Tympanostomy

Tympanostomy is a surgical procedure to create a small opening in the tympanic membrane and place tympanostomy tubes to ventilate the middle ear and drain fluid. The operation is common in children but is also performed in adults for chronic or recurrent middle ear disease.

Indications include persistent middle ear effusion with hearing loss for at least 3 months, recurrent acute otitis media defined as several episodes within a year, or complications such as eustachian tube dysfunction or barotrauma.

The procedure is usually performed under general anesthesia in children and is ambulatory. A tiny incision (myringotomy) is made in the eardrum and a small tube is inserted to ventilate the middle ear. Tubes can be short-term (extrude in 6-12 months) or long-term (12-18 months).

Recovery is typically quick; activity restrictions are minimal. After placement, most children resume normal activities, and hearing often improves. If necessary, guardians may be advised to protect the ears from water and avoid swimming with the tubes until they extrude or a clinician clears otherwise.

Benefits include improved ventilation and drainage, reduction of middle ear fluid, better hearing, and fewer ear infections, which can support speech and language development in children with otitis media with effusion.

Risks and complications include persistent perforation after tube extrusion, recurrent infections around the tube, otorrhea (ear discharge), tube blockage or dislodgement, tympanosclerosis (scarring), and, rarely, cholesteatoma or anesthesia-related risks.

Alternatives include observation without surgery for some cases, medical therapy such as antibiotics or nasal steroids, and adenoidectomy in selected children with recurrent disease.