Myringotomy

Myringotomy Definition

It is a surgical process that involves making a small incision in the tympanic membrane (eardrum) to ease buildup of pressure caused by excessive accumulation of fluids. The process may also be used to drain out pus. The surgery is usually conducted in both ears. It is used an optional curative process for swelling of the middle ear.

Myringotomy Etymology

The name of this operative procedure is derived from the fusion of the Latin term “myringa”, standing for “drum membrane”, and the Greek word “tome” which means “cutting”.

Myringotomy Names

The operative process is also known by other names like:

• Myringocentesis
• Tympanotomy
• Tympanostomy
• Paracentesis of the tympanic membrane

Myringotomy Cost

On an average, this operation costs around $2,800. In some cases, it may come as high as $5000. The price actually depends on where you live and where you are conducting it from.

Myringotomy Procedure

The actual operative procedure takes only about 10-15 minutes to be completed. However, the process requires some amount of preparation as well as after-care. Here are the steps to be followed before, during and after the surgery to help in successful completion of the operation.

Before the operation

Patients should not eat or drink anything at anytime between 6 and 24 hours before undergoing the surgery. This includes avoiding water completely. Physicians should be informed of any prior conditions or infections they might have had recently. Patients should inform doctors about any medications or herbs that they might have used recently or in the past. Since the procedure is generally conducted on children, their parents are asked to bring along stuffed animals or other toys that can make children feel more comfortable.

During the operation

During operation, patients are first administered with drugs that can make them relax. An anaesthesiologist is most likely to use general anesthesia for tranquilizing the patient. In some cases, however, local anesthesia may also be used. This involves application of a cream to the ear canal, which contains Prilocaine and Lidocaine. The cream is typically applied half-an-hour prior to the actual surgery. Rarely, medical acupuncture is used to manage painful symptoms. In such cases, acupuncture is usually started approximately 40 minutes before the operation and is continued until the surgery comes to an end.

After the operation

After the anesthesia is administered, surgeons thoroughly wash the ear and perform a small incision in the eardrum. The incision is made through the external ear canal with the aid of an operating microscope. The process does not leave any incisions or stitches that are outwardly visible. Once the incision has been made, accumulated fluids are suctioned out of the ear and an ear tube is put in the eardrum. In the majority of cases, drops are introduced into the ear. Cotton plugs are also inserted into the ear canal to control bleeding.

Myringotomy Video

This is a useful video that can allow you to get an idea of how the operation is actually performed.

Myringotomy in Adults

The operation is typically conducted in children aged between 1 and 2 years. In some cases, it is also found to be performed in 5 year old kids. In adults, the surgery can be carried out without the use of a general anesthetic. The patient needs to be very still even though they may experience some amount of pressure and discomfort.

Myringotomy Purpose

This surgical process is performed due to various reasons, such as:

• Providing relief from discomforting symptoms caused by the buildup of fluids in the eardrum
• Draining out fluid or taking a sample of it for laboratory examination to detect the presence of any known microorganisms
• Restoring hearing capabilities

The process can also be used to insert ear tubes. During surgery, ear tubes can be inserted into the incised area and left in place. Once the eardrum heals around the tubes, they get secured in place. Generally, these fall out within 6 months to one year without any external force. If that fails to happen, these may be removed by a doctor.

When left in place, the ear tubes prevent the closure of the incision by keeping open a channel between the middle and the outer ear. This lets air-drying of the fluid in the middle ear and prevents build-up of pressure in the middle ear. Once the fluid dries out, patients immediately find their hearing capability returning to normal. This also reduces the risk of recurrence.

Once ear tubes are inserted during Myringotomy, patients are often reported to hear and talk better. They are also found to sleep better and behave well without displaying any irritability.

In recent years, this operative process along with tube replacement has become a primary treatment for curing Otitis Media in children.

Myringotomy Complications

Like all surgeries, this operative procedure has its own risks. These include:

• Early protrusion of tube after surgery.
• Failure of the eardrum to recuperate after the falling out of the tube.
• If the incised area does not heal properly after surgery, a permanent hole can be formed in the eardrum. It can lead to partial loss of hearing and also raise the risk of infection.
• An improperly conducted operation may also make the ear tubes move inward and get stuck in the middle ear. In ideal conditions, the tubes should extend into the external ear and either fall out naturally or be removed by a doctor.
• An improper surgery may also lead to cutting or damaging of the external ear.
• Granular nodes may also develop at the site of surgery due to inflammation.
• If surgery is not conducted accurately, the eardrum can get perforated leading to permanent physical damage.
• A wrongly conducted operation may also cause buildup of cholesterol and skin cells in the middle ear. These can grow and damage the adjoining bone (Cholesteatoma)
• Following this operation, there can be a 13% risk of constant discharge from the ear (Otorrhea).
• In some people, general anesthesia or sedatives administered during the surgery can give rise to side effects.

The surgery does not guarantee permanent treatment. Approximately 30% children undergoing this operation as well as an insertion of ear tubes need to undergo the process in about 5 years.

Repeated surgeries of this type may result in structural changes in the eardrum, such as:

• Retraction or shrinkage
• Flaccidity or loss of tone
• Hardening of a region of the eardrum (Typmanosclerosis)

Repeated operations of these types may also increase the risk of hardening to 51%.

Bilateral Myringotomy

It is a surgical process conducted to place tubes within the ears. This helps stop recurring ear infections by allowing air to flow in and out of the middle ear of patients. However, it does not completely eliminate chances of ear infection. Tympanostomy tubes are typically made of Teflon or Silicon. Some are also made of stainless steel but used only infrequently. Their peculiar name comes from the fact that they are shaped like a Grommet or the English alphabet T.

Myringotomy and Grommets Insertion

This is a common operation that is conducted to allow free circulation of air in the middle section of the ear. The process includes insertion of grommets (also known as Tympanostomy tubes) into the eardrum. It helps relieve hear loss due to congestion caused by the presence of fluids in the middle ear. It also helps reduce pain occurring due to poor flow of air in the middle ear. Though a simple process, it can give rise to side effects like

• Soreness of ears after surgery
• Bloody discharge from the ears
• Development of scar tissues on the eardrum
• Drainage of pus after insertion of grommets (occasional)

Laser Myringotomy

Also referred to as OtoLAM or Laser Assisted Myringotomy, this laser-aided operation uses specialized Co2 laser equipment rather than a surgical instrument to make a hole in the eardrum. It is less invasive than incision by surgical equipments and can be conducted in an outpatient clinic or an office setting. It only requires use of a general anesthesia.

The process helps create an appropriate hole in the tympanic membrane which remains open for a number of weeks. According to clinical studies, around 60% cases resolve after the use of this process. It helps clear up underlying infection and also prevent repeated episodes of Otitis Media.

It was as early as in the 18th century when an incision in the ear drum was first promoted as a means to facilitate drainage of the ear cavity and cure deafness. With the aid of laser, Myringotomy has become even more advanced today and promises better chances of recovery. If properly carried out, the rate of healing is usually quite fast in any type of Myringotomy.

References:

http://www.yoursurgery.com/ProcedureDetails.cfm?BR=4&Proc=37

http://www.surgeryinformation.info/2011/08/myringotomy.html

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/ent/myringot.html

http://www.eardoc.info/faq-2/myringotomy