Myringotomy

Overview

A myringotomy is a surgical procedure designed to alleviate fluid buildup in the middle ear, which could include water, blood, or pus. This surgery is often recommended for treating otitis media with effusion, where fluid accumulates in the ear. During the procedure, a small incision is made in the eardrum (tympanic membrane) to allow the fluid to drain. The surgery can be performed on one or both ears, and the recovery period typically lasts about four weeks.

Reasons for undergoing the procedure

Myringotomy is a procedure more common in children due to their higher susceptibility to ear infections. Many adults also require myringotomies, often due to barotrauma.

Conditions or symptoms that may be treated with a myringotomy, include:

• Ear barotrauma (pain in the ears due to changes in air pressure).
• Recurrent ear infections (acute otitis media).
• Muffled hearing or hearing impairment 
• Ear bleeding brought on by an eardrum rupture, serious infection, or trauma
• Issues with balance
• In children, speech delays

Risks

A myringotomy procedure may have potential complications, such as:

• Adverse reaction to anesthesia
• Infection
• Persistent drainage
• Bleeding
• Eardrum scarring.
• A persistent, non-healing hole in the eardrum
• Eardrum hardening, which may result in hearing impairments
• Damage to the ear canal during surgery

Before the procedure

Prior the recommendation, a thorough ear examination is done using an otoscope. The healthcare provider may also conduct hearing and blood tests, along with a tympanogram to assess the eardrum’s response to pressure. 

If a myringotomy is deemed necessary, the healthcare provider will give preoperative instructions, which typically include fasting after midnight before the procedure and arranging for someone to drive the patient to and from the appointment.

During the procedure

Myringotomy surgery usually takes about 15 to 20 minutes. It can be done with a local anesthetic, or under general anesthesia for comfort.

Myringotomy is usually done as follows:

• The healthcare provider uses a small microscope to clearly view the eardrum 
• A tiny hole is made in the eardrum to drain fluid from the middle ear
• In some cases, a tympanostomy is performed by inserting an ear tube, also known as the myringotomy tube, into the incision to allow continued drainage
• After the surgery, the ear is packed with gauze

In a myringotomy, no stitches are needed as the incision heals on its own.

After the procedure

Anesthesia will prevent pain during the surgery, but mild discomfort may occur afterward. Over-the-counter pain relievers and possibly prescribed numbing ear drops can help.

Generally, after myringotomy surgery, it is normal for the ear to feel clogged, and hearing may take a few days to improve.

Following the detailed postoperative instructions is crucial for recovery, which generally includes:

• Taking medications as prescribed
• Changing gauze regularly
• Wearing earplugs while bathing or showering
• Avoiding submerging the head under water

Outcome

Overall, a myringotomy can help reduce ear infections, improve hearing, relieve ear pain and pressure, enhance balance, and support better speech and academic performance in children.

Most people recover from a myringotomy in about four weeks and can often return to work or school within one to two days. If ear tubes were inserted during the procedure, they usually fall out on their own within six to twelve months. 

During the recovery process from a myringotomy, it’s crucial to monitor for potential complications and seek medical attention if you experience:

• Redness, swelling, or significant discharge or bleeding from the ears
• Signs of infection, such as fever or chills
• Trouble hearing
• Pain not alleviated by medication
• Chest pain
• Persistent cough
• Difficulty breathing