Type of Surgery
Information
Last updated: 11/24/2009
Myringotomy with the insertion of ear tubes is an optional treatment for inflammation of the middle ear
with fluid collection (effusion) that lasts longer than three months (chronic otitis media with effusion) and does not...
respond to drug treatment. This condition is also called glue ear. Myringotomy is the recommended treatment if the condition lasts four to six months. Effusion refers to the collection of fluid that escapes from blood vessels or the lymphatic system. In this case, the effusion collects in the middle ear.
Initially, acute inflammation of the middle ear with effusion is treated with one or two courses of antibiotics. Antihistamines and decongestants have been used, but they have not been proven effective unless there is also hay fever or some other allergic inflammation that contributes to the problem. Myringotomy with or without the insertion of ear tubes is not recommended for initial treatment of otherwise healthy children with middle ear inflammation with effusion.
In about 10% of children, the effusion lasts for three months or longer, when the disease is considered chronic. In children with chronic disease, systemic steroids may help, but the evidence is not clear, and there are risks.
When medical treatment doesn't stop the effusion after three months in a child who is one to three years old, is otherwise healthy, and has hearing loss in both ears, myringotomy with insertion of ear tubes becomes an option. If the effusion lasts for four to six months, myringotomy with insertion of ear tubes is recommended.
The purpose of myringotomy is to relieve symptoms, to restore hearing, to take a sample of the fluid to examine in the laboratory in order to identify any microorganisms present, or to insert ear tubes.
Ear tubes can be inserted into the incision during myringotomy and left there. The eardrum heals around them, securing them in place. They usually fall out on their own in six to 12 months or are removed by a doctor.
While the tubes are in place, they keep the incision from closing, keeping a channel open between the middle ear and the outer ear. This allows fresh air to reach the middle ear, allowing fluid to drain out, and preventing pressure from building up in the middle ear. The patient's hearing returns to normal immediately and the risk of recurrence diminishes.
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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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Other Information
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.
Other Information
In 2006, estimates of the direct medical costs of allergic rhinitis in the US ranged from $1.16 billion to $4.5 billion, rising to $7.7 billion when indirect costs were included.
From: AHRQ
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