Aftercare The use of antimicrobial drops is controversial. Water should be kept out of the ear canal until the eardrum is intact. A doctor should be notified if the tubes fall out.
Risks The risks include: • cutting the outer ear • formation at the myringotomy site of granular nodes due to inflammation • formation of a mass of skin cells and cholesterol in the middle ear that can grow and damage surrounding bone (cholesteatoma) • permanent perforation of the eardrum
It is also possible that the incision wont heal properly, leaving a permanent hole in the eardrum. This result can cause some hearing loss and increases the risk of infection. The ear tube may move inward and get trapped in the middle ear, rather than move out into the external ear, where it either falls out on its own or can be retrieved by a doctor. The exact incidence of tubes moving inward is not known, but it could increase the risk of further episodes of middle-ear inflammation, inflammation of the eardrum or the part of the skull directly behind the ear, formation of a mass in the middle ear, or infection due to the presence of a foreign body.
The surgery may not be a permanent cure. As many as 30% of children undergoing myringotomy with insertion of ear tubes need to undergo another procedure within five years.
The other risks include those associated with sedatives or general anesthesia. Some patients may prefer acupuncture for pain control in order to minimize these risks.
An additional element of postoperative care is the recommendation of many doctors that the child use ear plugs to keep water out of the ear during bathing or swimming to reduce the risk of infection and discharge.
Normal results Parents often report that children talk better, hear better, are less irritable, sleep better, and behave better after myringotomy with the insertion of ear tubes. Normal results in adults include relief of ear pain and ability to resume flying or deep-sea diving without barotrauma.
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 arent 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.
Alternatives 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 childrens 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 childs 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 childs 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.
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