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. The doctor can withdraw fluid from the middle ear 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 a myringotomy. The tubes 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. Ear tubes are also sometimes called ventilation tubes.
Myringotomy with the insertion of ear tubes is an optional treatment for inflammation of the middle ear with fluid collection (effusion), also called glue ear, that lasts more than three months (chronic otitis media with effusion) and does not respond to drug treatment. Myringotomy is the recommended treatment if the condition lasts four to six months. Effusion is the collection of fluid that escapes from blood vessels or the lymphatic system. In this case, the effusion collects in the child's middle ear.
Initially, acute inflammation of the middle ear with effusion is treated with one or two courses of antibiotic drugs. Antihistamines and decongestants have also been used to treat otitis media, but they have not been proven effective unless the child also has hay fever or some other allergic inflammation that contributes to the ear problem. Myringotomy with or without the insertion of ear tubes is not recommended as the initial treatment for otherwise healthy children with middle ear inflammation with effusion.
In about 10 percent of children, the ear effusion lasts for three months or longer; at that point the condition is considered chronic. Systemic steroids may help children with chronic ear infections, but the evidence that these drugs are beneficial is not clear, and there are risks associated with steroid use.
Myringotomy with insertion of ear tubes becomes an option when medical treatment does not 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. If the effusion lasts for four to six months, myringotomy with insertion of ear tubes may be recommended. Although doctors in the past sometimes removed the child's tonsils or adenoids to treat recurrent otitis media with effusion, this practice is not recommended as of the early 2000s.
Myringotomy may be performed to relieve the pain and other symptoms of otitis media; to restore the child's hearing; to take a sample of the fluid to examine in the laboratory in order to identify any microorganisms present; or to insert ventilation tubes.
Ear tubes can be inserted into the incision during a 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 in place, the tubes keep the incision from closing, forming an open channel between the middle ear and the outer ear. This channel allows fresh air to reach the middle ear, allows fluid to drain out, and prevents pressure from building up in the middle ear. The patient's hearing returns to normal immediately and the risk of recurrence diminishes.
Parents often report that children talk better, hear better, are less irritable, sleep better, and behave better after myringotomy with the insertion of ear tubes.