MYRINGOTOMY AND TYMPANOSTOMY​

 

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Myringotomy is a surgical procedure that involves making a small incision in the eardrum (the tympanic membrane) to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. This procedure can be necessary in cases of chronic or recurrent middle ear infections or in patients with eustachian tube dysfunction, which can lead to problems with hearing or persistent discomfort.

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A myringotomy may be performed in conjunction with the placement of a tympanostomy tube (also known as an ear tube) into the incision. This tiny tube helps to maintain aeration of the middle ear and allows for continued drainage of fluid, thereby helping to prevent future ear infections and related issues.

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The procedure is typically done under general anesthesia in children and can be performed under local anesthesia in adults. It's usually quick, taking only about 15 to 30 minutes, and the recovery period is relatively short. Following the procedure, patients might experience mild discomfort or minor changes in hearing, but these typically resolve within a short time.

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A myringotomy is often a very effective treatment for chronic ear infections and eustachian tube dysfunction, offering relief from symptoms and helping to prevent potential complications, such as hearing loss. It is typically recommended after more conservative treatment measures, such as antibiotics or nasal steroids, have failed to resolve the issue.

                                                                                                 

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                                                             Anesthetic Implications for Myringotomy

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Anesthesia type: General

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Airway: Mask, LMA, or ETT

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Preoperative:

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• Myringotomy is a commonly performed procedure in pediatrics

• Assess for upper respiratory infection

• Mask induction with sevoflurane +/- N2O in pediatrics

• An oral airway is usually inserted to facilitate bag-mask ventilation or spontaneous ventilation

• In tympanostomy, ear tubes are placed

• Antibiotic ear drops are usually instilled after placing the tubes

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Intraoperative:

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• Position: Supine with head turned away from the surgical site

• Duration 5-10 minutes

• Keep the child covered and warm

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Postoperative:

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• Pain management

• PONV prophylaxis

• Monitor for emergence delirium

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Complications:

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• Infection

• Perforation of the eardrum

• Scarring

• Laryngospasm

• PONV

• Emergence delirium

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Sources:

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Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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