MYRINGOTOMY
Definition: It is an incision made on the tympanic membrane to drain out suppurative or non-suppurative middle ear effusion. This procedure can be done along with insertion of ventilation tube (Grommet).
Indications:
- Acute suppurative otitis media not responding to medical treatment.
- Serous otitis media.
- Eustachian tube dysfunction or malfunction.
- Atelectatic ear- for aeration of the middle ear with grommet insertion.
Anesthesia: Usually General anesthesia is preferred especially in children and person with acute inflammation. Local anesthesia can be given in cooperative adults.
Incision: This is made by sharp instrument called myringotome. The site of incision depends on the type of otitis media.
- In Serous otitis media, a small radial incision can be made in the anteroinferior or posteroinferior quadrant. The radial incision separates rather than cuts through fibers of the middle fibrous layer. Hence, healing is with minimal scarring.
- In Acute otitis media, a circumferential incision is made in the postero-inferior quadrant of the tympanic membrane. Thick fluid in the middle ear will ooze out through the incision.
3. Gentle suctioning of this fluid may be done.
4. A ventilation tube (grommet) may be inserted through this incision.
Pitfalls of myringotomy:
- In thick tympanic membrane, the incision may remain only in the superficial layer of the tympanic membrane.
- In congested and inflamed external auditory canal and tympanic membrane, incision may be given in the posterior meatal wall.
- Daily mopping of the ear.
- No water should be permitted to enter the ear canal for at least 1 week.
- In case of grommet insertion, entry of water is prevented so long as grommet is in position.
Complications:
- Anesthesia complications.
- Injury to Incudo-stapedial joint.
- Damage to facial nerve.
- Injury to jugular blub.
- Perforation of tympanic membrane.
- Middle ear infection.
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