What Is Myringotomy?

Introduction 

Myringotomy is a surgical procedure in which a small incision is made in the eardrum to relieve pressure caused by fluid buildup in the ear. This fluid may be blood, pus, or water. The surgeons may decide to put a small, hollow tube into the eardrum to prevent pressure build-up from reoccurring.  

Anatomy of the ear

The ear is an intricate structure consisting of small bones and membranes that all work together to orchestrate sound that your brain interprets. The ear is divided into three parts: 

• External ear (outer ear) is simply the ear canal and the visible part of the ear itself (also known as the pinna)
• Middle ear lies within one of the skull bones called the temporal bone and is divided from the external ear by the tympanic membrane (the eardrum). The middle ear contains three small bones called the auditory ossicles, which help transmit sound vibrations from the eardrum to the inner ear. The middle ear also houses the Eustachian tubes, which connect the ear to the back of the throat and help equalise the air pressure in your ears.
• Inner ear contains two main parts: the cochlea and semicircular canals. The cochlea is a snail-shaped structure that contains the nerves for hearing.  The fluid inside the cochlea causes tiny hairs inside it to vibrate, sending electrical impulses to your brain. The semicircular canals are responsible for balance.

A variety of conditions (including allergies and middle ear infections) can cause fluid to build up in the middle ear, causing increased pressure within the ear, which can cause a lot of pain, discomfort, or in some cases, loss of balance. 

Conditions requiring myringotomy

This surgical procedure is carried out when there is a build-up of fluid that doesn’t resolve itself with medical treatment. 

Here are the most common reasons for carrying out a myringotomy in children and adults:

• Frequent middle ear infections with fluid buildup (otitis media). This is often defined as more than 4-5 infections within 6 months.¹ 
• Insertion of a tympanostomy tube  - a tiny hollow tube placed into the eardrum to prevent fluid from building up behind the eardrum
• To reduce hearing loss caused by fluid buildup 
• To help treat Eustachian tube dysfunction
• To take a sample of the fluid in the ear for it to be examined in a lab for bacteria or other infections

After the procedure, you should feel relief from pressure and pain, and any hearing loss caused by the fluid buildup should improve too. 

Myringotomy procedure explained

Before the surgery

Before the procedure, the doctors will likely carry out a few checks. The doctors may carry out a hearing test, including a special test called a tympanogram. The tympanogram test measures how well the tympanic membrane (the eardrum) reacts to changes in pressure. They will also have a look at the tympanic membrane using a small light (an otoscope), which allows them to gain a clear view of the membrane. This way, they will be able to see if there is any obvious damage or fluid buildup, such as blood or pus. You may also need to have some blood tests taken. 

On the day

It’s a good idea to arrange transport to and from the hospital because if you’ve had a general anaesthetic, you must not drive for 24 hours after surgery. It’s important not to eat or drink anything for at least 8 hours before the procedure. 

If you take regular medication, talk to your doctor about which medications are appropriate for you to take on the day. 

During the surgery

During a myringotomy procedure, an ear, nose and throat (ENT) surgeon will guide a small camera into position to give them the best view possible. They will then make an incision into the tympanic membrane (the eardrum), which helps equalise pressure and allow any fluid to leave the ear. Sometimes, surgeons aid the draining by using a small amount of suction. 

In most cases, the surgeon will insert a small tube that passes through the tympanic membrane. This is because the semi-transparent tympanic membrane heals quickly, so the benefits of a small incision to allow the fluid out are short-term. Studies have shown that inserting one of these tubes, called a tympanostomy tube, decreases the amount of fluid and improves hearing compared to performing the myringotomy on its own.² 

No stitches will be used, as the incision will heal on its own. This surgical procedure usually takes between 15 and 20 minutes. 

After the surgery

Your doctor will give you specific instructions on what to do after the surgery. However, here is some general advice:

• If cotton wool was placed in your ear to absorb any excess blood, pus, or water, then change it regularly 
• If you have been prescribed ear drops, use as directed by your doctor
• If you plan on swimming or coming into contact with water, use the earplugs recommended by your doctor. Your doctor will advise you on when it is safe to shower and bathe again. 

