Myringotomies: When and Why?

A myringotomy is an incision in the eardrum. A tube is normally then inserted through this incision. These tubes, called tympanostomy tubes, are used to keep the incision open. Eardrums heal and regenerate very quickly, meaning that the hole would close up within weeks or even days if the tube was removed.

Myringotomies are used to help drain the tympanic cavity. This is needed when pus (acute otitis media—AOM) or liquid (serous otitis) accumulates in the tympanic cavity behind the eardrum, causing symptoms of otitis. In the latter case, these symptoms include reversible hearing loss. Fluid accumulates when the Eustachian tube, a thin canal that connects the middle ear to the back of the nose, fails to drain properly. This problem mainly occurs in young children; fortunately, it tends to correct itself as they grow.

A tympanostomy tube takes over for the Eustachian tube, which is responsible for balancing the pressure inside and outside of the ear. Insertion of this tube therefore prevents otitis and temporary hearing loss caused by the accumulation of liquid.

Two primary factors indicate that a myringotomy may be necessary. The first is frequent AOMs. ENT doctors consider the treatment when a child has AOMs approximately five times per year, or three to four times in six months. The time of year also factors into the decision, as AOMs are much more common in winter. The second factor is persistent effusion behind the eardrum for more than two to three months. Childhood is a major developmental period. Good hearing is therefore critical, especially for language development.

Tympanostomy tubes are placed under general or local anesthesia. The procedure only takes a few minutes. It is painless and patients can continue with normal activities the next day. Occasionally, a liquid resembling the drips from a runny nose may run out of the ear, particularly in young children. This is fairly common and is treated with simple antibiotic drops prescribed by the ENT doctor. Oral antibiotics are rarely needed. The ENT doctor will check the tubes regularly to ensure that they have remained in place and unblocked.

Tympanostomy tubes generally come out on their own, as the eardrum considers them foreign bodies and tries to push them out. This process takes a year on average; in most cases, the eardrum will appear normal afterwards. As the child will have grown and their ear will have developed during that time, issues are unlikely to reoccur.

In sum, myringotomies and tympanostomy tubes are used to create an artificial, temporary Eustachian tube to give the child’s natural Eustachian tube time to develop and do its job properly.