Myringotomy
A minor surgical procedure in which a doctor makes a tiny cut in the eardrum to drain trapped fluid and relieve pressure in the middle ear. It may be used to treat chronic ear infections, fluid buildup, hearing loss caused by fluid and pressure problems
What is myringotomy?
Myringotomy is a small cut in the eardrum. Your surgeon makes an opening a couple of millimetres long in the drum under a microscope, and suctions out the fluid sitting in the middle ear behind it.
In most cases a ventilation tube is then placed through that opening. The tube, often called a grommet, is a tiny spool of plastic or silicone that holds the hole open so air can reach the middle ear from the canal. It sits in the drum, does nothing mechanical, and works purely by letting the space behind the drum stay ventilated while the natural tube from the nose recovers.
The tube is not permanent and is not meant to be. The eardrum grows outwards from the centre, so over six to eighteen months it carries the tube to the edge of the canal and pushes it out on its own, and the hole closes behind it. The tube frequently falls out unnoticed, and finding it on a pillow is the usual way people discover it has gone.
What it involves
This is a Day Care procedure under general anaesthetic. It is very commonly done in children, and a general anaesthetic is used because the ear canal must be absolutely still. Nothing to eat for six hours or drink for two beforehand.
The operation itself is short, usually ten to fifteen minutes for both ears. Everything is done through the ear canal under a microscope: the wax is cleared, the cut is made in the drum, the fluid is suctioned, and the tube is set into place. There are no cuts on the outside, no stitches and no dressing.
Anaesthetic drops are sometimes placed in the ear afterwards. You or your child will be awake within minutes, and children are often unsettled and tearful for half an hour as the anaesthetic wears off, which passes.
Expect to be in the hospital for about half a day in total, and to go home the same afternoon with painkillers and, in many cases, antibiotic drops for a few days.
Recovery
This is one of the quickest recoveries in ear surgery. Pain is minimal and paracetamol is usually enough. Most children are back at school the next day and most adults back at work the next day.
Hearing generally improves immediately, and the change can be striking once the fluid has gone. A child may find ordinary sounds too loud for a few days while they get used to it, and voices can sound odd to you for the first day.
A little blood-stained or sticky discharge from the ear for two or three days is expected and settles.
The main instruction concerns water. Ordinary bathing and hair washing are fine, but avoid pushing the head under water, and no diving or swimming underwater. Many surgeons allow surface swimming without plugs and some prefer ear plugs, so follow the advice you are given instead of general rules. Your surgeon will check the tubes at about six weeks and then every few months until they come out on their own.
Questions about myringotomy
How long do the tubes stay in?
Six to eighteen months for the usual short-term type. They are not removed on a date: the eardrum grows outwards from its centre, carrying the tube with it, and eventually pushes it out into the ear canal on its own, after which the hole closes behind it. Most people never notice this happening, and the tube is often found on a pillow or cleared with wax. Longer-stay tubes are used where fluid has returned repeatedly, and those sometimes need taking out. Your surgeon will check the tubes every few months to see whether they are still in place and open.
Can my child swim with grommets in?
In most cases yes, at the surface. Evidence has shown that ordinary surface swimming and bathing do not meaningfully increase the chance of the ear becoming infected, so many surgeons now allow both without plugs. Diving, swimming underwater and jumping into a pool are different, since pressure forces water through the tube, and those are avoided. Soapy bath water enters more easily than clean water, so avoid submerging the head in the bath. Practice varies between surgeons and some still advise plugs for everything, so follow the specific instruction your own surgeon gives you.
Why does the ear keep running after the tube is in?
Discharge through the tube is the commonest nuisance after this procedure, and around one child in five has at least one episode. It usually follows a cold, when secretions travel up from the nose into the middle ear and drain out through the tube instead of building up behind the drum, and it is a sign the tube is doing its job. Water entering the ear can also set it off. Antibiotic ear drops treat most episodes within a week, and your doctor may add a cleaning of the ear. Repeated discharge despite drops occasionally means the tube has to be removed.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about myringotomy
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one