Myringotomy Surgery for Ear Tubes

A myringotomy, or surgery to make a hole in the eardrum, is a common surgery. It is typically paired with the insertion of a tympanostomy tube, a tiny tube that is placed in the newly created hole in the eardrum, which allows sterile material to drain from the middle ear. The procedure is performed by an otolaryngologist, also known as an ear, nose and throat doctor.


Myringotomy Surgery Explained

Doctor checking senior mans ear with otoscope
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The surgery may be performed on both ears if necessary, or only one if the middle ear problem is present only on one side. The procedure is most frequently performed on children, usually under five years of age, but may also be performed on older children and adults. The procedure is a temporary solution, as the ear tubes eventually fall out, but can be repeated if necessary.

The laser method of the myringotomy surgery can be performed in a doctor’s office with an ear numbing medication, but the vast majority of procedures are performed in a hospital with general anesthesia. It may be difficult to locate a doctor performing this procedure outside of a hospital as the laser equipment is extremely expensive.

It is important to properly prepare children for surgery so that the experience is not a terrifying one. While different age groups require different information before surgery, it is important that the child not find out about the surgery upon arrival at the hospital. It is well worth the time to make sure that a child’s fears and concerns are addressed prior to the procedure.


When Is a Myringotomy Necessary?

The most common reason a myringotomy, or surgery to place a hole in the eardrum, is performed is otitis media with effusion (OME) or a middle ear with fluid for greater than three months. The fluid builds up behind the eardrum, where it can be so thick that it is referred to as “glue ear.” This can interfere with hearing, and in some cases, slow speech development in children, especially if the problem is present in both ears.

Reasons for Ear Tube Insertion Surgery

  • Ear infection that does not respond to antibiotics or ear medications.
  • Middle ear fluid that is causing hearing loss or speech delays.
  • Repetitive acute otitis media (AOM) (three episodes in six months or four in 12 months) when it doesn't respond to ongoing antibiotic therapy and impairs speech, hearing or both.
  • Barotrauma: Damage from changes in pressure, such as scuba diving or flying.
  • Congenital malformation of the ear (cleft palate or Down's syndrome, etc).

Adults and Myringotomy

A myringotomy with ear tube insertion is much less common in adults than it is in children. While the procedure may be performed for a recurrent ear infection, this is less likely in adults because of structural changes in the ear canal as it grows.

In most cases, a myringotomy is performed on adults because of barotrauma. Barotrauma results from a significant difference in pressure inside the ear (behind the eardrum) and outside of the ear. Major differences in pressure can occur with altitude changes, such as riding in an elevator in a tall building or flying. Scuba diving can also result in barotrauma.

A myringotomy may be done as a temporary measure in adults, with the procedure being done to temporarily place a hole in the eardrum that will close once the pressure is released. The tube may or may not be placed based on the reasons that the surgery is being performed.


The Surgical Procedure

A myringotomy is performed using general anesthesia when it is performed in a hospital. After the anesthesia is administered, the procedure begins with the preparation of the ear. The ear is prepared with a solution that minimizes the possibility of infection.

Once the ear has been prepared, the surgeon will use either a laser or a sharp instrument to create a tiny hole in the eardrum. A tympanostomy tube is then inserted in the hole, which would heal and close without the tube.

If middle ear fluid is the reason for the surgery, gentle suction may be applied to the eardrum, removing the fluid through the new tube. This usually removes a significant amount of the fluid, which creates an improvement in hearing that is often noted immediately after surgery. The ear may then be packed with cotton or gauze to absorb any drainage that is present.

At this time, the surgery either is complete or the opposite ear is treated with the same procedure. The anesthesia is then turned off and medication is given to wake the patient. The patient is then taken to the recovery room to be closely monitored while the anesthesia wears off completely.


The Risks of Surgery

In addition to the general risks of surgery and the risks of anesthesia, a myringotomy procedure has its own risks. The risk associated with this procedure is minimal, as the surgery is quick (less than 15 minutes in most cases) so there is less exposure to anesthesia than with a typical surgery.

Risks of Myringotomy

  • Permanent hole in the eardrum that does not close over time, and may require a tympanoplasty to encourage healing
  • Sclerosis (hardening/thickening) of the eardrum, which can cause hearing loss
  • Surgical injury to the outer ear or ear canal
  • The need for the procedure to be repeated in the future
  • Infection
  • Chronic drainage
  • Scarring of the eardrum. This is typically not an issue for hearing, it is a condition that is noted during an ear examination but may not affect the function of the eardrum.

Recovering From Myringotomy

Once the surgery is complete, the patient will be taken to the recovery room to be observed while the anesthesia wears off. Once the patient is awake, alert and experiencing no post-operative complications, recovery can continue at home.

There is no need for incision care as the surgery is performed directly on the eardrum so no incision in the skin is made. In the first days of recovery, it is not uncommon to have drainage from the ear is expected. It may be pus-like in appearance, blood-tinged or clear. This is normal. At this point, the ear should be protected from water, which can get inside the ear through the tube, just as drainage comes out of the tube. Your surgeon may recommend earplugs be used during showers, swimming or any activity that has a risk of water entering the ear.


Life After Myringotomy

After having ear tubes inserted, the occurrence of fluid build up in the middle ear will be dramatically reduced. This will result in a decrease in pain, an improvement in the ability to hear, and in young children, the surgery will help improve speech.

In most cases, the ears will need to be protected from water until the tubes fall out naturally, which usually happens 6 to 18 months after surgery, and the hole in the ear closes completely. This can be done with earplugs to allow swimming and water activities. Your surgeon may recommend that earplugs be used in the shower as well.

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