Myringotomy is a surgical procedure in which a small incision is made in the eardrum (the tympanic membrane), usually in both ears. The English word is derived from myringa,modern Latin for drum membrane, and tome, Greek for cutting. It is also called myringocentesis, tympanotomy, tympanostomy, or paracentesis of the tympanic membrane. Fluid in the middle ear can be drawn out through the incision.
Ear tubes, or tympanostomy tubes, are small tubes open at both ends that are inserted into the incisions in the eardrums during myringotomy. They come in various shapes and sizes and are made of plastic, metal, or both. They are left in place until they fall out by themselves or until they are removed by a doctor.
Reasons for Procedure
A myringotomy may be done:
- To help treat an ear infection that is not responding to medical treatment
- To restore hearing loss caused by fluid build-up and to prevent delayed speech development caused by hearing loss in children
- To take sample fluid from the middle ear to examine in the lab for the presence of bacteria or other infections
- To place tympanostomy tubes These tubes help to equalize pressure. It may also help prevent recurrent ear infections and the accumulation of fluid behind the ear drum.
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.
How Are Ear Tubes Inserted ?
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).
Ear Tube Surgery
A light general anesthetic (laughing gas) is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly. Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.
Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications.
When complications do occur, they may include:
- Perforation – This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
- Scarring – Any irritation of the ear drum (recurrent ear infections), including repeated in-sertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problems with hearing.
- Infection – Ear infections can still occur in the middle ear or around the ear tube. How-ever, these infections are usually less frequent, result in less hearing loss, and are easier to treat – often only with ear drops. Sometimes an oral antibiotic is still needed.
- Ear Tubes Come Out Too Early Or Stay In Too Long – If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by the otolaryngologist.
The Risks Include:
- Cutting the outer ear
- Formation at the myringotomy site of granular nodes due to inflammation
- Formation of a mass of skin cells and cholesterol in the middle ear that can grow and damage surrounding bone (cholesteatoma)
- Permanent perforation of the eardrum
It is also possible that the incision won’t heal properly, leaving a permanent hole in the eardrum. This result can cause some hearing loss and increases the risk of infection .