MYRINGOTOMY & INSERTION OF TYMPANOSTOMY TUBES
Children presenting for myringotomy and inser-tion of tympanostomy tubes
have a long history of URIs that have spread through the eustachian tube,
causing repeated episodes of otitis media. Causative organisms are usually
bacterial and include Pneumococcus, H
influenza, Streptococcus, and Mycoplasma
pneumoniae. Myringotomy, a radial incision in the tympanic membrane,
releases any fluid that has accumulated in the middle ear. Tympanostomy tubes
provide long-term drainage. Because of the chronic and recurring nature of this
illness, it is not surprising that these patients often have symptoms of a URI
on the day of scheduled surgery.
Th ese are typically very short (10–15 min) outpa-tient procedures.
Inhalational induction is a com-mon technique. Unlike tympanoplasty surgery,
nitrous oxide diffusion into the middle ear is not a problem during myringotomy
because of the brief period of anesthetic exposure before the middle ear is
vented. Because most of these patients are other-wise healthy and there is no
blood loss, intravenous access is usually not necessary. Ventilation with a
face mask or LMA minimizes the risk of periopera-tive respiratory complications
(eg, laryngospasm) associated with intubation.