Myringotomy Surgery
Myringotomy surgery, also known as tympanostomy or ear tube surgery, is a common and effective ENT procedure used to treat persistent middle ear infections and fluid build-up that do not respond to medical treatment. The procedure improves hearing, prevents recurrent infections, and relieves chronic ear discomfort in both children and adults.
History & Definition
The concept of creating an incision in the tympanic membrane to relieve middle ear pressure dates back to the early 20th century. However, myringotomy became a widely accepted and standardized procedure only after the introduction of safe anesthesia, operating microscopes, and refined microsurgical instruments in the mid-1900s. Placement of ventilation tubes further revolutionized outcomes, especially in pediatric patients with recurrent ear infections.
Indications for Myringotomy Surgery
- Chronic Otitis Media: Persistent middle ear infection lasting more than 3 months
- Middle Ear Effusion: Fluid accumulation causing hearing loss
- Recurrent Ear Infections: More than 3–4 infections per year
- Eustachian Tube Dysfunction: Poor middle ear ventilation
- Barotrauma: Ear pain or fluid retention due to pressure changes
- Speech Delay in Children: Due to conductive hearing loss
In India, myringotomy is frequently performed at ENT centres for children and adults suffering from chronic infections, allergic rhinitis, and environmental risk factors.
Pre-Operative Evaluation
- Detailed ear examination using otoscope or microscope
- Pure tone audiometry (hearing test)
- Tympanometry to assess middle ear pressure and fluid
- Nasal and throat examination for adenoid or allergy-related issues
- Allergy and immunologic assessment in recurrent cases
- Pre-anaesthetic fitness evaluation
Surgical Technique
Myringotomy is a microsurgical procedure usually performed under general anesthesia in children and local anesthesia in adults. A small incision is made in the eardrum, middle ear fluid is suctioned out, and a tiny ventilation tube is inserted to maintain airflow and drainage. The procedure typically takes 15–30 minutes and is done as a day-care surgery.
Recent Advances
- Microscopic and endoscopic myringotomy techniques
- Improved tympanostomy tube materials and designs
- Laser-assisted myringotomy for precise incision
- Balloon eustachian tuboplasty for chronic dysfunction
- Drug-eluting ear tubes to reduce infection recurrence
- Office-based procedures in selected adult patients
Possible Risks & Complications
- Temporary ear pain or discomfort
- Tube blockage due to wax or discharge
- Premature tube extrusion
- Persistent tympanic membrane perforation (rare)
- Myringosclerosis (eardrum scarring)
- Occasional recurrent infections
Outcomes
Myringotomy surgery provides excellent outcomes in most patients. Hearing improvement, reduced infection frequency, and relief from ear pressure are commonly observed. Children show better speech and language development after timely intervention. Indian ENT centres report outcomes comparable to global standards with high success rates and minimal complications.
Conclusion
Myringotomy surgery with tympanostomy tube placement is a safe, effective, and widely practiced solution for chronic middle ear disease. Advances in surgical techniques, visualization, and tube design have significantly improved outcomes. With proper evaluation and follow-up care, patients experience lasting hearing improvement, fewer infections, and a better quality of life.