Myringotomy

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  • It is incision of the tympanic membrane
  • the purpose is
    • drain suppurative or nonsuppurative effusion of the middle ear
    • provide aeration in case of malfunctioning eustachian tube.
  • Ventilation tube (grommet) may also be required in the latter case.
  • Indications
    • Acute suppurative otitis media
      • Severe earache with bulging tympanic membrane.
      • Incomplete resolution with opaque drum and persistent conductive deafness.
    • Complications of acute otitis media,
      • facial paralysis
      • labyrinthitis
      • meningitis with bulging tympanic membrane.
    • Serous otitis media.
    • Aero-otitis media
      • to drain fluid and “unlock” the eustachian tube
    • Atelectatic ear
      • grommet is often inserted for long-term aeration
  • Contraindications
    • Suspected intratympanic glomus tumour.
      • Myringotomy in these cases can cause profuse bleeding.
      • Tympanotomy is preferred.
  • Technique
    • Incision
      • In acute suppurative otitis media,
        • a circumferential incision
        • made in the posteroinferior quadrant of tympanic membrane
        • midway between handle of malleus and tympanic annulus
        • avoid injury to incudostapedial joint
      • In serous otitis media
        • a small radial incision
        • given in the posteroinferior or anteroinferior quadrant
  • Complications
    • Injury to incudostapedial joint or stapes.
    • Injury to jugular bulb with profuse bleeding, if jugular bulb is high and floor of the middle ear dehiscent.
    • Middle ear infection
    • Myringoplasty
      • Closure of perforation of pars tensa of the tympanic membrane is called myringoplasty.
        • It has the advantage of:(MCQ)
          • restoring the hearing loss and in some cases the tinnitus.
          • preventing re-infection from external auditory canal and eustachian tube (nasopharyngeal infection ascends easily via eustachian tube in the presence of perforation than otherwise).
          • prveenting aeroallergens reaching the exposed middle ear mucosa, leading to persistent ear discharge.
          • Myringoplasty can be combined with ossicular reconstruction when it is called tympanoplasty.
    • Contraindications
      • Active discharge from the middle ear.
      • Nasal allergy. It should be brought under control before surgery.
      • Otitis externa.
      • Ingrowth of squamous epithelium into the middle ear
      • In such cases, excision of squamous epithelium from the middle ear or a tympanomastoidectomy may be required.
      • When the other ear is dead or not suitable for hearing aid rehabilitation.
      • Children below 3 years
  • Cortical mastoidectomy,
    • known as simple or complete mastoidectomy or Schwartz operation,
    • is complete exenteration of all accessible mastoid air cells and converting them into a single cavity.
    • Posterior meatal wall is left intact
    • Middle ear structures are not disturbed.
    • Indications
      • Acute coalescent mastoiditis.
      • Incompletely resolved acute otitis media with reservoir sign.
      • Masked mastoiditis.
    • As an initial step to perform:
      • endolymphatic sac surgery
      • decompression of facial nerve
      • translabyrinthine or retro-labyrinthine procedures for acoustic neuroma.
    • Complications
      • Injury to facial nerve.
      • Dislocation of incus.
      • Injury to horizontal semicircular canal.
      • Patient will have post-operative giddiness and nystagmus.
      • Injury to sigmoid sinus with profuse bleeding.
      • Injury to dura of middle cranial fossa.
      • Post-operative wound infection and wound break-down.
  • Radical Mastoidectomy
    • a procedure to eradicate disease from the middle ear and mastoid without any attempt to reconstruct hearing.
    • Posterior meatal wall is removed and the entire area of middle ear, attic, antrum and mastoid is converted into a single cavity.
    • All remnants of tympanic membrane, ossicles (except stapes footplate) and mucoperiosteal lining are removed
    • Eustachian tube is obliterated by a piece of muscle or cartilage.
    • Aim of the operation is to permanently exteriorise the diseased area for inspection and cleaning.
    • Indications
      • When all cholesteatoma cannot be safely removed,
        • that invading eustachian tube, round window niche, perilabyrinthine or hypotympanic cells.
      • If previous attempts to eradicate chronic inflammatory disease or cholesteatoma have failed.
      • As an approach to petrous apex.
      • Removal of glomus tumour.
      • Carcinoma middle ear.
        • Radical mastoidectomy followed by radiotherapy is an alternative to en bloc removal of temporal bone in carcinoma middle ear.
    • Complications
      • Facial paralysis.
      • Perichondritis of pinna.
      • Injury to dura or sigmoid sinus.
