Myringotomy and Tubes

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Myringotomy and tubes is also know as tympanostomy tubes, pressure-equalization tubes and grommets. This is the most common surgical procedure (under general anaesthesia) in humans. Indications include recurrent middle ear infections (6 per year or 4 in 6 months), chronic middle ear fluid with hearing loss (for 3 months or more) and retraction of the eardrum.

In all people, air is constantly being absorbed by the lining of the middle ear and must be replenished through the Eustachian tube, which connects to the back of the nose. If the Eustachian tube doesn’t work properly, then middle ear fluid, infections and/or retraction of the eardrum occurs. Severe retraction of the eardrum can have serious consequences. Eustachian tube function is worsened by smoke exposure, viruses, allergies and large adenoids and usually improves with age.

The surgery usually takes 5-10 minutes. In children, general anaesthesia is usually needed. The tympanostomy tube is inserted into the eardrum. The tube can not be reached with a finger or seen without an otoscope. After surgery, the patient may briefly have mild pain, which can be controlled with medication.

Ear drops containing antibiotics and steroids are often prescribed for a few days to prevent the tube from becoming clogged with dry mucous. When drops are given, the patient should lie flat with the ear facing the ceiling. After drops are placed in the ear canal, the tragus (structure in front of the ear canal) should be pushed several times to “pump” the drops through the tube.

It is best to speak with your otolaryngologist before the surgery about the different types of tubes and their rates of extrusion and eardrum perforation. The most practical issue relates to the fact that if water with enough bacteria goes through a tube, then infection will result. There are various prevention strategies, which can be reviewed with your otolaryngologist. If pus (yellow-green fluid) drains through a tympanostomy tube, then prescription ear drops are needed as soon as possible. Risks of certain ear drops may be discussed with your otolaryngologist.