Myringotomy Periprocedural Care

Updated: Jan 06, 2016
  • Author: Brian Kip Reilly, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Periprocedural Care

Preprocedural Planning

Pneumatic otoscopy by a physician is the primary diagnostic method for otitis media with effusion (OME) and acute otitis media (AOM). In addition, tympanometry can be performed by the audiologist to help diagnose and confirm fluid behind the eardrum. Alternatively, the ear can be examined under magnification.

Radiologic imaging and confirmatory blood chemistry studies usually are not indicated. Exceptions that benefit the patient occur if postauricular swelling or mental status changes develop or if the patient appears severely ill and toxic. In these clinical situations, computed tomography (CT) scans of the temporal bone can be done to confirm temporal bone diseases, such as mastoiditis, cholesteatoma, or a malignant process.

Unilateral effusions are less common and may indicate a nasopharyngeal mass or disease process, particularly in children older than 6 years. These circumstances mandate that a nasopharyngoscopy be performed.

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Equipment

Equipment used in myringotomy includes the following:

  • Pneumatic otoscope
  • Operative microscope
  • Speculum
  • Myringotomy blade (see the image below)
  • Ear tubes (if required)
    Myringotomy blade. Myringotomy blade.
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Monitoring and Follow-up

Postoperatively, the patient is placed on antibiotic ear drops. In most cases, oral acetaminophen suffices for analgesia.

The patient is seen in follow-up after the procedure. Cultures taken from the time of surgery can be used to determine what antibiotics are most appropriate. Children with effusions or otitis media refractory to myringotomy alone should undergo tympanostomy tube placement in addition to myringotomy.

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