MYRINGOTOMY &

MYRINGOPLASTY

Priyadarshini R

MYRINGOTOMY

MYRINGOTOMY refers to an incision

of the tympanic membrane to drain
middle ear fluid, which can be
suppurative or nonsuppurative.

MYRINGOTOMY

INDICATIONS FOR
MYRINGOTOMY
Indications

in acute otitis media (AOM)

- Severe earache with bulging eadrum.
- Incomplete resolution with opaque eardrum
and persistent conductive deafness.
- Complications: Facial paralysis, labyrinthitis
or meningitis with bulging tympanic membrane.
Serous otits media
Aero-otitis media
Atelectatic ear

CONTRAINDICATIONS
Suspected intratympanic glomus tumor

ANAESTHESIA
General

anesthesia
- In children and uncooperative adults
- Acutely inflamed eardrum
Local anesthesia
- In cooperative patients

PROCEDURE
Ear

canal is cleared of wax and debris.

Procedure is always done under operating
microscope.
Incision is made using a myringotome.
- circumferential incision
- radial incision

INCISIONS

INDICATIONS FOR
GROMMET
Recurrent

acute otitis media.

Chronic otitis media with effusion
Tympanic membrane abnormalities.
Eustachian tube dysfunction
Cleft palate with long standing OME and hearing
loss.
Treatment of Menieres disease for intratympanic
instillation of gentamicin or dexamethasone.
AOM with mastoiditis, facial paralysis and
intracranial complications.
Hyperbaric Oxygen therapy.

POSTOPERATIVE CARE
In cases of ASOM, daily mopping of the ear discharge will be
required.
In serous otitis media, just a wad of cotton wool if left for 2448 hrs.
No water should be permitted to enter the ear canal for at
least 1 week, and if a grommet has been inserted, entry of
water is prevented so long as grommet is in position.

COMPLICATIONS
Trauma

Otorrhea

Myringosclerosis
Tympanic

membrane- perforation, atrophy,

reaction, atelectasis, cholesteatoma.
Grommet associated.

MYRINGOPLASTY

Closure of perforation of

pars tensa of the tympanic

membrane

MYRINGOPLASTY

ADVANTAGES
Restoring

the hearing loss and in some cases the

tinnitus.
Checking repeated infection from external
auditory canal and eustachian tube.
Checking aeroallegens reaching the exposed
middle ear mucosa, leading to persistent ear
discharge.

CONTRAINDICATIONS
Active discharge from the middle ear.
Nasal allergy.
Otitis externa.
Ingrowth of squamous epithelium into the middle ear.
When the other ear is dead or not suitable for hearing aid
rehabilitation.
Children below 3 years.

PRE REQUISITES
Central

perforation which has been dry for atleast

6weeks
Normal middle ear mucosa
Intact ossicular chain
Good cochlear nerve
Patent eustachian tube.
Absence of infection in nose, PNS and pharynx.

 ANESTHETIC

CONSIDERATIONS
Local or general anesthesia

POSITION

OF THE PATIENT
Supine with face turned to one side; ear to
be operated is up.

TECHNIQUES
Underlay

technique
Overlay technique

UNDERLAY
TECHNIQUE
This

technique is simpler and most commomly

used technique.
Ideal to repair small and easily visualised
perforations.
Here the graft is placed under the
tympanomeatal flap which has been elevated.
MAJOR ADVANTAGE- Easy to perform with
good success rate.

PROCEDURE

Debride the edges of the

perforations

Elevation of the
tympanomeatal flap

Pack the middle ear with

gelfoam

Placing the temporalis

fascia graft

Replacing the
tympanomeatal flap

OVERLAY TECHNIQUE
Difficult

technique to master.
Typically stored for total perforations, anterior
perforations or failed underlay technique
Here the graft material is inserted under the
squamous epithelium of the tympanic membrane.

PROCEDURE

POSTOPERATIVE CARE
Stitches

are removed after 5-6 days.

Ear pack is removed after 5-6 days without
disturbing the gelfoam.
Patient is seen at 3 and 6 weeks after operation.
Complete epihtelialisation of graft takes 6-8
weeks.

GRAFT MATERIALS
TEMPORALIS

FASCIA (most common)

Areolar fascia overlying the temporal fascia
Perichondrium from the tragus.
Cartilage
Vein
Periosteum

COMPLICATIONS
UNDERLAY TECHNIQUE

OVERLAY TECHNIQUE

Middle

Blunting

Ear becomes

narrow
Graft may get
adherent to
promontory.
Anteriorly, graft may
lose contact from the
remnant of tympanic
membrane leading to
anterior perforations.

of the
anterior sulcus
Epithelial pearls
Lateralisation of graft.

BIBILIOGRAPHY
of EAR, NOSE and THROAT- Dhingra
Hazaarika
Diseases