Myringotomy is a surgical

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 procedure in which a tiny incision is created in the eardrum

Eardrum

The eardrum, or tympanic membrane, is a thin membrane that separates the external ear from the middle ear in humans and other tetrapods. Its function is to transmit sound from the air to the ossicles inside the middle ear. The malleus bone bridges the gap between the eardrum and the other ossicles...

, so as to relieve pressure caused by the excessive build-up of fluid, or to drain pus

Pus

Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...

. Myringotomy is often performed as a treatment for acute suppurative otitis media. If a patient requires myringotomy for drainage or ventilation of the middle ear, this generally implies that the Eustachian tube

Eustachian tube

The Eustachian tube is a tube that links the nasopharynx to the middle ear. It is a part of the middle ear. In adult humans the Eustachian tube is approximately 35 mm long. It is named after the sixteenth-century anatomist Bartolomeo Eustachi...

 is either partially or completely obstructed and is not able to perform this function in its usual physiologic fashion. Before the invention of antibiotics, myringotomy was the main treatment of severe acute otitis media (middle ear infection).

The eardrum, also called the tympanic membrane, ordinarily heals within two weeks or so of a myringotomy – unless a tube

Tympanostomy tube

A tympanostomy tube is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of mucus in the middle ear. The operation to insert the tube involves a myringotomy...

 is inserted into the opening that was made or unless the opening is made with a laser. Depending on the design of the tube, a myringotomy and tube procedure can allow external ventilation of the middle ear space for weeks, months or even years. Myringotomy with tube insertion is performed for the relief of otitis media.

Pressure equalization tubes, known as tympanostomy or myringotomy tubes

Tympanostomy tube

A tympanostomy tube is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of mucus in the middle ear. The operation to insert the tube involves a myringotomy...

, are usually placed at the time of myringotomy to stent

Stent

In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...

 the eardrum open. Otherwise the rapid healing of the eardrum (a few days) would necessitate future myringotomies before the underlying condition is fully treated. Most tubes are made of a synthetic plastic material, such as silicone

Silicone

Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

 or teflon. They typically stay in place about nine months before they are naturally extruded by the rapidly healing eardrum.

Otolaryngologists can perform myringotomy and tube placement in the clinic using a topical anesthetic

Topical anesthetic

A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams,...

, but children usually require general anesthesia or strong sedation in the operating room. Typically an operating microscope is used, but is not always necessary. Most people report rapid return of their hearing.

The most common complications to myringotomy and tube placement include early extrusion of the tube and failure of the eardrum to heal after the tube has fallen out. Rarely the tube can extrude inward into the middle ear or mastoid and therefore be retained. These complications may actually require additional procedures to rectify.

LAM - Laser Assisted Myringotomy

Laser Assisted Myringotomy, sometimes referred to as OtoLAM, for OtoScan Laser Assisted Myringotomy (OtoScan is the tradename of one of the otoscope-mounted systems used), is a treatment developed in the 1990s that utilizes a laser to create the hole in the eardrum rather than using a surgical incision.. The laser technique is less invasive than surgical incision and can be performed in an office setting or outpatient clinic using only topical anesthesia. With the aid of a specialized CO₂ laser system, the procedure creates a precisely sized hole in the tympanic membrane that remains open for several weeks. During this time, the middle ear stays ventilated, providing fast relief from otitis media related pain and allowing the underlying infection time to resolve. If more time is needed for resolution, tubes can easily be inserted into the bloodless hole, although at the expense of increasing invasiveness over just the laser technique alone. Clinical studies found that 60% of the cases resolved after a single OtoLAM treatment and clearing the underlying infection helps prevent recurring episodes of otitis media.