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A myringotomy is an ear surgical procedure in which a small incision is made in the tympanic membrane (eardrum) to remove fluid such as blood, pus or water from the middle ear. Unlike in tympanoplasty, the middle ear is not directly involved in the procedure. It is performed when there is no infection in the middle ear space, its mucosa lining and the ossicles.

A myringotomy is performed to relieve the buildup of pressure in the middle ear. This is usually due to chronic middle ear infections which are resistant to other treatments especially antibiotics. There may also be excessive fluid present due to severe reactions to allergens.

When is there a Need for A Myringotomy?

Myringotomy or myringoplasty is mostly performed for adults. Adults usually require this surgical operation as a result of barotrauma, or sudden change in ear pressure, which may be caused by physical activities such as scuba diving, air travel, mountain climbing or explosion. Adults may also require a myringotomy when they develop mastoiditis which occurs when an infection of the bone behind the ear has spread or is in danger of spreading.

Most doctors do not suggest a myringotomy for children's ear infections unless;

  • There are recurring ear infections in a short period of time.
  • A buildup of fluid in one of the ears persists for over 6 months
  • A buildup of fluid persists for over 3 months in both ears
  • A hearing is badly affected
  • There is a speech delay or slurring of speech
  • It is necessary to remove fluid for laboratory examination

A myringotomy is nearly always successful and provides immediate relief from symptoms. It has about 95% success rate with little or no minimal risks. Most children on whom this procedure is performed do not suffer any loss of hearing, ear discharge or speech delays.

Myringoplasty should not be performed if there is active discharge from the parent's middle ear, or if the patient has an uncontrolled nasal allergy, or when the other ear is dead and cannot be suitable for hearing, otitis externa and if the children are less than 3 years of age. Myringotomy is often done under general anesthesia, but it can also be done under local anesthesia.

Procedure of Myringotomy

The ear is washed and a small incision is made in the eardrum. Any fluid that is present is then aspirated, then the tube of choice inserted, and the ear packed with cotton wool to control any slight bleeding that might occur. This is known as conventional (or cold knife) myringotomy and usually heals in about one to two days.

Laser surgery is also used called tympanostomy or laser-assisted tympanostomy. This uses a CO2 laser and is performed with a computer-driven laser and a video monitor to show a precise location for the hole in the ear. The laser takes less than a second to create the opening, without damaging surrounding skin or other ear structures. This perforation remains open for several weeks and helps in ventilation of the middle ear without the need for tube placement.

Though laser myringotomies maintain patency slightly longer than cold-knife myringotomies (two to three weeks for laser while it takes two to three days for cold-knife without tube insertion), they have not proven to be more effective in the management of fluid seeping out. It was found by doing one randomized controlled study that laser myringotomies are safe but less effective than ventilation tube in the treatment of chronic otitis media. Multiple occurrences in children, a strong history of allergies in children, the presence of thick mucus drainage, and history of tympanostomy tube insertion in adults make it highly probable that laser tympanostomy will be ineffective.

Various tympanostomy tubes are available for a myringotomy. Traditional metal tubes have been replaced by more common used tubes like silicon, titanium, polyethylene, gold, stainless steel, or fluoroplastic tubes. Some recently used ones are coated with antibiotics and phosphorylcholine.

Risks of a Myringotomy

Though it is generally considered an extremely safe procedure there are risks involved in any type of surgery. Risks of surgery in general (not only myringotomy) may include:

  • Excessive bleeding
  • Infection
  • Breathing difficulties
  • Adverse reactions to anesthesia or medications
  • Risks of a myringotomy, in particular, may include continuing drainage from the ear, continuous episodes of middle ear inflammation or effusions or a hole in the eardrum that refuses to heal. In the case of the patent perforation, the eardrum will need to be surgically operated.