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Summary

Myringotomy is a surgery that involves making a hole in the ear drum to remove or drain out the fluid accumulated inside the middle ear. An eardrum is a membrane located between the middle and the external ear. It vibrates to outer sounds and helps us in hearing. The excessive build-up of fluid in the middle ear may compromise your hearing ability. 

Prior to this surgery, the doctor will perform certain tests like a hearing test or tympanometry to examine your eardrum. You will have to arrange for your drive back home after the surgery. The doctor may ask you to fast for up to eight hours until the procedure is conducted. The surgery can be done in adults or children. Children need general anaesthesia for this surgery, however, in adults, a myringotomy can be performed with a local anaesthesia (only the surgical site is numbed). During this surgery, the doctor will make a cut on the eardrum to remove the fluid. A tube may be inserted to expel the fluid. After the surgery, you will be prescribed ear drops and will be asked to use earplugs until the cut is completely healed.

  1. What is myringotomy?
  2. Why is myringotomy recommended?
  3. Who can and cannot get myringotomy?
  4. What preparations are needed before myringotomy?
  5. How is myringotomy done?
  6. How to care for yourself after myringotomy?
  7. What are the possible complications/risks of myringotomy?
  8. When to follow up with your doctor after a myringotomy?

Myringotomy is a surgery performed to drain the fluid accumulated in the middle ear. The fluid can contain water, dead cells and blood (or infection). The surgery is conducted by making a hole in the eardrum. An eardrum is a membrane that divides the external and the middle parts of your ear. Sound waves from the outside travel through the external part of the ear, enter the ear canal and reach the eardrum, which vibrates from these waves. The vibrations further travel to the inner ear, from which the signals are sent to the brain, which helps you understand and interpret those signals. However, the amassing of fluid in the middle ear may affect your hearing ability.

This surgery may also include the placement of a tympanostomy tube through a surgically created hole in the eardrum. This tube can be manufactured from metal, plastic or Teflon material. The placement of the tube enables the expulsion of fluid, thereby improving your hearing ability.

Your healthcare practitioner will perform this surgery if you have the following conditions: 

  • Otitis media: Otitis media refers to an infection of the middle ear (behind the eardrum). Doctors initially prescribe antibiotic medicines for the management of infection. However, a myringotomy is recommended if there is an occurrence of repeated infections for more than a few months. The symptoms of an ear infection are:
    • Pain in the ear 
    • Loss of appetite
    • Irritation due to pain in the ears 
    • Fever
    • Discharge of yellow, brown or white fluid that is not earwax
    • Difficulty in sleeping because of the pain
    • Difficulty in hearing
  • Delayed speech: Loss of hearing can delay speech development in children. This surgery is performed to prevent a delay in speech development in a child by restoring their hearing ability.
  • Fluid examination: The doctor may perform this surgery to examine the fluid accumulated in the ear for the presence of an infection.
  • Placement of tympanostomy tubes: The positioning of these tubes inside the middle ear may remove the accumulated fluid and help in avoiding repeated ear infections in the middle ear. These tubes may also help you to balance the pressure inside the ear.

You cannot have this surgery if you:

  • Have a mass (cancerous or non-cancerous) in the middle ear 
  • Abnormalities in the blood vessels near this area. 

If you have previously had neck or head radiotherapy, this surgery may be risky for you.

The preparations for the surgery are as follows:

  • Tests: Your ear, nose and throat (ENT) surgeon will examine your ear with an instrument called an otoscope. He/she will conduct the following tests for determine your eligibility for the surgery:

    • Hearing test 
    • Tympanometry (a test to check how the eardrum responds to the change in pressure) 
    • Blood tests may also be done to check your overall health
  • Fasting: You will need to fast for at least eight hours before this surgery until you are deemed fit to eat again. 
  • Driving: You will need someone (a friend or family member) to take you back home after the surgical procedure.
  • Medicines: 
    • Your doctor should be apprised about all the medicines that you (or your child) are taking. This information should also include vitamins, minerals, supplements or natural medicines. You may be instructed to stop the administration of some medicines for at least a week before surgery.
    • You should stop taking medicines such as aspirin, vitamin E and warfarin for a few weeks before the surgery.
  • Consent form: You will need to sign a consent form that gives permission to conduct this surgery.
  • Inform your doctor if you:
    • Have had recent dental problems 
    • Have had blood clots or have bleeding disorders 
    • Are allergic to medicines, latex, skin-cleansing solutions, any foods, iodine, adhesives or skin tapes
    • Drink or smoke
    • Have had cold, flu or fever recently.

