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Occasionally, children who have chronic middle ear fluid with symptoms of pain or hearing loss, or repeated ear infections that don’t respond to antibiotics may require surgery. Surgical treatment can help to relieve pain caused by pressure from chronic fluid build-up in the middle ear. Surgery can also help to restore hearing loss related to fluid build-up, which can help prevent delayed speech development in children.

Myringotomy

During myringotomy, a small incision is made in the eardrum and fluid (blood, pus, and/or water) is removed from the middle ear. The fluid is often cultured to determine which antibiotics will be most effective in destroying the bacteria causing the infections. In cases of chronic otitis media, a small tympanostomy tube is also inserted in the middle ear to help keep the hole open and air pressure in the middle ear normal. This surgery is most often done on children, but is sometimes done on adults as well.

Myringotomy is usually done under general anesthesia or sometimes with topical application of an anesthetic. This procedure can be done with a laser, although any additional benefits from this procedure (laser-assisted tympanic membrane fenestration) remain unproven. No stitches are used in the incision. Complete healing without complications should occur within 4 weeks.

Adenoidectomy

The adenoids are tonsil-like structures located in the back of the nose, invisible to usual methods of examination of either the nose or throat. When adenoids are large, children tend to mouth-breathe, and they may snore at night. Many children with enlarged adenoids have a nasal-sounding voice because of obstruction. The eustachian tubes open into the nose close to the adenoids, and their opening may be blocked when adenoids are enlarged. Blocked eustachian tubes are among the causes of chronic otitis media.

When there are other reasons for removal of adenoids (primarily severe snoring especially with accompanying sleep apnea), then adenoidectomy may reduce the frequency or duration of ear infections. Even in the absence of strong evidence, some surgeons recommend adenoidectomy as a primary treatment for chronic otitis media, usually along with myringotomy and placement of tubes.

REFERENCES:

Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116345/Acute-otitis-media-AOM. Updated May 17, 2016. Accessed September 27, 2017.

Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at: http://www.nidcd.nih.gov/health/hearing/pages/earinfections.aspx. Updated May 12, 2017. Accessed September 27, 2017.

Matilla PS, Joki-Erkkila VP, et al. Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg. 2003;129(2):163-168.

Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx. Updated February 22, 2013. Accessed September 27, 2017.

Last reviewed September 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD  Last Updated: 9/17/2014