Myringotomy
(Tympanostomy; Tympanotomy; Ear Tubes Surgery)
Definition
A myringotomy is a procedure to put a hole in the eardrum. This is done so that fluid or infection trapped in the middle ear can drain out. The fluid may be blood, pus, and/or water. In most cases, a small tube is inserted into the hole in the eardrum. The tube helps to maintain drainage.
Reasons for Procedure
A myringotomy may be done to:
- Restore hearing loss caused by chronic fluid build-up and to prevent delayed speech development caused by hearing loss in children
- Place tympanostomy tubes—these tubes help to equalize pressure. It may also help prevent recurrent ear infections and the accumulation of fluid behind the eardrum
- Take sample fluid from the middle ear to examine in the lab for the presence of bacteria or other infections
- Help treat an ear infection that is not responding to medical treatment
After the procedure, pain and/or pressure in the ear due to fluid build-up should be alleviated. Hearing loss due to fluid build-up should improve as well.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Bleeding
- Infection
- Chronic scarring
- Failure of the myringotomy incision in the eardrum to heal as expected, which may result in frequent drainage
- Hearing loss
- Injury to ear structures other than the eardrum
- Need for repeat surgery
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Hearing test
- Tympanogram—a test that measures how well the eardrum responds to changes in pressure
Leading up to your procedure:
- Arrange for a ride to and from the procedure
- Do not eat or drink anything for at least 8 hours before the procedure
Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
Anesthesia
General anesthesia is most often used. You will be asleep. In some cases, a local anesthetic will be used to numb the ear.
Description of Procedure
A small microscope is placed in position to give the doctor a better view. A tiny incision will be made in the eardrum. Fluid from the middle ear will then be drained. In most cases, a small tube will be inserted and left in place. This will allow the drainage to continue.
No stitches will be used to close the incision. The incision will heal itself. The procedure is often done on both ears. Some doctors may use a laser beam to make the opening in the eardrum.
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How Long Will It Take?
The surgery will last about 15–20 minutes.
Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. Lidocaine ear drops may also be given to decrease pain.
Postoperative Care
Home care may include:
- Replacing cotton in the ear canal used to absorb postsurgical drainage.
- Using ear drops a few times a day.
- Monitoring your ear for drainage if water gets inside your ear.
- Using ear plugs while swimming or bathing.
- Avoiding underwater swimming and diving until further notice.
- Not cleaning your ear after surgery or placing anything other than ear drops, cotton, or ear plugs into your ear.
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. Complete healing without complications should occur within 4 weeks. If ear tubes were inserted, they typically fall out within 6-12 months. In some cases, surgery to remove the ear tubes may be necessary. Most eardrums heal normally after tubes come out, but visible scarring is not unusual.
Call Your Doctor
It is important for you to monitor your recovery after you leave the care center. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the ear
- Pain that you cannot control with the medications you were given
- Drainage from ear continues for more than 4 days after surgery
- Decreased hearing
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Any other new concerns
If you think you have an emergency, call for emergency medical services right away.
RESOURCES:
Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org
National Institute on Deafness and Other Communication Disorders (NIDCD)
https://www.nidcd.nih.gov
CANADIAN RESOURCES:
Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org
Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca
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 16, 2017. Accessed August 29, 2017.
Myringotomy and PE tubes. Baylor College of Medicine Department of Otorhinolaryngology and Communicative Sciences website. Available at: https://www.bcm.edu/healthcare/care-centers/center-hearing-balance/procedures/myringotomy-pe-tubes. Accessed August 29, 2017.
Myringotomy and Tubes. The University of Chicago Children's Hospital website. Available at: http://d3qi0qp55mx5f5.cloudfront.net/comer/i/basic_pages/Myringtomy_with_Tubes_Postoperative_Instructions.pdf?mtime=1500997217. Accessed August 29, 2017.
Otitis media with effusion. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T115313/Otitis-media-with-effusion. Updated September 18, 2016. Accessed August 29, 2017.
Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children—executive summary. Otolaryngol Head Neck Surg. 2013;149(1):8-16.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 9/30/2013