Chapter 92 Myringotomy with/without PE Tubes
PATHOPHYSIOLOGY
A myringotomy is a surgical procedure that involves making a small hole in the ear drum to insert pressure-equalizing tubes in the tympanic membrane. This allows for ventilation of the middle ear space, relieves the negative pressure the child often feels in the ears, and allows for drainage of fluid congestion that builds up in the middle ear space. This fluid congestion occurs as a result of frequent and/or unresolved otitis media infections (see Chapter 59). The procedure can relieve symptoms of chronic otitis media with effusion, and allow a sample of middle ear fluid to be taken for culture. This procedure is performed on children with chronic ear infections that have not resolved with antibiotic therapy, and those who have a persistent middle ear effusion.
During the myringotomy procedure, an opening is made in the ear drum to relieve the effusion and/or to insert tympanostomy tubes. This is almost always done on both ears during the same procedure. The ear drum will heal around the tubes and secure them in place. The tubes may be shaped like a bobbin; these fall out in 9 to 12 months. There are also T-shaped tubes; these stay in longer and may need surgical intervention for removal. Tubes are either plastic or metal. Myringotomy with tube insertion is usually done by an ear, nose, throat specialist. It is usually done in an ambulatory or outpatient surgical setting.
INCIDENCE
1. About 1 million children have tubes placed annually.
2. Most are placed in 1- to 3-year-old children.
3. About 30% of children having tubes placed will need an additional set within 5 years.
4. By the time a child is about 5 years old, the eustachian tube becomes wider and longer, making it less likely that a child will get ear infections.
MEDICAL MANAGEMENT
Children with recurrent otitis media are treated based upon the current guidelines from the American Academy of Pediatrics. After recurrent otitis media and persistent effusion, a myringotomy and tube placement is often performed. After surgery, the child will require administration antibiotic ear drops for a short period of time.
Discharge Planning and Home Care
1. Instruct parents to keep ears dry by using ear plugs for shampooing hair and during swimming.
2. Instruct parents to use ear drops as prescribed upon return home.
3. Instruct parents to monitor for ear drainage and to expect some in the week after surgery.
4. Ensure that parents have follow-up visit date scheduled with surgeon.
5. Instruct parents regarding other possible complications that may occur from anesthesia.
6. Instruct parents to have child’s hearing checked after follow-up appointment with surgeon.
Barclay L:. Prompt use of tympanostomy tubes may not improve developmental outcomes at age six years. [(serial online):] .Medscape, 2006. www.medscape.com/viewarticle/510438. Accessed on January 9
Goldstein NA, et al. Water precautions and tympanostomy tubes: a randomized controlled trial. Laryngoscope. 2005;115(2):324.
Nomura Y, et al. Effect of myringotomy on prognosis in pediatric acute otitis media. Int J Pediatr Otorhinolaryngol. 2005;69(1):61.
Paradise JL, et al. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med. 2005;353(6):576.
U.S. National Library of Medicine and the National Institutes of Health. Ear tube insertion. [(serial online)] .MedlinePlus, 2006. www.nlm.nih.gov/medlineplus/ency/article/003015.htm. Accessed on January 14
