October 11, 2017
A myringotomy is a procedure to put a small incision in the eardrum so that fluid or infection trapped in the middle ear can drain out. The fluid may be blood, pus, and/or water. In many cases, a small tube is inserted into the hole in the eardrum to help ventilate the middle ear and maintain drainage.
When Is Myringotomy with Ear Tubes Recommended?
According to the American Academy of Otolaryngology (AAO), ear tubes may be recommended when a person experiences repeated middle ear infections (acute otitis media) or has hearing loss caused by persistent fluid in the middle ear (otitis media with effusion). These conditions most commonly occur in children one to three years old, but also can be present in teens and adults. It is the most common surgery with anesthetic performed on children, with more that half a million ear tube surgeries occurring every year.
If left untreated, recurrent ear infections may lead to speech and balance problems, hearing loss, poor school performance, or changes in the structure of the ear drum. The AOO points out that “Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down syndrome, cleft palate, and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes as in flying and scuba diving).”
A myringotomy with ear tubes is typically an outpatient surgery and 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.
- To help treat an ear infection that is not responding to medical treatment.
- Reduce the risk of future ear infection.
- Improve speech problems and balance problems.
- Improve behavior and sleep problems caused by chronic ear infections.
- Help children do their best in school.
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.
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What to Expect Prior to the Procedure
Your doctor will likely do the following:
- Blood tests
- Hearing test
- Tympanogram—a test that measures how well the eardrum responds to changes in pressure
- Examine the external ear and the eardrum with an instrument called an otoscope
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 one week before the procedure.
Description of a Myringotomy Procedure
General anesthesia is most often used during a myringotomy procedure. You will be asleep. In some cases, a local anesthetic will be used to numb the ear. A small microscope is placed in position to give the doctor a better view and a tiny incision is made in the eardrum. Fluid from the middle ear will then be drained and, in most cases, a small tube is inserted and left in place. This allows the drainage to continue.
No stitches are used to close the incision, and it 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. The surgery only lasts about 15-20 minutes, and the patient can usually return home after an hour or two.
What to Expect After the Procedure
Hearing loss associated with fluid buildup usually resolves as soon as the fluid is drained from the ear. Pain and discomfort after the procedure can be managed with medications. Lidocaine ear drops may also be given to decrease pain. At home, care may include:
- Replacing cotton in the ear canal used to absorb postsurgical drainage.
- Using ear drops a few times a day.
- Monitoring the ear for drainage if water gets inside.
- Using ear plugs while swimming or bathing.
- Avoiding underwater swimming and diving until further notice.
- Not cleaning the ear after surgery or placing anything other than ear drops, cotton, or ear plugs into the ear.
If ear tubes are inserted, the patient 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 should 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.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- 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
It is important for you to monitor your recovery after you leave the care center. If any of the following occur, call your doctor right away:
- 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 medication(s) 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.
If you suspect you or a family member are a candidate for ear tubes, please consult your healthcare provider. Dr. Paul Lenkowski of LewisGale Physicians is available to answer all of your questions. To schedule an appointment, call the practice at (540) 444-8100 or book an appointment online below.Book An Appointment Online with Dr. Paul Lenkowski