Type of Surgery
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Last updated: 11/24/2009
In the United States, myringotomy and tube placement have become a mainstay of treatment for recurrent otitis media in children. An article published in the March 1998 Consumer Reports stated that the "… number of myringotomies has risen nearly...
250 percent in recent years, making the operation the sixth most common operation in the United States." According to the New York University School of Medicine, myringotomy and tube placement is the most common surgical procedure performed in children as of 2003, largely because otitis media is the most common reason for children to be taken to a doctor's office.
Myringotomy in adults is a less common procedure than in children, primarily because adults benefit from certain changes in the anatomy of the middle ear that occur after childhood. In particular, the adult ear is less likely to accumulate fluid because the Eustachian tube, which connects the middle ear to the throat area, lies at about a 45-degree angle from the horizontal. This relatively steep angle means that the force of gravity helps to keep fluids from the throat containing disease organisms out of the middle ear. In children, however, the Eustachian tube is only about 10 degrees above the horizontal, which makes it relatively easy for disease organisms to migrate from the nose and throat into the inner ear. Myringotomies in adults are usually performed as a result of barotrauma that is also known as pressure-related ear pain or barotitis media. Barotrauma refers to earache caused by unequal air pressure on the inside and outside of the eardrum. Adults with very narrow Eustachian tubes may experience barotrauma in relation to scuba diving, using elevators, or frequent flying. A myringotomy with tube insertion may be performed if the condition is not helped by decongestants or antibiotics.
Most myringotomies in children are performed in children between one and two years of age. One Canadian study found that the number of myringotomies performed was 12.8 per thousand for children 11 months old or younger; 54.2 per thousand for children between 12 and 23 months old; and 11.1 per thousand for children between three and 15 years old. Sex and race do not appear to affect the number of myringotomies in any age group, although boys are reported to have a slightly higher rate of ear infections than girls.
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It is not uncommon for fluid to accumulate behind the eardrum (tympanic membrane). In this animation, we see the surgery used to open the tympanic membrane (myringotomy) and the placement of a drainage tube. This procedure is known colloquially as a patient "getting tubes in his ears."
During a myringotomy, an incision is made into the ear drum, or tympanic membrane (B). The fluid in the ear canal is suctioned out (C), and a small tube is put in place to allow future drainage in the event of an infection (D). (Illustration by GGS Inc.)
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Myringotomy is a surgical procedure in which a small incision is made in the eardrum (the tympanic membrane), usually in both ears. The word comes from myringa, modern Latin for drum membrane, and tomē, Greek for cutting. It is also called myringocentesis, tympanotomy, tympanostomy, or paracentesis of the tympanic membrane. Fluid in the middle ear can be sucked out through the incision.
Ear tubes, or tympanostomy tubes, are small tubes, open at both ends, that are inserted into the incisions in the eardrums during myringotomy. They come in various shapes and sizes and are made of plastic, metal, or both. They are left in place until they fall out by themselves or until they are removed by a doctor.
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The decision to undergo ear tube surgery should be discussed carefully with the doctor, ... A variety of factors go into this decision. If you think putting tubes in the child's ears is going to improve developmental outcome at age 3, the answer is: no, it won't.
-Jack Paradise
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