Myringotomy

(Tympanostomy, Tympanotomy, Ear Tubes Surgery)

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

A surgical procedure to open the tympanic membrane (eardrum) and remove fluid (blood, pus, and/or water) from the middle ear, 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 pain caused by pressure due to chronic fluid buildup in the middle ear that lasts 3-6 months and does not respond to non-surgical treatments
• To restore hearing loss caused by fluid build-up, and, in children, to prevent delayed speech development caused by hearing loss
• 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

Risk Factors for Complications during the Procedure

• Recent illness, especially upper respiratory infection
• Chronic illness
• Previous ear drum perforation
• Smoking
• Use of narcotics or other mind-altering drugs
• Use of certain prescription medications, including anti-hypertensives, insulin, and beta-adrenergic blockers

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Blood tests
• Urine 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.

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

Anesthesia - General or sometimes local (by topical application)

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 repeated on the other ear (in most cases).

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

How Long Will It Take? 60-90 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 non-prescription 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
• Surgical wound infection
• Permanent hearing loss
• Cutting of outer ear
• Formation of granular nodes (in ear) due to inflammation
• Formation of cholesterol and mass skin cells in middle ear, which may damage surrounding bone
• Need for repeat surgery
• Scarring of eardrum

Average Hospital Stay: 0-1 days

Postoperative Care:

• If cotton was placed in the ear canal to absorb post surgical drainage, change it regularly. (Drainage should end or reduce to a minimal amount within 2-3 days.)
• If you are given eardrops, place 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, and if drainage continues for 3 days, call your doctor.
• To speed healing, resume normal activities as soon as possible; within 2 days after surgery.
• Take antibiotics to fight infection, if prescribed by your doctor.
• Do not take prescription medication, if prescribed, for more than 7 days.
• Use earplugs while swimming or bathing, and avoid underwater swimming and diving.
• Do not drive for at least 3-4 days after surgery.
• See your doctor for follow-up blood tests and a hearing test.
• Do not clean your ear after surgery until after you've seen your doctor for a follow-up visit (usually, 2-3 weeks after the procedure)

Outcome

Complete healing without complications should occur within 4 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 6-12 months. In some cases, surgery to remove the ear tubes may be necessary.

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 4 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

SOURCE:

Baylor College of Medicine Department of Otorhinolaryngology and Communicative Sciences

The University of Chicago Children's Hospital

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Last reviewed June 2001 by Medical Review Board