Surgical Procedures for Middle Ear Infections

Occasionally, children who have chronic middle ear fluid with symptoms of pain or hearing loss, or repeated ear infections that don’t respond to antibiotics may require surgery. Surgical treatment can help to relieve pain caused by pressure from chronic fluid build-up in the middle ear. Surgery can also help to restore hearing loss related to fluid build-up, which can help prevent delayed speech development in children.

Myringotomy

During myringotomy, a small incision is made in the eardrum and fluid (blood, pus, and/or water) is removed from the middle ear. The fluid is often cultured to determine which antibiotics will be most effective in destroying the bacteria causing the infections. In cases of chronic otitis media, a small “tympanostomy” tube is also inserted in the middle ear to help keep the hole open and air pressure in the middle ear normal. This surgery is most often performed on children, but is sometimes performed on adults as well.

Myringotomy is usually performed under general anesthesia or sometimes with topical application of an anesthetic. This procedure can be performed with a laser, although any additional benefits from this procedure (laser-assisted tympanic membrane fenestration) remain unproven. No stitches are used in the incision. Complete healing without complications should occur within four weeks.

Adenoidectomy

The adenoids are tonsil-like structures located in the back of the nose, invisible to normal methods of examination of either the nose or throat. When adenoids are large, children tend to mouth-breathe, and they may snore at night. Many children with enlarged adenoids have a “nasal” sounding voice because of obstruction. The eustachian tubes open into the nose very close to the adenoids, and their opening may be blocked when adenoids are enlarged. Blocked eustachian tubes are among the causes of chronic otitis media.

When there are other reasons for removal of adenoids (primarily severe snoring especially with accompanying sleep apnea), then adenoidectomy may reduce the frequency or duration of ear infections. Even in the absence of strong evidence, some surgeons recommend adenoidectomy as a primary treatment for chronic otitis media, usually along with myringotomy and placement of tubes.

Revision Information

  • Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov.

  • Current Surgical Diagnosis and Treatment. 10th ed. Appleton & Lange; 1994.

  • Harrison’s Internal Medicine Online. McGraw-Hill; 2002.

  • Matilla PS, Joki-Erkkila VP, et al. Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg. 2003;129(2):163-168.

  • National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov.

  • 9/25/2013 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Bell L. Tympanostomy tubes in children. NEJM. 2013 Aug 12. Reviewing Rosenfeld RM et al., Otolaryngol Head Neck Surg 2013 Jul 149:8.