Dr. Manish Prakash
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Ent Surgries

Myringotomy and Tubes Instructions

What is a Myringotomy?
During a Myringotomy a small incision is placed in the ear drum to drain the fluid and relieve pressure from the middle of the ear. A small tube shaped like a spool of thread, known as pressure-equalizing (P.E.) tube, is placed into the opening to ventilate the ear and prevent fluid from accumulating. The ear drum heals around the tubes. The tubes are expected to fall out naturally in 6-12 months or may be removed by a physician.

Your child has received general anesthesia for this procedure. He/she may feel somewhat dizzy and/or sleepy after the surgery. Anesthetic agents can remain in one’s body for up to 24 hours. It is important for your child to rest for the remainder of the day and be under adult supervision. Your child should not ride his/her bike or perform such activities that require coordination.

Postoperative care:
Once your child feels better, they can start doing all the things s/he does normally. They may have a small amount of bleeding or a small amount of light yellow fluid from their ears. Please notify the doctor’s office if the drainage is continuous or the bleeding is excessive. Your doctor may send you home with some ear drops to prevent a bacterial infection. If there is cotton in the ears, it may be removed in the afternoon or evening after surgery. When blowing your nose, do so gently. Try and sneeze with your mouth open. Keep your head elevated on at least two pillows.

Swimming/ bathing:
Try to avoid water from entering into the ear for up to 10 days. However, it is more of a problem if soap enters the ear through the tubes than if water does. For this reason, when washing hair or showering, use ear plugs. Washing ears with a face cloth is allowed. Use ear plugs when swimming as well.

Pain Control: A slight earache is not unusual. This is usually relieved by giving your child Acetaminophen or Tylenol. Severe pain must be reported to your physician.

Notify your doctor if the following occurs:
• There is excessive bleeding for more than three days
• There is excessive drainage for more than three day.
• Fever greater than 101
• Ear pain lasting more than two days.
• A displaced tube (out of the ear).

Endoscopic Ear Surgery

Endoscopic ear surgery is a new technique. In some cases, endoscopic ear surgery may result in a less invasive operation that can be performed entirely through the ear canal.
The ear contains some of the smallest structures that can be operated upon. For example, the three bones of the middle ear (called ossicles) are the smallest bones in the human body. In order to perform surgery on anatomy this delicate, surgeons often use a microscope

Microscopes have been used in otology for over seventy years. They make structures appear larger and have a very bright light. Surgical microscopes are large devices, weighing hundreds of pounds. The lens of the microscope needs to be about a foot away from the object (or target) the surgeon is looking at. As a result, other structures between the target and the lens can block the view. For example, the ear canal (or external auditory canal) is shaped like a bent tube, and can often get in the way. Bone can also obstruct the view with a microscope. To overcome blocked views, surgeons sometimes need to make a larger incision (for example behind the ear canal) or drill away bone.

An endoscope is another type of device that can help surgeons see during surgery. It is shaped like a narrow tube and the lens is at the tip. The lens can be placed extremely close to the target, less than half an inch (or thirty times closer than with the microscope). This allows a very detailed view. Because the endoscope is so narrow, it can be slid past blocking structures. In some instances, this can avoid a larger incision or prevent drilling away of blocking bone. The endoscope also provides a wide panoramic view, whereas the microscope provides a narrower view. (See Figure) Finally, endoscopes can have angled lenses, allowing the surgeon to literally see around corners. Endoscopes are not a new technology; however recent improvements have allowed high quality endoscopes small enough to use for ear surgery.

The microscope and endoscope each have their own advantages and disadvantages. The microscope produces three dimensional images, whereas the endoscope produces two dimensional images. However, because the endoscope can be easily moved around, surgeons can get a sense of 3D (called pseudo-3D). The endoscope must also be held in the surgeon’s hand, leaving only one hand left to operate. As a result, endoscopic ear surgeons need specialized experience.

The endoscope may sometimes be used in combination with the microscope. For example, after removing a middle ear growth called a cholesteatoma, a surgeon may use an endoscope to look around to see if any pieces are left.
The ideal purpose of the endoscope is to allow surgery through the ear canal, which is the natural opening into the middle ear (this is termed transcanal endoscopic ear surgery, or TEES). A microscope can also be used to perform surgery through the ear canal; however, sometimes larger incisions or more bone removal is required in order to see well.
Surgeons at Mayom are actively using an endoscopic approach. Several disorders include eardrum (tympanic membrane) perforations, cholesteatomas limited to the middle ear, and problems with the ossicles (bones in the middle ear) causing a conductive hearing loss.