospital website. Available at: http://www.uchicagokidshospital.org/ .



Last reviewed November 2007 by Elie Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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