This surgery is performed under the influence of general anaesthesia in children. Adults do not require general anaesthesia during the surgery. Local anaesthesia is injected to numb only the area of surgery.

The ENT surgeon and their medical team will perform the following steps for this surgery:

  • You will be positioned on an examining chair with your head tilted away (at the right position) from the ear to be examined. 
  • The surgeon will use a small microscope to get a clearer view of the inside of your ear. 
  • In adults, the surgeon will insert phenol solution inside the middle ear. The solution is not given to children/individuals who are not able to stay still during the procedure
  • Then, he/she will make a tiny cut on your eardrum. 
  • With the use of a suction device, the surgeon will remove the fluid collected in your middle ear. 
  • The surgeon may also insert tubes (typanostomy tube) to continue to drain fluid after the surgery. 
  • The cut on the eardrum will heal on its own. 
  • A healthcare practitioner will put antibiotic ear drops or topical solution on your ear after the surgery to prevent infections. 
  • A cotton ball will be placed inside your ear canal for further protection.

This surgery is quick and may take up to 15–20 minutes. You will be discharged on the day after the surgery. Monitoring in the hospital is not required.

Once you are home, you will need to take the following care:

Anaesthesia care:

Your child may feel sleepy or dizzy because of anaesthesia for up to 24 hours after the surgery. You must let your child to rest until he/she feels better. Once these symptoms disappear, they can resume their normal activities. Local anaesthesia does not have any such symptoms.

Ear care: 

  • You should replace the cotton ball in the ear in the afternoon or evening after the surgery.
  • You should put ear drops a few times in a day as directed by your surgeon.
  • While sneezing, you must gently sneeze while keeping your mouth open.
  • While sleeping, keep your head tilted with at least two pillow cushions under the head.
  • You should not put anything in your ear except earplugs, cotton or the prescribed ear drops.

Medicines: The doctor will prescribe pain killer medicines to ease your pain after the surgery. 

Othe things: 

  • You must avoid getting water inside the ear for up to 10 days after the surgery and take precautions afterwards too. 
  • Use earplugs while showering or washing your hair. 
  • You can clean your ear using a face cloth. 
  • Avoid swimming underwater or diving until advised by the doctor. 

Ear tube care:

  • You may hear sounds such as popping, clicking or pulsations due to the ear tubes. It may also cause minor pain while burping, yawning or chewing. It is normal to feel this until your ear is completely healed. 
  • Your ear tubes will come out within six months or a year.

When to see the doctor?

You need to call your doctor immediately if you experience the following symptoms after the surgery:

  • Fever more than 101 degree Fahrenheit
  • Chills
  • Reduced hearing ability
  • Redness, excess bleeding, increasing pain, swelling or discharge from the ear
  • Cough
  • Shortness of breath
  • Pain even after the administration of pain medicines 
  • Pain in chest 
  • Nausea or vomiting 
  • Discharge of fluid from the ear for more than four days after the surgery

This surgery may have the following complications:

  • Infection
  • Chronic scars - they form over time and can increase especially in children who need the procedure more than once
  • Loss of hearing 
  • Bleeding 
  • Injury to the structures inside the ear other than the eardrum 
  • Frequent drainage from ear because of failure of surgery 
  • Need to repeat the surgery

If you have ear tubes placed, you will need to visit the doctor every six months; otherwise, no follow-up is needed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Myringotomy
  2. Lucile Packard Children's Hospital: Stanford Children's Health [Internet]. Stanford University Health System. California. US; Anatomy and Physiology of the Ear
  3. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Word! Eardrum
  4. Boston Children's Hospital [Internet]. Boston. Massachusetts. USA; Ear Tubes
  5. UCSF Health [Internet]. University of California San Francisco. California. US; Myringotomy
  6. Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L. Clinical nursing skills: basic to advanced skills. 9th ed. New York, NY: Pearson; 2016. Chapter 26, Perioperative care.
  7. Townsend Courtney, Beauchamp R. Daniel, Evers B. Mark, Mattox Kenneth. Sabiston Textbook of Surgery: The biological basis of modern surgical practice. 20th ed. Philadelphia, PA: Elsevier; 2017. Chapter 10, Principles of preoperative and operative surgery.
  8. Newton-Wellesley Hospital [Internet]. Massachusetts. US; Myringotomy and Tubes Instructions
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