A myringotomy is a common, minor surgical procedure involving the eardrum (tympanic membrane). It involves creating a small incision in the eardrum to access the middle ear. This opening allows for the drainage of accumulated fluid and the equalization of pressure. The procedure is quick but is typically performed with the insertion of a small device to ensure long-term ventilation.
Why a Myringotomy is Necessary
The primary reason for a myringotomy is to treat conditions where the middle ear accumulates fluid that will not drain naturally. This fluid buildup, known as otitis media with effusion, occurs when the Eustachian tube is blocked or malfunctioning. When the tube does not open properly, air pressure cannot equalize, and a vacuum forms that draws fluid into the middle ear space.
Chronic fluid accumulation is a concern because it can cause significant hearing loss, which is detrimental to speech development in children. Myringotomy is also indicated for recurrent acute otitis media, defined as three or more distinct episodes of infection in six months, or four episodes within a year. The procedure removes the fluid that fuels the infection cycle and helps prevent further occurrences.
The procedure can also address severe ear barotrauma, a painful injury caused by extreme air pressure changes. It may also relieve pain from a severe, acute ear infection that has not responded to antibiotics. The goal is to restore normal middle ear function, relieve discomfort, and prevent complications like chronic eardrum retraction or permanent hearing damage.
The Myringotomy Procedure
A myringotomy is usually performed as an outpatient procedure. Children almost always receive general anesthesia to ensure they remain still during the delicate process. Adults may sometimes undergo the procedure using only a local anesthetic applied directly to the eardrum.
The surgeon uses an operating microscope for precise visualization of the eardrum. A specialized surgical instrument creates a small incision, typically 3 to 5 millimeters long, in the tympanic membrane. Immediately after the incision, any trapped fluid—which may be thin, watery, or thick—is gently suctioned out of the middle ear space.
The procedure concludes with the insertion of a tympanostomy tube, often called a pressure-equalizing (PE) tube or “ear tube,” into the incision. This small, spool-shaped device, made of silicone or metal, acts as a temporary ventilation shaft. The tube keeps the incision open, ensuring the middle ear remains ventilated until the Eustachian tube functions normally. The entire surgical process often takes only 15 to 20 minutes.
Recovery and Aftercare
Patients are typically ready to go home shortly after the anesthesia wears off, and most children can return to normal activities the next day. Mild pain or discomfort is common for one to two days and is managed with over-the-counter pain relievers. A small amount of clear or slightly bloody drainage may occur for the first few days, and the surgeon may prescribe antibiotic ear drops to prevent local infection.
The tubes are temporary and are designed to be naturally pushed out by the healing eardrum as it grows, a process called extrusion. This usually occurs between 6 and 18 months after insertion, and the small hole left behind typically heals closed on its own. Follow-up appointments monitor tube placement, check the status of the middle ear, and assess hearing improvement.
Water precautions are necessary, as water entering the middle ear through the tube can introduce bacteria. Specialists advise using earplugs or petroleum-jelly-coated cotton balls to protect the ear during bathing or swimming, especially in non-chlorinated water. The procedure is highly effective, leading to immediate improvement in hearing and a significant reduction in the frequency of ear infections.