      • Labyrinthitis, if stapes gets dislocated.
      • Severe conductive deafness of 50 dB or more.
        • This is due to removal of all ossicles and tympanic membrane.
      • Cavity problems.
        • Twenty five percent of the cavities do not heal and continue to discharge, requiring regular after-care.
  • Modified Radical Mastoidectomy
  • as much of the hearing mechanism as possible is preserved.
  • antrum is removed
    • disease process is often localised to the attic
  • whole area is fully exteriorised into the meatus
  • removal of the posterior meatal and lateral attic wall is done
  • Indications
    • Cholesteatoma confined to the attic and antrum.
    • Localised chronic otitis media.
    • Irreversibly damaged tissues are removed
    • preserves the rest to conserve or reconstruct hearing mechanism
  • Adenoidectomy
    • Adenoidectomy may be indicated alone or in combination with tonsillectomy.
    • In the latter event, adenoids are removed first and the nasopharynx packed before starting tonsillectomy
    • Indications
      • Adenoid hypertrophy causing snoring, mouth breathing, sleep apnoea syndrome or speech abnormalities, i.e. (rhinolalia clausa).
      • Recurrent rhinosinusitis.
      • Chronic secretory otitis media associated with adenoid hyperplasia.
      • Recurrent ear discharge in benign CSOM associated with adenoiditis/adenoid hyperplasia.
      • Dental malocclusion.
        • Adenoidectomy does not correct dental abnormalities
        • Adenoidectomy will prevent its recurrence after orthodontic treatment.
  • Contraindications
  • Cleft palate or submucous palate.
    • Removal of adenoids causes velopharyngeal insufficiency in such cases.
  • Haemorrhagic diathesis.
  • Acute infection of upper respiratory tract.
  • Complications
    • Haemorrhage,
      • usually seen in immediate post-operative period
      • Rising pulse rate is important indicator.
      • Postnasal pack under general anaesthesia is often required.
    • Injury to eustachian tube opening.
    • Injury to pharyngeal musculature and vertebrae.
      • This is due to hyperextension of neck and undue pressure of curette.
      • Care should be taken when operating patients of Down’s syndrome as 10-20% of them have atlanto-axial instability.
  • Griesel syndrome.
    • Patient complains of neck pain and develops torticollis.
    • Mostly it is due to spasm of paraspinal muscles
    • It can be due to atlanto-axial dislocation requiring cervical collar and even traction.
  • Velopharyngeal insufficiency.
    • It is necessary to check for submucous cleft palate by inspection and palpation before removal of adenoids.
  • Nasopharyngeal stenosis due to scarring.
    • Recurrence. This is due to regrowth of adenoid tissue left behind.


Myringotomy – Ear Tubes Infection
his medical animation shows the myringotomy (ear tube) procedure to remove fluid from the middle ear to create equal air pressure on both sides of the eardrum, and to reduce risk of infection. In this surgery, the doctor makes an incision in the eardrum (tympanic membrane) and implants a small ventilation tube which eventually dissolves.
Endoscopic Myringotomy (Ear Drainage)
Myringtomy is performed routinely for reasons of chronic middle ear fluid, acute severe ear infection and for ear protection prior to air travel. Here is a good illustration of the steps involved and how it’s done in the office setting.
3D Animation: Myringotomy Tube Docentia Tutorial
This animation is for DZX Medical, a company that provides medical information to both physicians and patients. In this 2-minute animation, you will be able to learn why fluid build up in the middle ear and how surgeons treat the problem. I strongly believe that if people in the medical field can adopt multimedia technologies, they can dramatically change the way medical is presented today.
Myringotomy with Grommet
Endoscopic Myringotomy with Grommet insertion using 15%Lidocam Spray
titis Media and Myringotomy in the Office Ear drainage of fluid
Otitis media drained in the office with rigid scope, Otitis media, Myringotomy, Dr B Todd Schaeffer, MD, Long Island Nassau County, Lake Success, Great Neck,Manhasset, ENT and Allergy Associates, LLP
Myringotomy tube insertion
Example of myringotomy and tube placement
Tubes are inserted for chronic are signifcant recurrent ear infections. They typically stay several months to a couple of years. They are intended to ventilate the middle ear space in order to treat as well as prevent future middle ear infections.
Myringotomy Insertion of Tube Surgery PreOpĀ® Patient Education
Myringotomy and Grommet Insertion
An anterior inferior myringotomy is performed in the left ear of a young patient with OME followed by suction of thick middle ear fluid and the insertion of a ventilation tube