The words myringotomy, tympanotomy, tympanostomy, and tympanocentesis overlap in

meaning. The first two are always synonymous, and the third is often used synon
ymously.[2] The core idea with all of them is cutting a hole in the eardrum to a
llow fluid to pass through it. Sometimes a distinction is drawn between myringot
omy/tympanotomy and tympanostomy, in parallel with the general distinction betwe
en an -otomy (cutting) and an -ostomy (creating a stoma with some degree of perm
anence or semipermanence). In this distinction, only a tympanostomy involves tym
panostomy tubes and creates a semipermanent stoma. This distinction in usage is
not always made. The word tympanocentesis specifies that centesis (aspiration fo
r sampling) is being done.
Etymologically, myringotomy (myringo-, from Latin myringa "eardrum",[3] + -tomy)
and tympanotomy (tympano- + -tomy) both mean "eardrum cutting", and tympanostom
y (tympano- + -stomy means "making an eardrum stoma".
History[edit]
In 1649, Jean Riolan the Younger accidentally pierced a patient's ear drum while
cleaning it with an ear spoon. Surprisingly, the patient's hearing improved. Th
ere are also reports from the 17th and 18th centuries describing separate experi
ments exploring the function of the ear drum.[4] In particular, the animal exper
iments of Thomas Willis were expanded upon by Sir Astley Cooper, who presented t
wo papers to the Royal Society in 1801 on his observations that myringotomy coul
d improve hearing. First, he showed that two patients with perforations of both
eardrums could hear perfectly well, despite conventional wisdom that this would
result in deafness. Second, he demonstrated that deafness caused by obstruction
of the Eustachian tube could be relieved by myringotomy, which equalized the pre
ssure on each side of the tympanic membrane.
Widespread inappropriate use of the procedure later led to it falling out of use
. However, it was reintroduced by Hermann Schwartze in the 19th century. An inhe
rent problem became recognized, namely the tendency of the tympanic membrane to
heal spontaneously and rapidly, reversing the beneficial effects of the perforat
ion. In order to prevent this, a tympanostomy tube, initially made of gold foil,
was placed through the incision to prevent it from closing. dm Politzer, a Hungaria
n-born otologist practicing in Vienna, experimented with rubber in 1886. The vin
yl tube used today was introduced by Armstrong in 1954.[5]
Indications[edit]
Retracted ear drum
There are numerous indications for tympanostomy in the pediatric age group,[1][6
] the most frequent including chronic otitis media with effusion (OME) which is
unresponsive to antibiotics, and recurrentotitis media. Adult indications[1][7][
8] differ somewhat and include Eustachian tube dysfunction with recurrent signs
and symptoms, including fluctuating hearing loss, vertigo, tinnitus, and a sever
e retraction pocket in the tympanic membrane. Recurrent episodes of barotrauma,
especially with flying, diving, or hyperbaric chamber treatment, may merit consi
deration.
Procedure[edit]
Myringotomy is usually performed as an outpatient procedure. General anesthesia
is preferred in children, while local anesthesia suffices for adults. The ear is
washed and a small incision made in the eardrum. Any fluid that is present is t
hen aspirated, the tube of choice inserted, and the ear packed with cotton to co
ntrol any slight bleeding that might occur. This is known as conventional (or co
ld knife) myringotomy and usually heals in one to two days.[9]
A new variation (called tympanolaserostomy or laser-assisted tympanostomy) uses
CO2 laser, and is performed with a computer-driven laser and a video monitor to
pinpoint a precise location for the hole. The laser takes one tenth of a second
to create the opening, without damaging surrounding skin or other structures. Th
is perforation remains patent for several weeks and provides ventilation of the
middle ear without the need for tube placement.
Though laser myringotomies maintain patency slightly longer than cold-knife myri
ngotomies (two to three weeks for laser and two to three days for cold knife wit

hout tube insertion),[10] they have not proven to be more effective in the manag
ement of effusion. One randomized controlled study found that laser myringotomie
s are safe but less effective than ventilation tube in the treatment of chronic
OME.[11] Multiple occurrences in children, a strong history of allergies in chil
dren, the presence of thick mucoid effusions, and history of tympanostomy tube i
nsertion in adults, make it likely that laser tympanostomy will be ineffective.[
9]
Various tympanostomy tubes are available. Traditional metal tubes have been repl
aced by more popular silicon, titanium, polyethylene, gold, stainless steel, or
fluoroplastic tubes. More recent ones are coated with antibiotics and phosphoryl
choline.
Aftercare[edit]
There is little scientific evidence to guide the care of the ear after tubes hav
e been inserted. A single, randomized trial found statistical benefit to using e
ar protective devices when swimming although the size of the benefit was quite s
mall.[12] In the absence of strong evidence, general opinion has been against th
e use of ear protection devices. However, protection such as cotton covered with
petroleum jelly, ear plugs, or ear putty is recommended for swimming in dirty w
ater (lakes, rivers, oceans, or non-chlorinated pools) to prevent ear infections
. For bathing, shampooing, or surface-water swimming in chlorinated pools, no ea
r protection is recommended.
Complications[edit]
The placement of tubes is not a cure. If middle ear disease has been severe or p
rolonged enough to justify tube placement, there is a strong possibility that th
e child will continue to have episodes of middle ear inflammation or fluid colle
ction. There may be early drainage through the tube (tube otorrhea) in about 15%
of patients in the first two weeks after placement, and developing in 25% more
than three months after insertion, although usually not a longterm problem.[13]
Otorhea is considered to be secondary to bacterial colonization. The most common
ly isolated organism is Pseudomonas aeruginosa, while the most troublesome is Me
thicillin-resistant Staphylococcus aureus (MRSA). Some practitioners use topical
antibiotic drops in the postoperative period, but research shows that this prac
tice does not eradicate the bacterial biofilm.[1] A laboratory study showed that
tubes covered in the antibiotic vancomycin prevented in-vitro formation of MRSA
biofilm as compared to noncoated ones,[14] although no study has been conducted
on humans yet. Comparing phosphorylcholine-coated fluoroplastic tympanostomy tu
bes to uncoated fluoroplastic tympanostomy tubes showed no statistically signifi
cant difference in the incidence of post-operative otorrhea, tube blockage, or e
xtrusion.[15]
Other early common complications are dislodgement or obstruction of the tube, wh
ile late complications include deposition of fat or dead cells, cholesteatoma, o
r thinning or persistent perforation of the tympanic membrane.[citation needed]
Efficacy[edit]
Evidence suggests that tympanostomy tubes only offer a short-term hearing improv
ement in children with simple OME who have no other serious medical problems. No
effect on speech and language development has yet been shown.[16]
A retrospective study of success rates in 96 adults and 130 children with otitis
media treated with CO2 laser myringotomy showed about a 50% cure rate at six mo
nths in both groups.[9] To date, there have been no published systematic reviews
.
Balloon dilation eustachian tuboplasty (BDET), a new treatment, has proven to be
effective in treating OME secondary to eustachian tube dysfunction.[17][18] How
ever, the number of patients in the studies cited, 22 and 8 respectively, is ext
remely small and simply points to the need for large, well-controlled studies.