Myringotomy

Myringotomy is a diagnostic and therapeutic surgical procedure in which a small incision is made in the tympanic membrane. This procedure is also known as paracentesis of the tympanic membrane, a term that comes from the Ancient Greek words παρά, meaning “at the side”, and κέντησις, meaning “to pierce”. The incision allows fluid or pus to drain from the middle ear and helps restore normal middle ear pressure.

This procedure is one of the most commonly performed in otologic surgery. When carried out promptly in cases of acute otitis media, myringotomy can relieve symptoms, speed recovery, and prevent serious complications such as mastoiditis or intracranial infection.

Indications for Tonsillectomy

The primary purpose of myringotomy is to create a controlled outlet for fluid or pus accumulated in the middle ear.

Main indications:

• Acute suppurative otitis media: This is the main indication. Myringotomy is performed in the pre-perforation stage if any of the following occur:
  • High fever and severe systemic symptoms.
  • Signs of inner ear involvement, such as vertigo, or facial nerve paresis.
  • Lack of improvement with ongoing therapy.
  • Development of complications, including mastoiditis or intracranial infection.
• Otitis media with effusion: When conservative treatment fails, myringotomy allows removal of thick secretions and, if necessary, placement of a ventilation tube (grommet).
• Hemotympanum: Blood accumulated in the middle ear after trauma, including barotrauma, can be drained through paracentesis of the tympanic membrane.
• Diagnostic purposes: Fluid can be collected for microbiological analysis in atypical or treatment-resistant cases.

Surgical Technique

Myringotomy is performed by an ENT surgeon under direct visual control using an operating microscope. In adults, local anesthesia is usually sufficient, while children generally require general anesthesia.

Using a myringotomy lance, the surgeon makes a small incision in the tympanic membrane. To avoid injury to the ossicles or surrounding nerves, the incision is made in the safest quadrants (anteroinferior or posteroinferior). Once the incision is made, fluid (pus or serous exudate) is drained and aspirated. If ongoing middle ear ventilation is needed, a tympanostomy tube (grommet) is inserted through the incision.

Clinical Significance and Outcomes

Myringotomy provides rapid relief from pain in acute otitis media by reducing middle ear pressure. Unlike spontaneous perforations, the surgical incision has smooth edges and typically heals within 7–10 days, leaving only a minimal scar. This precise approach prevents spontaneous perforation, which could otherwise result in a persistent defect and chronic middle ear disease. When performed correctly, complications are rare but may include minor bleeding or infection.