Myringotomy and ear tubes (tympanostomy)
- Procedure
A small cut is made in the eardrum, the fluid is suctioned out and a tiny tube is left to ventilate the middle ear.
What it is
Myringotomy is an incision in the tympanic membrane to drain the middle ear. When a ventilation tube is also left in place (tympanostomy), the middle ear stays aerated while the eustachian tube matures. It is one of the most common operations in children and is usually a day case, under general anaesthesia in children and sometimes local anaesthesia in adults. This page is an educational overview of the operation: the management of otitis is on the page on otitis media in children.
Indications and contraindications
- Persistent otitis media with effusion (3 months or more) with hearing loss, speech, learning or balance problems.
- Recurrent acute otitis media with persistent effusion between episodes.
- At-risk children (Down syndrome, cleft palate, pre-existing sensorineural hearing loss, developmental delay): considered earlier.
- Complications of acute otitis (mastoiditis, facial palsy, intracranial complication): myringotomy to drain and take a culture.
- Recurrent middle ear barotrauma in adults who fly or dive; early retraction pockets of the eardrum.
- Not indicated for a single episode of acute otitis or for effusion of less than 3 months without risk factors.
- Relative contraindication: one-sided effusion in an adult without a nasopharyngeal examination; anomalous middle ear vascular anatomy.
How it is done
- Before: audiometry or tympanometry and otoscopy confirming the effusion; the plan is explained to the family.
- Under the microscope, the ear canal is cleaned and the whole eardrum is seen.
- Radial or circumferential incision in the anteroinferior quadrant of the pars tensa.
- The middle ear fluid is suctioned; if there is a complication, it is sent for culture.
- The ventilation tube is placed in the incision; short tubes last months and long (T) tubes last longer.
- Ear drops for a few days as the surgeon advises; follow-up with audiometry and otoscopy in the following weeks.
- The child is reviewed every few months until the tube falls out and the eardrum closes.
Myringotomy alone, short tube and long tube
| Procedure | How long it stays open | Typical use |
|---|---|---|
| Myringotomy alone | A few days: the incision closes quickly | Urgent drainage and culture in complications of acute otitis |
| Short (grommet) tube | Months; falls out on its own | Persistent effusion and recurrent acute otitis in children |
| Long (T) tube | Years; sometimes needs removal | Chronic tubal dysfunction, cleft palate, repeated surgery |
Complications
- Tube otorrhoea (the most common): topical quinolone drops and canal cleaning.
- Persistent perforation after the tube falls out, more often with long tubes.
- Tympanosclerosis (white plaques on the eardrum), almost always without effect on hearing.
- Early extrusion of the tube or a tube displaced into the middle ear.
- Tube blockage by secretions or dried blood.
- Rare: implantation cholesteatoma and granulation tissue around the tube.
Next step / Initial management
- Before referral: confirm the effusion with pneumatic otoscopy or tympanometry and request audiometry appropriate for age.
- After surgery: otorrhoea without fever is managed with quinolone ear drops (ciprofloxacin or ofloxacin) and cleaning; do not use aminoglycoside drops with an open eardrum.
- Water precautions: generally not required for surface swimming; avoid soapy water or river and lake water if the surgeon advises so.
- Refer on a routine basis to ENT if otorrhoea lasts more than a week despite drops, if the tube is still in place after 2 to 3 years, or if a perforation remains.
- Refer urgently, the same day, if there is high fever with pain behind the ear, a displaced pinna, facial palsy or severe vertigo.
Test yourself
Think of the answer, then tap the question to see it.
A 3-year-old has bilateral otitis media with effusion for 4 months and hearing loss on audiometry. Which procedure is indicated?
Myringotomy with ventilation tube insertion (tympanostomy); adenoidectomy may be added if there are adenoid symptoms or depending on age.
In which quadrant of the eardrum is a myringotomy usually made?
In the anteroinferior quadrant of the pars tensa, away from the ossicular chain and the chorda tympani.
A child with ventilation tubes has ear discharge without fever. What is the first-line treatment?
Quinolone ear drops (ciprofloxacin or ofloxacin) and canal cleaning; oral antibiotics are kept for systemic symptoms or cellulitis.
A 50-year-old has a one-sided middle ear effusion that does not resolve. What must be ruled out before a tube is placed?
A nasopharyngeal tumour (nasopharyngeal carcinoma) blocking the eustachian tube; the nasopharynx is examined endoscopically.
Elsewhere in DurgiPedia
Connections
In Pharmacology2
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Tympanostomy Tube Insertion (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2024); Otitis Media With Effusion (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2025); Ear tube insertion (MedlinePlus, U.S. National Library of Medicine, 2026).
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Representative model, for educational purposes only.