https://wikianesthesia.org/w/api.php?action=feedcontributions&feedformat=atom&user=EbrandfordWikiAnesthesia - User contributions [en]2026-05-01T21:06:16ZUser contributionsMediaWiki 1.37.1https://wikianesthesia.org/w/index.php?title=Myringotomy_for_ear_tubes&diff=16351Myringotomy for ear tubes2024-03-27T15:25:41Z<p>Ebrandford: added reference for IM toreadol, fent. Edited wording to clarify that typically done with facemask only and without IV</p>
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<div>{{Infobox surgical procedure<br />
| anesthesia_type = General<br />
| airway = Anesthesia mask vs LMA vs ETT<br />
| lines_access = No access vs PIV x 1<br />
| monitors = Standard ASA monitors<br />
| considerations_preoperative = Assessment of upper respiratory infection<br />
| considerations_intraoperative = Laryngospasm<br />
| considerations_postoperative = Laryngospasm, PONV, emergence delirium<br />
}}<br />
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Myringotomy is a commonly performed procedure in pediatrics. The procedure involves placement of tubes within the middle ear to provide better drainage decreasing the risk of otitis media. Indication for the procedure includes recurrent otitis media episodes of six or more in one year, chronic serous otitis media, eustachian tube dysfunction and hearing loss <ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref>. The procedure begins with an incision of the tympanic membrane. A tympanostomy tube is placed within the incision allowing for equalization of pressure and drainage of fluid in the middle ear<ref>{{Cite journal|last=Robinson|first=Hal|last2=Engelhardt|first2=Thomas|date=2017-04-19|title=Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives|url=https://www.dovepress.com/ambulatory-anesthetic-care-in-children-undergoing-myringotomy-and-tube-peer-reviewed-fulltext-article-LRA|journal=Local and Regional Anesthesia|language=English|volume=10|pages=41–49|doi=10.2147/LRA.S113591|pmc=PMC5403003|pmid=28458577}}</ref>. <br />
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== Preoperative management ==<br />
<br />
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===<br />
{| class="wikitable"<br />
|+<br />
!System<br />
!Considerations<br />
|-<br />
|Pulmonary<br />
|Assess for upper respiratory infection(URI), often patients have brief intervals between URI, if febrile illness is due to otitis media, may proceed with anesthesia. However, if febrile illness with lower respiratory tract infection, patient should not proceed with anesthesia <br />
|-<br />
|Other<br />
|Assess for conductive hearing loss <br />
|}<br />
<br />
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===<br />
<br />
* PO midazolam for anxiety<br />
* consider IN dexetomidine for anxiety and emergence delirium (alternatively, can administer intraoperatively)<br />
* PO acetaminophen for pain<br />
<br />
== Intraoperative management ==<br />
<br />
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===<br />
<br />
* Standard ASA monitors <br />
* Typically, no IV is placed. May consider placing PIV pending patient comorbidities<br />
<br />
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===<br />
<br />
* Mask induction with sevoflurane +/- N<sub>2</sub>O<br />
* Anesthesia mask kept on for the duration of the procedure<br />
** Rarely place LMA (severe obstruction not relieved by oral airway placement), ETT (laryngospasm)<br />
<br />
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===<br />
<br />
* Supine with head turned away from surgical site <br />
<br />
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===<br />
<br />
* Maintained on volatile anesthetic via facemask<br />
*Consider intramuscular fentanyl, toradol <ref name=":0">{{Cite journal|last=Stricker|first=Paul A.|last2=Muhly|first2=Wallis T.|last3=Jantzen|first3=Ellen C.|last4=Li|first4=Yue|last5=Jawad|first5=Abbas F.|last6=Long|first6=Alexander S.|last7=Polansky|first7=Marcia|last8=Cook-Sather|first8=Scott D.|date=2017-01|title=Intramuscular Fentanyl and Ketorolac Associated with Superior Pain Control After Pediatric Bilateral Myringotomy and Tube Placement Surgery: A Retrospective Cohort Study|url=https://pubmed.ncbi.nlm.nih.gov/27861435/|journal=Anesthesia and Analgesia|volume=124|issue=1|pages=245–253|doi=10.1213/ANE.0000000000001722|issn=1526-7598|pmid=27861435}}</ref> <br />
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=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===<br />
<br />
* Emergence delirium common<br />
<br />
== Postoperative management ==<br />
<br />
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===<br />
<br />
* PACU<br />
* Most cases discharged home <br />
<br />
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===<br />
<br />
* Minimal post-operative pain, preferably avoiding longer acting opioids<br />
<br />
* Multimodal analgesia <br />
** If no PIV:<br />
*** PO/PR acetaminophen<br />
*** IM ketoralac<ref name=":0" /><br />
*** IM/IN fentanyl<ref name=":0" /><br />
** If PIV <br />
*** PO/IV acetaminophen<br />
*** IV ketoralac<br />
*** IV fentanyl <br />
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=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===<br />
<br />
* Laryngospasm<br />
<br />
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==<br />
<br />
{| class="wikitable wikitable-horizontal-scroll"<br />
|+<br />
!<br />
!Myringotomy<br />
|-<br />
|Unique considerations<br />
|Can be performed without IV access<br />
|-<br />
|Position<br />
|Supine<br />
|-<br />
|Surgical time<br />
|5-10 minutes<br />
|-<br />
|EBL<br />
|Minimal<br />
|-<br />
|Postoperative disposition<br />
|Home<br />
|-<br />
|Pain management<br />
|Mild, multimodal<br />
|-<br />
|Potential complications<br />
|Laryngospasm<br />
|}<br />
<br />
== References ==<br />
<br />
[[Category:Surgical procedures]]</div>Ebrandford