Your tympanic membrane (eardrum) should heal within 4 weeks if there are no complications. If tympanostomy tubes were inserted, these should naturally fall out after 6-12 months. In some cases, these may need to be removed with surgery. 

Remember to attend any follow-up appointments to allow your doctor to monitor your progress. 

What are the risks of myringotomy?

As mentioned, this procedure drains the fluid, which will alleviate most of the symptoms you are experiencing, whether it be an ear infection or hearing loss from too much fluid in the middle ear. 

This is a simple procedure; however, as with all surgical procedures, there are risks that you should be aware of. These include:

• Bleeding
• Infection during surgery
• Failure of the incision of the tympanic membrane to heal
• Hearing loss
• Injury or damage to the other structures within the ear 
• You may need repeat surgery

When to call the doctor?

Once you’ve undergone a myringotomy, it’s important to be on the lookout for any early signs of complications. If you experience any of the following symptoms, contact your doctor or GP practice. 

• Indicators of infection, such as fevers or chills 
• Pain that doesn’t get better with medication 
• Redness, swelling, or abnormal bleeding/discharge from the ear
• Hearing issues 
• Nausea and vomiting 
• Persistent coughing 
• Difficulty breathing or shortness of breath 

FAQs

What is the most common symptom that necessitates a myringotomy?

The most common symptom necessitating a myringotomy is persistent ear infections, especially in cases of chronic otitis media.³

Does a myringotomy hurt?

You will be given anaesthesia during the surgery, so you will not feel any pain. Some people experience small amounts of pain after the surgery, but this can be resolved with pain medication. 

Is myringotomy the same as grommets?

No, myringotomy is a surgical procedure involving an incision in the eardrum to drain fluid. Grommets (tympanostomy tubes) are tiny tubes placed during myringotomy to ventilate the middle ear and prevent fluid buildup.

Do grommets damage the eardrum?

Grommets are designed to be minimally invasive and do not cause permanent damage to the eardrum. They are typically expelled naturally as the eardrum heals.

What is another name for myringotomy?

It’s common for medical professionals to use the terms myringotomy and tympanostomy interchangeably. Myringotomy refers to incising a small opening in the eardrum, and tympanostomy refers to making a small opening and then inserting a hollow tube called a tympanostomy tube. 

Are you awake for a myringotomy?

Myringotomy is commonly carried out under general anaesthesia, so individuals are asleep during the procedure.

What is the success rate for myringotomy?

The success rate of myringotomy is generally high, with many individuals experiencing improved hearing, reduced ear infections, and overall better ear health. 

What should you avoid after a myringotomy?

After a myringotomy, it's advisable to avoid water exposure in the ears, especially when swimming in pools or hot tubs. Additionally, protecting the ears from loud noises and maintaining proper ear hygiene are recommended.

Do grommets fix Eustachian tube dysfunction?

The Eustachian tube connects your middle ear to the nasopharynx, which is the space at the back of your nasal canal. The grommets will allow air to pass directly through, which helps with Eustachian tube dysfunction. However, the grommets will not treat the underlying cause.

How long does it take for hearing to improve after a myringotomy?

Hearing improvement after a myringotomy can vary, but many individuals experience better hearing shortly after the procedure. It’s essential to follow post-operative care guidelines for optimal recovery.

Summary

Myringotomy is a surgical procedure designed to alleviate the discomfort and potential complications associated with constant fluid build-up in the middle ear. It is a necessary intervention for various ear conditions, particularly among children who experience frequent ear infections.

As we've delved into the intricacies of the ear's anatomy, it’s clear to see how myringotomy works as a targeted solution to restore pressure balance and preserve auditory function. 

The outline of the various parts of the surgical procedure should give you a thorough understanding of the pre-and post-operative care. We hope this clarity alleviates any apprehensions and allows you to make informed decisions if you’re considering or undergoing the procedure.

Myringotomy is not merely a surgical intervention; it is a thoroughfare to improved hearing, reduced ear infections, and better overall ear health.