Tympanostomy tube insertion (Myringotomy with tube placement) is a common minimally invasive otolaryngology procedure primarily used to relieve middle ear effusion and improve hearing. The procedure involves creating a small incision in the eardrum to drain accumulated fluid from the middle ear and inserting a ventilation tube to maintain aeration of the middle ear. This treatment is especially effective for children with serous otitis media and recurrent acute otitis media, helping to prevent hearing loss and speech development delays caused by prolonged fluid retention.
The surgery is typically performed under local or general anesthesia, lasting approximately 15-30 minutes, with most patients able to complete it on an outpatient basis. Its main goal is to restore middle ear pressure balance, promote mucosal function recovery, and reduce the risk of recurrent infections. Advances in technology have made this procedure one of the preferred treatments for middle ear diseases in recent years.
This procedure consists of two stages: "myringotomy" and "ventilation tube placement." First, using microscopic instruments, a 2-3 mm incision is made in the eardrum to drain middle ear fluid, immediately followed by the insertion of a specially designed silicone or metal ventilation tube. The tube helps regulate middle ear pressure, prevent fluid re-accumulation, and promote normal epithelial metabolism of the mucosa.
The material and size of the ventilation tube are adjusted based on the patient’s age. In children, short-term tubes with diameters of 0.5-1.2 mm are commonly used, while longer-lasting types may be selected for adults. The mechanism involves establishing a permanent channel between the middle ear and external auditory canal until the tube is naturally expelled, with an average retention time of 6-18 months.
The main indications include:
For cases unresponsive to antibiotics or with immune deficiencies prone to recurrent infections, this surgery can effectively break the vicious cycle. However, it should be performed after comprehensive evaluation by an ENT specialist.
The procedure is usually performed in an ENT clinic or operating room. Children require general anesthesia, while adults often undergo local anesthesia. The process includes:
Hospitalization is generally not necessary, but patients should follow medical instructions regarding the use of antibiotic ear drops and oral medications. The size and type of ventilation tube are adjusted according to the patient’s age and medical history, with short-term tubes preferred for young children to prevent prolonged ear canal blockage.
The main benefits include:
Compared to traditional medication therapy, this surgery can immediately resolve middle ear ventilation issues, preventing long-term damage to the eardrum or ossicular chain sclerosis caused by fluid accumulation. The design of the ventilation tube can maintain middle ear aeration for several months, providing sustained therapeutic effects.
Short-term risks may include:
Serious but rare complications include:
Preoperative considerations include:
Contraindications include:
It should be combined with antibiotic therapy, and corticosteroid ear drops may be needed within 3 days postoperatively. Patients on anticoagulants (such as warfarin) should have their medication levels adjusted accordingly. When combined with adenoidectomy, the sequence and anesthesia risks should be evaluated.
There is no direct interaction with hearing aids, but during tube retention, water exposure should be avoided; earplugs are recommended during swimming or bathing. If nasal steroid sprays are used, follow medical instructions for timing adjustments.
Clinical studies show that 95% of patients undergoing this procedure have cleared middle ear effusion, with an average hearing improvement of 20-30 decibels. Long-term follow-up indicates a reduction in recurrent infections by over 70%, especially benefiting language development in children under 3 years old.
Randomized controlled trials confirm that the ventilation tube group has significantly more stable hearing compared to medication-only groups, and the tubes effectively prevent fluid re-accumulation during their retention period. This therapeutic effect lasts for 6-12 months in patients with chronic otitis media, aligning with WHO guidelines for middle ear disease treatment.
Non-surgical options include:
Alternative surgical options include:
What preparations are needed before surgery? Is fasting required?
Before myringotomy with tube placement, children typically need to fast for 4-6 hours, while adults follow the physician’s instructions. Inform the doctor of any allergies or current medications, and avoid using ear drops or topical ear medications for at least 3 days prior. Keep the ear area clean on the day of surgery to reduce infection risk.
Is it normal to have ear discharge after surgery? How should it be handled?
Short-term, mild yellowish discharge may occur postoperatively, which is normal and can be gently wiped from the outer ear. If the discharge turns greenish-yellow, accompanied by ear pain or fever, it may indicate infection, and medical attention should be sought immediately. Do not attempt to remove the tube or insert ear drops without medical guidance, and follow the doctor’s instructions regarding antibiotic ear drops.
How long does it take to recover normal hearing after tube placement?
Most patients experience significant hearing improvement within 1-2 weeks post-surgery, as the middle ear fluid drains and pressure balances. However, if long-standing hearing impairment or middle ear structural damage exists, recovery may take longer, requiring regular hearing assessments.
How should I protect my ears during bathing? Can I swim?
Use special earplugs or waterproof covers during bathing to prevent water ingress; avoid hot water which may irritate the ear canal. Swimming should be delayed for at least 4-6 weeks post-surgery, and earplugs are recommended. Swimming in unclean water environments (ponds, beaches) should be postponed until the tube falls out.
Will the ventilation tube fall out on its own? How often should I follow up?
Most tubes naturally fall out within 6-12 months and are expelled with earwax. During this period, patients may not notice any symptoms. Follow-up visits every 3-6 months are recommended for endoscopic examination to confirm tube status. If the tube remains in place for an extended period and causes ear canal blockage, it can be easily removed in an outpatient setting.
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