What is myringotomy or tympanotomy?

The myringotomyalso called tympanotomy or tympanostomyis a surgical procedure that performs a small incision in the tympanic membrane. The goal is to increase ventilation in the middle ear, relieve pressure inside the tympanic cavity, or drain fluids such as mucus or pus in case of infection.

The drainage and ventilation of the middle ear is normally carried out through the Eustachian tubes, also called pharyngotympanic tubes or auditory tubes. People who require myringotomy usually have some obstructive problem in the Eustachian tubes that prevent their normal functioning.

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

Main indications

Myringotomy has numerous indications. The most frequent in pediatric ages is to treat chronic otitis media and otitis media exudative or with effusion that does not respond appropriately 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 retraction of the eardrum. 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) generally due to height changes during flights and sudden pressure changes during diving.

Process

Typically, myringotomy is a outpatient surgery 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.

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

Subsequently, the tympanostomy 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, which is why the tube is placed to maintain the opening. There are several types of tympanostomy tubes, the most common are silicone and titanium. They can be coated with antibiotics.

The laser myringotomyor tympanolaserostomy, uses a CO lasertwo and it is done with the assistance of video and computer equipment that directs the laser to make the incision with greater precision in the appropriate location. The laser makes the opening in the eardrum in a tenth of a second with minimal damage to surrounding tissues. The laser incision remains open for several weeks without the need for a tube.

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

During the postoperative period, otorrhea (suppuration or excretion of fluids) may occur secondary to colonization by bacteria. The most frequent are Pseudomonas aeruginosa Y Staphylococcus aureus methicillin resistant. Antibiotic tubes and antibiotic ear drops are used to prevent it.

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

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