Myringotomy for ear tubes

Myringotomy for ear tubes
Anesthesia type	General
Airway	Anesthesia mask vs LMA vs ETT
Lines and access	No access vs PIV x 1
Monitors	Standard ASA monitors
	Primary anesthetic considerations
Preoperative	Assessment of upper respiratory infection
Intraoperative
Postoperative	Laryngospasm
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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 ^[1]. 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.

Preoperative management

Patient evaluation


System	Considerations
Respiratory	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
Other	Assess for conductive hearing loss

Patient preparation and premedication

PO midazolam for anxiety
IN dexetomidine for anxiety and emergence delirium
PO acetaminophen for pain

Intraoperative management

Monitoring and access

Standard ASA monitors
No access may be needed vs PIV x 1

Induction and airway management

Mask induction with sevoflurane +/- N₂O
Anesthesia mask may be kept on for the duration of the procedure
LMA
ETT rarely indicated (laryngospasm)

Positioning

Supine with head turned away from surgical site

Maintenance and surgical considerations

Maintained on volatile anesthetic

Emergence

Emergence delirium

Postoperative management

Disposition

PACU
Most cases discharged home

Pain management

Minimal post-operative pain

Multimodal analgesia
- If no PIV:
  - PO/PR acetaminophen
  - IM ketoralac
  - IM/IN fentanyl
- If PIV
  - PO/IV acetaminophen
  - IV ketoralac
  - IV fentanyl
  - IV hydromorphone

Potential complications

Laryngospasm

Procedure variants


	Myringotomy
Unique considerations
Position	Supine
Surgical time	5-10 minutes
EBL	Minimal
Postoperative disposition	Home
Pain management	Mild, multimodal
Potential complications	Laryngospasm

References

↑ Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)

Top contributors: Cornel Chiu, Elena Brandford and Chris Rishel

[1] Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)

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