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.
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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.
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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
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Your
Consultation
The child may not have food or water for
four to six hours before anesthesia.
Antibiotics are usually not needed.
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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
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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.
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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.
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Frequently Asked
Questions
Q: What is Myringotomy with insertion of ear
tubes?
A:
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.
Q:
What are myringotomy tubes (also called ear
tubes, tympanostomy tubes, or ventilation
tubes)?
A:
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.
Q: What are the benefits of ear tubes?
A:
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.
Q: What are the risks of using ear tubes?
A:
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.
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