Myringotomy (Syn. Tympanostomy) ENT

Definition: Incision of the tympanic membrane to drain middle ear effusion (suppurative or non-suppurative) or to provide aeration (for malfunctioning Eustachian tube).

Indications

1. Acute Suppurative Otitis Media (ASOM):
   • Severe earache with bulging drum.
   • Incomplete resolution (persistent deafness/opaque drum).
   • Complications: Facial palsy, Labyrinthitis, Meningitis.
   • Recurrent attacks.
2. Otitis Media with Effusion (OME): Serous otitis.
3. Aero-Otitis Media: To "unlock" the Eustachian tube.
4. Atelectatic Ear: For insertion of Grommet (ventilation tube).

Anaesthesia

• Infants & Children: Always General Anaesthesia.
• Adults:
  • Inflamed TM (Acute): General Anaesthesia.
  • Non-inflamed TM: Local Anaesthesia or None.

Steps & Incision Sites

Performed under Operating Microscope using a sharp Myringotome.

Condition	Incision Type	Location (Quadrant)
Acute OM (Pus)	Circumferential (Curvilinear)	Postero-Inferior. *Midway between umbo and annulus. Avoids Incudostapedial joint.
OME (Fluid)	Radial (Small)	Postero-Inferior OR Antero-Inferior.
Grommet Insertion	Small stab	Antero-Superior. *Preferred for longer retention of tube.

Pitfalls & Complications

Pitfalls (Errors)

• Incomplete Incision: Cutting only superficial layers (common if TM is thick).
• Canal Injury: Incising posterior meatal wall (distinction lost due to inflammation).
• Vascular Injury: Beware of aberrant Carotid artery, Glomus Tympanicum, or High Jugular Bulb.

Complications

• Injury to Incudostapedial Joint or Stapes.
• Injury to Jugular Bulb (Profuse bleeding).
• Introduction of infection into middle ear.

Post-Operative Care

• ASOM: Daily dry mopping of discharge.
• OME: Leave cotton wad for 24-48 hrs.
• Precaution: No water in ear canal for 1 week (or as long as grommet is in place).
• Healing: Incisions usually heal rapidly.