Background Information:

What are the other Names for the Procedure?

• Myringocentesis
• Tympanostomy
• Tympanotomy

What is Myringotomy surgical procedure?

Myringotomy is a procedure that involves surgically opening the eardrum and removing fluid that builds up within the middle ear. A small tube, called a tympanostomy tube or an ear tube, is then inserted into this opening.

What part of the Body does the Procedure involve?

A Myringotomy procedure involves the eardrum, middle ear, and external ear canal.

Why is the Myringotomy surgical procedure Performed?

A Myringotomy is performed for long-standing middle ear inflammation with fluid collection, and for the following reasons:

• The condition is not responding to medical treatment
• Relieving pain that is causing pressure
• Prevent additional ear infections
• Prevent temporary or permanent loss of hearing

What are some Alternative Choices for the Procedure?

There are no alternatives to Myringotomy. The procedure is as such performed, when all other medical treatments have failed to treat the inflammatory condition.

What are the Recent Advances in the Procedure?

The Myringotomy procedure may be done using a laser beam, which may reduce the need for an ear tube placement.

What is the Cost of performing the Myringotomy surgical procedure?

The cost of Myringotomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Myringotomy on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgeryencyclopedia.com/La-Pa/Myringotomy-and-Ear-Tubes.html (accessed on 09/20/2014)

Prior to Myringotomy surgical procedure:

How is the Myringotomy surgical procedure Performed?

• A Myringotomy procedure can generally be performed under local anesthesia
• After numbing and washing the ear canal, a tiny incision is made on the eardrum to remove fluid from the middle ear
• An ear tube is inserted to keep this opening patent
• The ear is the packed using cotton, to stop any bleeding

Where is the Procedure Performed?

A Myringotomy procedure is usually performed in an out-patient surgery center facility or a hospital.

Who Performs the Procedure?

An otolaryngologist surgeon perform the Myringotomy surgical procedure

How long will the Procedure take?

It takes about a few minutes to perform the Myringotomy procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Myringotomy procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Myringotomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Myringotomy surgical procedure?

Before a Myringotomy procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• Audiometry (hearing test)
• Tympanogram

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Myringotomy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Myringotomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by topical anesthesia or general anesthesia by injection and inhalation is administered for the Myringotomy procedure.

How much Blood will you lose, during the Procedure?

There is hardly any blood loss during a Myringotomy procedure.

What are the possible Risks and Complications during the Myringotomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Myringotomy surgery are:

• Injury to the ear canal or outer ear
• Infection of the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Myringotomy surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Myringotomy surgical procedure:

What are the possible Risks and Complications after the Myringotomy surgical procedure?

The possible risks and complications that may arise after the Myringotomy procedure are:

• Infection in the surgical wound
• Perforated eardrum that does not heal
• Trapping of the ear tube in the middle ear
• Cholesteatoma - a condition in which the skin cells grow inside the middle ear and erode the underlying bone
• Loss of hearing

What is the Prognosis after the Surgery?

A complete recovery from a Myringotomy procedure is normally achieved and the hearing should improve. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea or vomiting
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headache
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Myringotomy surgical procedure?

At home, the following post-operative care is recommended, after a Myringotomy procedure:

• Medicated eardrops may be prescribed to treat infections, if additional ear infections develop
• Complete the course of prescribed medication, as advised by your physician
• Take antibiotic medication to help combat or prevent infections
• Use of ear plugs while showering may be advised
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain (as prescribed)

How long does it normally take to fully recover, from the Procedure?

When an ear tube is placed, it may remain there for a few months. The ear drum heals around the tube in a matter of days.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Sample of the middle ear fluid may be taken for examination for cultures, in order to determine, if a bacteria is causing infection.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

No tissue is removed during the Myringotomy procedure.

Who will you receive a Bill from, after the Myringotomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, a physician’s office/clinic, an emergency room, or a hospital
• An anesthesiologist (if anesthesia was administered)
• An otolaryngologist

The patient is advised to inquire and confirm the type of billing, before the Myringotomy surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA