A Brief note on Myringotomy
A myringotomy is a surgical procedure in which an incision is created in the eardrum (tympanic membrane) to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously within two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.
Myringotomy is usually performed as an outpatient procedure. General anesthesia is preferred in children, while local anesthesia suffices for adults. The ear is washed and a small incision made in the eardrum. Any fluid that is present is then aspirated, the tube of choice inserted, and the ear packed with cotton to control any slight bleeding that might occur. This is known as conventional (or cold knife) myringotomy and usually heals in one to two days. A new variation (called tympanolaserostomy or laser-assisted tympanostomy) uses a CO2 laser, and is performed with a computer-driven laser and a video monitor to pinpoint a precise location for the hole. The laser takes one-tenth of a second to create the opening, without damaging surrounding skin or other structures. This perforation remains patent for several weeks and provides ventilation of the middle ear without the need for tube placement. Though laser myringotomies maintain patency slightly longer than cold-knife myringotomies (two to three weeks for laser and two to three days for cold knife without tube insertion), they have not proven to be more effective in the management of effusion.
One randomized controlled study found that laser myringotomies are safe but less effective than ventilation tube in the treatment of chronic OME. Multiple occurrences in children, a strong history of allergies in children, the presence of thick mucoid effusions, and history of tympanostomy tube insertion in adults, make it likely that laser tympanostomy will be ineffective. Various tympanostomy tubes are available. Traditional metal tubes have been replaced by more popular silicon, titanium, polyethylene, gold, stainless steel, or fluoroplastic tubes. More recent ones are coated with antibiotics and phosphorylcholine.
Evidence suggests that tympanostomy tubes only offer a short-term hearing improvement in children with simple OME who have no other serious medical problems. No effect on speech and language development has yet been shown. A retrospective study of success rates in 96 adults and 130 children with otitis media treated with CO2 laser myringotomy showed about a 50% cure rate at six months in both groups. To date, there have been no published systematic reviews. Balloon Dilation Eustachian Tuboplasty (BDET), a new treatment, has proven to be effective in treating OME secondary to eustachian tube dysfunction. However, the number of patients in the studies cited, 22 and 8 respectively and 18 in the tympanometric study, is extremely small and simply points to the need for large, well-controlled studies.