Myringotomy

Otitis media exudative, one of the most common diseases in paediatrics, is caused by the constant presence of catarrh in the middle ear over a long period of time (usually at least three months). It may be asymptomatic or present with pain, fever, headache and asthenia.

There are various causes: it can be the consequence of acute otitis media, obstruction of the Eustachian tube, inflammatory processes of the nose or throat, allergies, adenoid hypertrophy. Other causes include the particular anatomical conformation of the Eustachian tube in the first few years of life, prolonged sucking, such as using a soother or feeding bottle for a long time, as well as passive smoking and artificial breastfeeding. 

It is important for the disease to be detected early because hearing loss in children can go undetected resulting in speech delay and chronic inflammatory processes. 

Generally, otitis media is defined as recurrent when three episodes of catarrhal otitis occur in six months. The symptoms are throbbing otalgia (ear pain), hearing loss and even high fever. The most frequent cause of recurrent otitis media is the common cold. Excessive accumulation of exudate in the middle ear can also lead to perforation of the tympanic membrane.

The use of mucoregulators and frequent nasal washes (e.g. with saline solution, sulphurous water, hyaluronic acid) lead to better aeration of the middle ear, which favours the drainage of secretions through the Eustachian tube.

In children, therapy is also based on the elimination of risk factors, such as the use of dummies, exposure to passive smoking, treatment of nasal infections and the possible removal of adenoids. 

The pressure in the middle ear is regulated through the opening and closing (3-4 times per minute) of the Eustachian tube, a narrow duct that connects the eardrum case of the middle ear to the nasopharynx. If the patency of the Eustachian tube is compromised, a negative relative pressure develops in the middle ear, which can lead to an accumulation of fluid that may be sterile or contain viruses or bacteria. This effusion causes hearing loss.

Myringotomy is normally a fairly quick operation; it takes about 5 minutes and the patient can be discharged after a few hours. General and local antibiotics are generally prescribed for 5-7 days.

Transtympanic ventilation tubes, inserted after a myringotomy, are intended to aerate the middle ear, eliminating secretions and promoting healing. These tubes remain in place until they are spontaneously expelled when the tympanic membrane closes again. Usually, they do not cause discomfort, but it is important to prevent water from entering the ear, so it is recommended not to swim in the pool or sea and to use special plugs when showering or bathing.

If the tube is ejected and the tympanic membrane does not close spontaneously, surgery may be necessary to close the perforation. It is essential to undergo regular specialist check-ups: the first check-up is 10-15 days after surgery, followed by visits every 30-40 days to monitor the recovery of hearing ability, middle ear function and the condition of the tube.

After a myringotomy, recovery usually does not involve any particular problems. In general, it is normal for a serous-hematous or purulent secretion to come out of the ear. Although this can sometimes cause worry, it is perfectly normal behaviour and is indeed a sign that the middle ear is emptying. In the event of a haematic discharge, excessive post-operative pain or dizziness, the doctor should be consulted.

The risks associated with myringotomy are very rare: it is a minimally invasive procedure and complications are rare. However, it can happen that water enters the operated ear: this, if it occurs in the days after the operation, can be the cause of infections with the appearance of otorrhea, i.e. discharge of mucus or pus from the ear, which can be easily treated with both local and general antibiotics.

After myringotomy it is important to avoid contact of the operated ear with water, particularly in the days following the operation, but more generally also afterwards, until the tube of drainage is completely expelled.

In the first week post-surgery, however, it is important to take a few extra precautions, such as: not using earphones, cotton buds or introducing foreign bodies into the ear.