Most common operation among children in the U.S.
Main indication for the procedure in young children is persistent otitis media with effusion of three to six months.
A myringotomy, is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear.
A tympanostomy tube is placed into the eardrum to keep the middle ear aerated.
The terms myringotomy, tympanotomy, tympanostomy, and tympanocentesis overlap in meaning.
A myringotomy prevent reaccumulation of fluid in the eustachian tube.
The incision in the thympanic membrane usually heals spontaneously in two to three weeks.
The tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.
Patients requiring a myringotomy usually have an obstructed or dysfunctional eustachian tube that is unable to perform drainage or ventilation.
Before antibiotics, myringotomy without tube placement was also used as a major treatment of severe acute otitis
Indications for tympanostomy in the pediatric age group: chronic otitis media with effusion (OME) which is unresponsive to antibiotics, and recurrent otitis media.
Adult indications include: Eustachian tube dysfunction with recurrent signs and symptoms, including fluctuating hearing loss, vertigo, tinnitus, and a severe retraction pocket in the tympanic membrane.
Recurrent episodes of barotrauma, especially associated with flying, diving, or hyperbaric chamber treatment, may be a treatment consideration.
Myringotomy is usually performed as an outpatient procedure with general anesthesia in children, while local anesthesia adequate for adults.
A small incision made in the eardrum, fluid that is present is aspirated, and the tube of choice inserted.
The myringotomy and usually heals in one to two days.
Tympanolaserostomy or laser-assisted tympanostomy uses CO2 laser to achieve myringotomy.
The usage of the laser takes one-tenth of a second to create the opening, without damaging surrounding skin or other structures.
The tympanic membrane perforation remains patent for several weeks and provides ventilation of the middle ear without the need for tube placement.
Laser myringotomies maintain patency slightly longer than cold-knife myringotomies: 2-3 weeks for laser and 2-3 days for cold knife without tube insertion.
Laser management has not proven to be more effective in the management of middle ear effusion because of: Multiple recurrences in children, a strong history of allergies in children, the presence of thick mucoid effusions, and history of tympanostomy tube insertion in adults, make it likely that laser tympanostomy will be ineffective.
Traditional metal myringotomy tubes have been replaced by silicon, titanium, polyethylene, gold, stainless steel, or fluoroplastic tubes.
Tubes are now coated with antibiotics and phosphorylcholine.
There are varying incision types used:
Cutting type: given in posterior inferior quadrant, this is done in cases of acute otitis media.
Splitting type: given in anterior inferior quadrant, in cases of serious otitis media
The placement of tubes is not a cure, and there is a possibility that recurrent episodes of middle ear inflammation or fluid collection can occur.
Drainage through the tube occurs in about 15% of patients in the first two weeks , and develops in 25% more than three months after insertion.
Otorrhea is considered to be secondary to bacterial colonization, with most commonly Pseudomonas aeruginosa, and most troublesome is Methicillin-resistant Staphylococcus aureus.
Tympanostomy tubes only offer a short-term hearing improvement in children with simple otitis media who have no other serious medical problems.
Tympanostomy has no effect on speech and language development in children.
A study of success rates in adults and children with otitis media treated with CO2 laser myringotomy showed about a 50% cure rate at six months in both groups.