Overview
Myringotomy is a surgical procedure to create a small incision in the tympanic membrane, often followed by insertion of a tympanostomy tube.
Myringotomy is crucial for treating chronic otitis media with effusion, recurrent acute otitis media, and hearing loss in children.
Learn more in our comprehensive RxDx ENT Course
Indications
Persistent middle ear effusion
Multiple episodes per year
Conductive hearing loss
Due to hearing loss
Chronic dysfunction
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient assessment, anesthesia planning, equipment setup, and understanding contraindications.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, administer anesthesia.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate anesthesia
💡 Pro Tip:
Use proper positioning.
Step 2: Ear Canal Preparation
Clean and prepare ear canal.
⚠️ Common Mistakes to Avoid:
- Inadequate cleaning
- Poor exposure
💡 Pro Tip:
Ensure clean field.
Step 3: Tympanic Membrane Incision
Make incision in tympanic membrane.
⚠️ Common Mistakes to Avoid:
- Wrong location
- Inadequate incision
💡 Pro Tip:
Use proper technique.
Step 4: Fluid Aspiration
Aspirate middle ear fluid.
⚠️ Common Mistakes to Avoid:
- Incomplete aspiration
- Trauma
💡 Pro Tip:
Use gentle suction.
Step 5: Tube Insertion
Insert tympanostomy tube.
⚠️ Common Mistakes to Avoid:
- Wrong size
- Poor placement
💡 Pro Tip:
Ensure proper placement.
Step 6: Post-procedure Care
Monitor and provide instructions.
⚠️ Common Mistakes to Avoid:
- Poor monitoring
- Inadequate instructions
💡 Pro Tip:
Provide clear instructions.
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Post-procedure Care
Post-procedure care involves monitoring tube function, preventing water exposure, and follow-up evaluation.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Tube extrusion | 5-10% | Early tube loss | Reinsertion if needed | Proper placement |
| Persistent perforation | 1-3% | Non-healing tympanic membrane | Tympanoplasty | Proper technique |
| Infection | 1-2% | Otitis externa, otorrhea | Antibiotics | Sterile technique |
| Granulation tissue | 2-5% | Tissue overgrowth | Removal, cautery | Proper technique |
Clinical Pearls
Use proper microscope positioning.
Make incision in anterior-inferior quadrant.
Ensure complete fluid aspiration.
Check tube placement carefully.
Document procedure details.
Provide clear post-op instructions.
Monitor for complications.