Myringotomy with Tympanostomy Tube Insertion

Video Type: CVideo
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Author: Thomas Mitchell
Published:
Specialties: Otolaryngology, Pediatric Otolaryngology, Pediatric Surgery
Schools: University of Texas at Houston Medical School
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Basic Info

Myringotomy with tympanostomy tube insertion is among the most common pediatric operative procedures and is indicated to provide ventilation of the middle ear.  Surgical incision in the tympanic membrane (myringotomy) is followed by tympanostomy tube insertion to prevent premature closure of the incision site.  The goal of the procedure is to reduce the frequency, duration, and severity of subsequent otitis media episodes and to prevent recurrence of middle ear effusions.

  • Soham Roy (University of Texas at Houston Medical School)
  • Thomas Mitchell (University of Texas at Houston Medical School)
Advanced

Procedure

Myringotomy with Tympanostomy Tube Insertion: The tympanic membrane is visualized with a microscope through a speculum placed in the external auditory canal. Cerumen may need to be removed to achieve sufficient visualization. The membrane is incised using a myringotomy knife - this incision is typically placed in the anterior-inferior quadrant of the tympanic membrane, although it may also be in the anterior-superior area. If an effusion is present, suction is employed to aspirate the effusion. Finally, a tympanostomy tube is introduced and the flange is inserted through the incision in the tympanic membrane. Saline or antibiotic drops may be instilled to conclude.

Indications

Recurrent or refractory acute otitis media, conductive hearing loss associated with middle ear effusion.

Contraindications

Vascular anomalies in the middle ear, intratympanic glomus tumor, prior radiation to ear (possible)

Instrumentation

Setup

The patient is subject to local or general anesthesia. A microscope is focused on the external auditory meatus. A speculum is placed into the external auditory canal and cerumen is removed so that the tympanic membrane can be visualized.

Preoperative Workup

Pneumatic otoscopy, audiology with tympanometry

Anatomy and Landmarks

The incision in the tympanic membrane should not be placed in the posterosuperior quadrant due to risk of injury to the bony ossicles and/or chorda tympani nerve. Incisions are commonly made in either anterior quadrant.

Advantages/Disadvantages

Tympanostomy tubes do not ¢ïïcure¢ïï otitis media, but they have been proven to reduce the frequency, duration, and severity of episodes for a majority of patients.

Complications/Risks

Tube otorrhea, tube occlusion, persistent tympanic membrane perforation, premature tube extrusion, tympanic membrane retraction pocket, tympanosclerosis, cholesteatoma

Disclosure of Conflicts

Tube otorrhea, tube occlusion, persistent tympanic membrane perforation, premature tube extrusion, tympanic membrane retraction pocket, tympanosclerosis, cholesteatoma

Acknowledgements

References

Rosenfeld RM, Schwartz SR, Pynnonen MA et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngology Head and Neck Surgery. 2013 July; 149(1):8-16

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