Myringotomy (Ear tubes)
MEDICAL ANIMATION TRANSCRIPT: A myringotomy, also known as a tympanostomy or tympanotomy, is a surgical procedure to remove fluid in the middle ear and reestablish equal air pressure on both sides of the ear drum. The ear consists of three main parts, the outer ear, the middle ear, and the inner ear. The outer ear includes the pinna, which collects sound waves, and the ear canal, which transports sound waves to the eardrum, a paper thin layer of tissue separating the outer and middle ear. Sound waves cause the eardrum to vibrate, which in turn vibrates three tiny bones inside the middle ear, called the malleus, incus, and stapes, which pass the sound vibrations along to the inner ear. The inner ear translates vibrations into electrical signals, which are picked up by the auditory nerve, sent to the brain, and interpreted as sound. This complex process occurs instantly, allowing us to hear the sounds around us as they happen. For the eardrum to vibrate properly, the air pressure in the middle ear must be at the same level of pressure as air outside the ear. Air enters the middle ear through eustachian or auditory tube. When you yawn and hear a pop, eustacian tube has just carried an air bubble to your middle ear to equalize the pressure. An infection, allergy, mass, or enlarged adenoids can block the eustachian tube, allowing fluid to collect in the middle ear. Fluid prevents the ear drum from vibrating properly, blocking normal transmission of sound through the middle ear, which may cause hearing loss. In some instances the fluid may become infected with bacteria, resulting in a otitis media, or ear infection. Reasons for performing a myringotomy include draining ear fluid trapped in the ear for more than three months, treating chronic ear infections not cleared up with antibiotics, restoring hearing loss caused by fluid build up, preventing delays in speech development due to hearing loss in children, or testing fluid from the middle ear for bacteria. Before the procedure, an intravenous line will be started. In most cases, general anesthesia is used to put the patients to sleep for the duration of the procedure. The surgeon will make a small incision in the ear drum using a scalpel or laser, and drain the fluid in the middle ear. In many cases the surgeon place of a ventilation tube, or PE tube through the incision. This small tube will drain any fluid that collects after surgery and allow air into the middle ear to help dry it out. If necessary, the surgeon will repeat the procedure on the opposite ear. The entire procedure takes 30 to 60 minutes. The incision in the ear drum will heal itself, so no stitches are required. After surgery, the patient will go to the recovery room for monitoring. Children maybe fussy after their procedure and should be encouraged to eat and drink anything they can tolerate. If your child has pain, avoid aspirin and instead use acetaminophen at an age specific dose. If additional pain relief is necessary, your doctor can recommend other options. The PE tube usually falls out on it's own within several months.