Acute ear infections can be quite painful, and fluid in the middle ear creates a sense of pressure and blocked hearing. Persistent fluid in children can cause balance problems, speech delay, behavioral problems and poor school performance. Difficulty equalizing the ears may cause pain when flying. In these instances, an otolaryngologist may recommend a myringotomy with insertion of ear tubes.
VIDEO: Dr. Armstrong Discusses Ear Tubes
What is a myringotomy?
A myringotomy is the creation of a hole in the eardrum. This is typically performed using a topical anesthetic for adults, and under mask anesthesia for children. The surgeon makes a small incision (cut) through the eardrum, vacuums the fluid out and buttons a tiny tube into the hole to keep it open. The patient may go home 15 minutes later. The tube allows equilibration of atmospheric air pressure, drainage of infected fluid and delivery of medication within the middle ear space. The procedure is sometimes called a tympanotomy, and the tubes may be referred to as ventilation tubes or pressure equalization (PE) tubes.
Ear tubes are made of various materials, shapes and sizes. Short term tubes will fall out in 6 to 12 months, and the eardrum usually heals on its own. Larger tubes are designed to last 1-2 years, and may require removal in the office. Rarely, it is necessary to repair the eardrum.
Common reasons to perform myringotomy:
Recurrent acute otitis media
Children between the age of 1 and 3 years old frequently suffer painful middle ear infections (acute otitis media). They will often receive antibiotics and sometimes have side effects to the antibiotics. Myringotomy and tubes are an option for children having 4 or more painful infections within 6 months.
Persistent otitis media with effusion
Older children and some adults may develop persistent fluid in the middle ear (otitis media with effusion) that interferes with hearing. If this fluid persists for more than 3 months, tubes are recommended to remove the fluid and restore normal hearing. Otitis media with effusion is more common in patients with large adenoids, allergies, or congenital problems such as Down Syndrome or cleft palate.
Eustachian tube dysfunction
Occasionally, patients will simply have chronic popping or difficulty equalizing the pressure through the eustachian tubes. This can be a problem for patients with frequent air travel. A myringotomy with ear tubes will eliminate the need to equalize pressure during air travel.
Potential benefits of myringotomy:
- Alleviate ear pain and pressure
- Reduce frequency of ear infections
- Restore hearing loss caused by fluid
- Improve sleep and behavior problems
- Improve speech and school performance
- Improve balance
Risks of myringotomy:
- Drainage from the ear
- Persistent perforation
- Recurrence of infection
- Scarring of the eardrum
- Need for tube replacement
- Permanent hearing loss
- Complications of anesthesia
The majority of problems after surgery are minor and are related to the underlying disease. Permanent injury to the ear, permanent hearing loss and major anesthetic complications are exceedingly rare.
Alternatives to myringotomy:
- Antibiotics for acute otitis media
- Nasal steroids for allergic rhinitis
- Adenoidectomy for large adenoids, snoring, mouth breathing, or repeated myringotomies.
- Balloon dilation of the Eustachian tubes
- Use prescribed ear drops for 3-7 days
- Avoid dirty bath or lake water in the ear
- Ear plugs are not recommended
- Make an appointment in 2-4 weeks
© 2020 Mike Armstrong MD, Michaela Bailey.