Myringotomy

Myringotomy
Intervention
ICD-9-CM	20.0

Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum, so as to relieve pressure caused by the excessive build-up of fluid, or to drain pus. 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 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 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, are usually placed at the time of myringotomy to stent 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 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, 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.^[1]. 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.^[2]

References

1. ^ Szeremeta,Wasyl M.D., Adenoidectomy With Laser or Incisional Myringotomy for OME, 4/30/2000
2. ^ Reilly JS; Deutsch ES; Cook S. Laser-assisted myringotomy for otitis media: a feasibility study with short-term followup. Ear Nose Throat J 2000 Aug;79(8):650-2, 654-7