Myringotomy
Anesthesia Implications
Position: Supine, Bed turned 90 degrees
Time: 5-30 min (very short)
Blood Loss: Zero
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
- Mask Induction, Mask Management
- GLMA, Mask Induction
This procedure is usually done in pediatric patients 1-8 years old that have had repeated ear infections.
Typically, this surgery will be done bilaterally.
N2O is contraindicated in patients with otitis media for its expanding affect on closed-air spaces.
Supplemental fentanyl (1 ug/kg) and/or precedex (0.5 – 1.0 ug/kg) are common after mask induction and the IV is placed.
Rarely a vagal response (reduction in heart rate) may be seen in response to the tympanic incision.
Minimal pain. This can easily be corrected by PO acetaminophen (10-20 mg/kg) preoperatively or rectal administration (30 – 40 mg/kg) after the patient is sedated. The oral route is preferred because onset and peak effects are far more rapid than rectal administration.
Highly recommended: If masking the patient intraoperatively, to use an oral airway. This will assist in opening the airway and reducing chances of obstruction (resulting in additional movement and/or delays during the surgery).
Otitis media is a common finding in pediatric patients. Upper respiratory infections and the common cold are often the culprit. If uncorrected, it can lead to hearing loss and cholesteatoma. Children with cleft palate are especially apt to have reoccurring or chronic middle ear infections. This is due to abnormalities in the cartilage and/or muscles surrounding the auditory canal. Down syndrome patients are known to have narrow ear canals which may prolong the surgery. In cases like these, an LMA may be preferable.
After attempting conservative medical management, surgery is considered to drain the chronic accumulation of fluid from the inner ear. After surgical drainage by a small incision in the tympanic membrane, a grommet or T-tube is placed. This allows for continued drainage until it is either naturally discarded or removed. Typical time frame for this to occur is about 6 months.
