Myringotomy and Ear Tubes Health Article

Morbidity and mortality rates

Morbidity following myringotomy usually takes the form of either otorrhea, which is a persistent discharge from the ear, or changes in the size or texture of the eardrum. The risk of otorrhea is about 13%. If the procedure is repeated, the eardrum may shrink, retract, or become flaccid. The eardrum may also develop an area of hardened tissue. This condition is known as tympanosclerosis. The risk of hardening is 51%; its effects on hearing aren't known, but they appear to be insignificant.

A report published in 2002 indicates that morbidity following myringotomy in the United States is highest among children from families of low socioeconomic status. The study found that children from poor urban families had more episodes of otorrhea following tube insertion then children from suburban families. In addition, the episodes of otorrhea in the urban children lasted longer.

Mortality rates are extremely low; case studies of fatalities following myringotomy are rare in the medical literature, and most involve adults.

Preventive measures

There are several lifestyle issues related to high rates of middle ear infection. One of the most serious is parental smoking. One study of the effects of passive smoking on children's health estimated that as many as 165,000 of the myringotomies performed each year on American children are related to the use of tobacco in the household.

Another risk factor is daycare placement. A 1997 study at the University of North Carolina found that 31% of the children in a sample of 346 children in daycare required myringotomy with tube insertion as compared to 11% of 63 children cared for at home. In addition, the children in daycare who had ventilation tubes had to have the tubes reinserted three times as often as the children in home care with ventilation tubes.

A third factor that affects a child's risk of recurrent middle ear infection is breastfeeding. Researchers at the University of Arizona reported in 1993 that infants who had been breastfed exclusively for at least four months had significantly fewer middle ear infections as toddlers.

Other surgical approaches

There is some controversy among doctors as to whether removal of the adenoids helps to lower the risk of recurrent ear infections. A 2001 Canadian study reported that removing the child's adenoids at the time of the first insertion of ventilation tubes significantly reduced the likelihood of additional ear operations in children two years of age and older. Other doctors think that adenoidectomy at the time of tube placement should be performed only on children with a large number of risk factors for recurrent otitis media. Most agree that further study of this question is needed.

Alternative medicine

According to Dr. Kenneth Pelletier, former director of the program in complementary and alternative medicine at Stanford University, there is some evidence that homeopathic treatment is effective in reducing the pain of otitis media in children and lowering the risk of recurrence.

BOOKS

"Acute Otitis Media." Section 7, Chapter 84 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2001.

Lanternier, Matthew L., MD. "Otolaryngology: Ear Pathology," Chapter 20 in The University of Iowa Family Practice Handbook, 4th edition, edited by Mark Graber, MD, and Matthew L. Lanternier, MD. St. Louis, MO: Mosby, 2001.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II: CAM Therapies for Specific Conditions: Otitis Media. New York: Simon & Schuster, 2002.

PERIODICALS

Ah-Tye, C., J. L. Paradise, and D. K. Colborn. "Otorrhea in Young Children After Tympanostomy-Tube Placement for Persistent Middle-Ear Effusion: Prevalence, Incidence, and Duration." Pediatrics 107 (June 2001): 1251–1258.

Coyte, P. C., R. Croxford, W. McIsaac, et al. "The Role of Adjuvant Adenoidectomy and Tonsillectomy in the Outcome of the Insertion of Tympanostomy Tubes." New England Journal of Medicine 344 (April 19, 2001): 1188–1195.

Desai, S. N., J. D. Kellner, and D. Drummond. "Population-Based, Age-Specific Myringotomy with Tympanostomy Tube Insertion Rates in Calgary, Canada." Pediatric Infectious Disease Journal 21 (April 2002): 348–350.

Gates, George A., MD. "Otitis Media—The Pharyngeal Connection." Journal of the American Medical Association 282 (September 8, 1999): 987–999.

Jassir, D., C. A. Buchman, and O. Gomez-Marin. "Safety and Efficacy of Topical Mitomycin C in Myringotomy Patency." Otolaryngology—Head and Neck Surgery 124 (April 2001): 368–373.

Lin, Yuan-Chi, MD. "Acupuncture Anesthesia for a Patient with Complex Congenital Anomalies." Medical Acupuncture 13 (Fall/Winter 2002) [cited February 22, 2003]. <http://www.medicalacupuncture.org/aama_marf/journal/vol13_2/poster3.html>.

Perkins, J. A. "Medical and Surgical Management of Otitis Media in Children." Otolaryngology Clinics of North America 35 (August 2002): 811-825.

Siegel, G. J., and R. K. Chandra. "Laser Office Ventilation of Ears with Insertion of Tubes." Otolaryngology—Head and Neck Surgery 127 (July 2002): 60–66.