Myringotomy and the placement of a tympanostomy tube is a treatment modality for clearing the fluid from the middle ear. This fluid accumulation mostly happens due to middle ear infections. These procedures help to improve effusion-associated hearing loss.
Myringotomy is a minimally invasive surgical procedure that involves creating a small incision in the eardrum (tympanic membrane). This procedure relieves pressure and drains fluid or pus from the middle ear. When this procedure is accompanied by the placement of a tympanostomy tube in the myringotomy incision, it is called a tympanostomy.
How are myringotomy and tympanostomy performed?
The procedure can be done on an outpatient basis under local anesthesia. Children usually require general anesthesia. The patient is made to lie down with their head tilted so that the affected ear is accessible. The surgeon uses an operative microscope or endoscope with a camera and light to see inside the ear. A small incision is made in the lower part of the tympanic membrane using a small knife called a myringotomy knife. The incision is small, around 3-5 mm in length. The fluid or pus from the middle ear is suctioned out. Following this, a tympanostomy tube of 3, 5, or 7 mm in size is inserted to release fluid, prevent the accumulation of fluid in the middle ear, and equalize pressure. The procedure is short and takes around 10 minutes.
What happens after myringotomy and tympanostomy?
Patients can typically go home the same day after the procedure. The recovery period is quite short. Patients may experience minimal pain and discomfort, but this usually resolves in a few days. The doctor may prescribe painkillers, antibiotic ear drops, or oral antibiotics. The doctor may also prescribe oral decongestants, nasal decongestant drops, and nasal steroid sprays. Nasal allergies and nasal discharge can cause fluid accumulation in the middle ear through the eustachian tube.
Once the tympanostomy tubes are placed, patients would not be able to perform certain activities, such as scuba diving or swim deep underwater (swimming on the surface is acceptable). Patients may need to wear earplugs after the procedure to prevent water from entering the ears. The tympanostomy tubes will eventually fall out of the tympanic membrane in around 6-9 months and the opening that was made will seal on its own. Rarely, the tube may have to be removed by the doctor and the opening may need to be surgically closed.
The risks of a tympanostomy procedure are as follows:
- Persistent tympanic membrane perforation: This may need an additional procedure to seal the membrane
- Tympanostomy tube otorrhea: Persistent ear discharge due to a biofilm formation over the tube
- Retained tympanostomy tubes requiring another operation for removal
- Accidental displacement of the tube into the middle ear cavity
- Localized thinning of the tympanic membrane due to the cut made
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Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical Practice Guideline: Tympanostomy Tubes in Children. Otolaryngol Head Neck Surg. July 2013;149(1 Suppl):S1-35. https://pubmed.ncbi.nlm.nih.gov/23818543/
Pelton S. Otitis Media With Effusion (Serous Otitis Media) in Children: Management. UpToDate. https://www.uptodate.com/contents/otitis-media-with-effusion-serous-otitis-media-in-children-management?search=myringostomy&source=search_result&selectedTitle=2~32&usage_type=default&display_rank=2