Myringotomy Surgery for Ear Tubes

Myringotomy Surgery Explained

Allergies, repeated infections, large adenoids can all prevent the Eustachian tube from letting air from the nasopharynx enter the middle ear. When blocked, the air in the middle ear will be absorbed by the membrane. This causes increasing negative pressure to occur in the middle ear, which will eventually draw fluid to fill the cavity. This interferes with hearing.

Surgery purpose:

• The purpose of the surgical incision is to remove the fluid from the middle ear.
• Then the tube keeps it open to prevent another blockage.

The surgery may be performed on both ears if necessary, or only one if the problem is only present on one side.

The vast majority of procedures are performed in a hospital with general anesthesia, and a laser method of myringotomy surgery can be performed in a doctor’s office with an ear numbing medication.

When Is a Myringotomy Necessary?

The most common reason for a myringotomy is otitis media with effusion (OME), which is fluid accumulation in the middle ear for longer 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, it can affect speech development in children, especially if the problem is present in both ears.

Reasons for Ear Tube Insertion Surgery

• Ear infection that does not improve with antibiotics
• 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) that doesn't improve with 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

Recurrent ear infections are not common in adults because of the structure of the ear canal as it grows.

Barotrauma is the most common reason for adults to have a myringotomy. Barotrauma can occur due to a significant difference between the 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

A myringotomy may be done as a temporary measure in adults, with an incision in the eardrum that will close once the pressure is released. A tube may or may not be placed, depending on the specific reason for surgery.

The Surgical Procedure

This procedure generally takes between 15 minutes to an hour, but you will spend more time at the hospital due to preparation and anesthesia.

When it's done in a hospital, general anesthesia is usually used for a myringotomy. After the anesthesia is administered, 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 incision in the eardrum.
• If the surgery is being done due to a build-up of fluid in the middle ear, gentle suction may be applied to the eardrum to remove the fluid.
• A tympanotomy tube is then inserted in the incision, which would otherwise heal and close without the tube.

After the procedure. your ear may then be packed with cotton or gauze.

At this point, your surgery may be complete or your opposite ear will be treated with the same procedure.

Once your surgery is complete, anesthesia is discontinued. You will be 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.

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
• Scarring of the eardrum can be noted during an ear examination, but may not affect the function of the eardrum
• Surgical injury to the outer ear or ear canal
• The need for a repeated procedure in the future
• Infection
• Chronic drainage

Recovering From Myringotomy

Once the surgery is complete, you will be taken to the recovery room to be observed while the anesthesia wears off. Once you are awake and alert, your recovery can continue at home if you aren't having post-operative complications.

There is no need for incision care because the surgery is performed directly on the eardrum.

If the surgery was done for serous otitis media, the fluid is sterile and completely removed before tube insertion, and there will be no discharge afterward. If you have fluid drainage that looks like pus, this means that you have developed an infection.

You should protect your ear from water, which can get inside the ear through the tube. Your surgeon may recommend that you use earplugs during showers, swimming, or any activity that has a risk of water entering the ear.

Life After Myringotomy

After having ear tubes inserted, fluid should not recur. With a functioning tube in place, the tube keeps the middle ear pressure equal to the atmospheric pressure. This will result in decreased pain and an improvement in the ability to hear. In young children, the surgery will help improve speech.