Myringotomy +/- Aspiration

 

Indications for Myringotomy and Its Applications 

 

Reasons for Myringotomy 

• Middle Ear Effusion 

When fluid accumulates in the middle ear cavity and cannot drain independently or frequently recurs, a physician may consider performing a myringotomy. Middle ear effusion may result from infections, Eustachian tube dysfunction, or sinusitis. Myringotomy facilitates the drainage of fluid, alleviates pressure, and assists in restoring hearing. 

 

• Otitis Media 

Severe otitis media can lead to swelling, thinning, or perforation of the tympanic membrane. A myringotomy can promote the drainage of purulent fluid and reduce pressure within the middle ear cavity, thereby alleviating pain and inflammation. 

 

• Tympanic Membrane Accumulation of Pus 

When pus accumulates in the space behind the tympanic membrane, a myringotomy may be necessary to drain the pus and cleanse the middle ear. 

 

• Hearing Loss 

Certain middle ear conditions that result in hearing loss may be improved through myringotomy. 

 

Examination and Treatment 

In some instances, a physician may require a myringotomy to examine the middle ear and tympanic cavity for the diagnosis or treatment of specific ear diseases or conditions.

 

Causes of Otitis Media and Middle Ear Effusion 

Otitis media refers to the infection or inflammation of the middle ear, typically caused by viruses or bacteria. This infection may extend from an upper respiratory infection (such as the common cold) or an ear infection (such as an external ear canal infection). When the Eustachian tube, which connects the throat and nasal cavity to the air space of the middle ear, becomes obstructed, pressure increases within the middle ear, allowing bacteria or viruses to enter and cause infection. This condition is particularly common in children, as their Eustachian tubes are shorter and more horizontal than those of adults, which increases their susceptibility to obstruction. 

 

Middle ear effusion refers to the accumulation of fluid in the middle ear without infection or inflammation. This condition typically arises from abnormal or obstructed Eustachian tube function. When the Eustachian tube fails to properly drain fluid from the middle ear, fluid accumulates within the cavity, leading to effusion. This situation often occurs following upper respiratory infections, as the infection may cause swelling or blockage of the Eustachian tube. 

 

Common symptoms of otitis media and middle ear effusion include ear pain, hearing loss, tinnitus, and dizziness. Treatment options vary based on the condition and may include antibiotics to treat infections, anti-inflammatory medications to reduce inflammation, decongestants or nasal sprays to facilitate drainage through the Eustachian tube, and surgical interventions when necessary. 

 

A myringotomy is a procedure in which your doctor creates a small hole in the eardrum so fluids such as water, blood, or pus can drain out. In many cases, your doctor will put in a tube so it won't get backed up again.  

  

Indications  

  

• Secretory otitis media 

• Eustachian tube dysfunction 

• Acute otitis media 

  

Intended Benefits and Expected Outcome 

  

• To normalize the middle ear pressure 

• To drain the middle ear 

• Hearing improvement 

• There is chance of incomplete relief of symptoms and recurrence after extrusion of the grommet 

  

 

Before the Procedure  

• Fasting Instructions: Patients are generally required to fast for 6 hours before surgery, meaning no food intake for 6 hours prior to the procedure. A small amount of plain water is allowed until 2 hours before the surgery. 

• Preoperative Medications: Take any prescribed medications as instructed. 

 

Procedures 

1. Anesthesia: Myringotomy is typically performed under general anesthesia or monitored anesthesia with local anesthesia to ensure that you feel no pain during the procedure. 
2. Surgical Preparation: Once the anesthesia takes effect, the doctor will use surgical instruments (such as a Myringotomy knife or Myringotomy needle) for the procedure. The doctor will first clean the area around the ear and may use a disinfectant on the ear. 
3. Tympanic Membrane Incision: The doctor will gently pull on the tympanic membrane to expose the middle ear cavity. Then, using cutting instruments, a small incision will be made in part of the tympanic membrane. This incision allows fluid or pus in the middle ear to drain, relieving pressure and facilitating healing. 
4. Treatment and Cleaning: After the tympanic membrane is incised, the doctor may use a suction device or other instruments to remove fluid, pus, or foreign objects from the middle ear. At the same time, the doctor may further assess the condition of the middle ear and provide additional treatment as necessary. 
5. Recovery of the Tympanic Membrane: After the Myringotomy, the tympanic membrane typically heals on its own. During the recovery process, the doctor may provide specific care instructions, such as avoiding water in the ear, refraining from forcefully blowing the nose, or avoiding intense pressure on the ear. 

 

Wound Care 

• For a period after surgery, avoid getting water in the ear. Use earplugs or cotton balls, ensuring they fit snugly to prevent water from entering. 

• After myringotomy, avoid forcefully blowing your nose, as this may increase pressure in the ear and affect wound healing. Gently wipe your nose or use a nasal aspirator or saline spray to clear the nasal passages. 

• Avoid prolonged exposure to high altitudes, flying, or diving, as these situations can cause significant pressure changes that may adversely affect the ear. 

 

After the Procedure  

• Strictly follow the doctor’s instructions and recommendations. This may include taking medications (such as antibiotics or pain relievers), attending regular check-ups, and monitoring for any unusual symptoms. 

• Avoid rubbing or irritating the surgical site on the ear. Gently clean the area around the ear and avoid inserting cotton swabs or other sharp objects into the ear canal. 

• Clean the wound regularly as advised by the doctor. Gently use saline solution or the recommended cleanser to clean the area around the ear. Avoid using alcohol or irritating cleansers. 

• If you experience fever, severe pain, noticeable discharge, worsening hearing, or any other abnormal symptoms after surgery, contact your primary physician immediately. 

 

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Reference

Schilder, A. G., et al. (2016). Otitis media. Nature reviews Disease primers, 2(1), 1-18.

 

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