What is myringotomy or tympanotomy?

Myringotomy, also called tympanotomy or tympanotomy, is a surgical procedure that makes a small incision in the tympanic membrane. The aim is to increase ventilation in the middle ear, relieve pressure within the tympanic cavity, or drain fluids such as mucus or pus in case of an infection.

The drainage and ventilation of the middle ear is normally carried out through the Eustachian tubes, also called pharyngotympanic tubes or Eustachian tubes. People who need a myringotomy often have an obstructive problem with the eustachian tubes that prevent their normal functioning.

The eardrum incision made by myringotomy heals on its own within 2-3 weeks. In many cases, a small tube is inserted into the incision (tympanotomy tube) so that the passage between the outer ear and middle ear remains open longer.

Main indications

Myringotomy has numerous indications. The most frequent in pediatric ages is to treat chronic otitis media and exudative or effusion otitis media that do not respond adequately to antibiotic treatment.

In adults it is widely used in patients with Eustachian Tube Dysfunction who suffer from recurrent episodes of conditions such as vertigo, tinnitus, hearing loss or severe eardrum retraction. In these cases, there is the alternative of tuboplasty to dilate the pharyngotympanic tubes and improve their function.

Tympanotomy is also indicated in some cases of barotrauma (pressure trauma) usually due to height changes during flights and sudden pressure changes during diving.

Process

Normally, myringotomy is an outpatient surgical procedure, that is, it does not require hospitalization and the patient returns home the same day. In adults, local anesthesia is usually used, while in children, general anesthesia is more common.

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Before any incision, the external auditory canal and the surface of the tympanic membrane are cleaned and disinfected. In conventional myringotomy or cold cutting, the eardrum is incised with a scalpel. Once the incision is made, any fluid present in the tympanic cavity is aspirated.

Subsequently, the ventilation tube is placed in the incision and, finally, the external auditory canal is plugged with cotton to contain possible bleeding. In a few days the wound can heal, so the tube is placed to maintain the opening. There are several types of ventilation tubes, the most common are silicone and titanium. They can be coated with antibiotics.

The laser myringotomy, or tympanolaserostomy, uses a CO2 laser and is performed with the aid of video and computer equipment that direct the laser to make the incision with greater precision at the appropriate location. The laser opens the eardrum in a tenth of a second with minimal damage to surrounding tissue. The laser incision remains open for several weeks without the need for a tube.

Although laser myringotomy is safe and ventilation is maintained for a longer time, it does not offer greater efficiency in the management of chronic exudative otitis media in children, and there are even studies that conclude that ventilation tubes are more effective in these cases.

Gallery

Myringotomy Diagram Tympanostomy tube inserted into the tympanic membrane

Postoperatively, otorrhea (suppuration or fluid excretion) secondary to colonization by bacteria may occur. The most common are methicillin-resistant Pseudomonas aeruginosa S Staphylococcus aureus. Antibiotic tubes and antibiotic ear drops are used to prevent it.

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Another possible early complication is tube obstruction and displacement. Later complications include deposits of fat and dead tissue in the tube, development of cholesteatoma, and persistent perforation of the tympanic membrane.

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