Myringotomy & Ear Tube Insertion

Myringotomy with ear tube insertion is a short surgical procedure in which a doctor makes a tiny cut in the eardrum and places a small hollow tube — called a ventilation tube or grommet — through the opening to allow fluid and air to pass in and out of the middle ear.

The middle ear is the air-filled space just behind the eardrum. When fluid builds up there and cannot drain on its own, pressure rises, hearing drops, and infections can keep coming back. The tube bypasses the Eustachian tube (the natural drainage channel that connects the middle ear to the back of the throat) and gives the middle ear a direct pathway to drain fluid and stay aired. Most tubes fall out on their own after several months to a couple of years as the eardrum heals around them.

Doctors recommend this procedure when the middle ear cannot drain or ventilate properly on its own, and the problem is affecting the patient's hearing, quality of life, or overall health. It is one of the most common ear surgeries performed in children, but adults can need it too.

• Otitis media with effusion (also called 'glue ear') — persistent fluid in the middle ear that does not clear after weeks or months, causing muffled hearing
• Recurrent acute otitis media (frequent ear infections) — several painful infections within a short period that do not respond well to antibiotics
• Chronic otitis media — long-lasting middle ear inflammation or infection
• Eustachian tube dysfunction — when the drainage channel between the middle ear and throat is blocked or does not work properly, leading to pressure, popping, or pain
• Hearing loss in children linked to persistent middle ear fluid, which may delay speech and language development
• Barotrauma (ear pain or damage caused by pressure changes, for example in divers or frequent flyers) when other treatments have not helped

This procedure is usually not suitable in certain situations. A doctor will carefully assess each patient before recommending it.

• Fluid that has been present only a very short time and is still likely to resolve on its own
• Certain abnormalities of the eardrum or middle ear that require a different surgical approach
• Active outer ear infection at the time of surgery, as this may need to be treated first
• Patients with bleeding disorders or other medical conditions that significantly raise the anaesthetic risk — the team will evaluate these cases individually

Myringotomy with ear tube insertion is generally considered a low-risk procedure, but like any surgery it carries some possible complications that patients should be aware of.

• Ear discharge (otorrhoea) — a small amount of fluid or mucus draining from the ear after the tube is placed; this is usually the intended effect but can occasionally become infected and produce pus
• Tube blockage — the tube may become plugged with dried mucus or wax, stopping it from working
• Early tube displacement — the tube may fall out sooner than expected, and the original problem may return
• Persistent hole in the eardrum (persistent perforation) — in a small number of cases, the eardrum does not seal over after the tube falls out, and a minor repair procedure may be needed
• Scarring of the eardrum (tympanosclerosis) — white calcium deposits may form on the eardrum over time, though these rarely cause a significant hearing problem
• Mild temporary hearing change immediately after surgery as the ear adjusts
• Risks related to general anaesthesia, which is commonly used in young children — these will be discussed separately by the anaesthesia team
• Very rarely, injury to nearby structures in the middle ear

Preparation depends on the patient's age and the type of anaesthesia planned. In young children, general anaesthesia (being fully asleep) is almost always used. In cooperative older children and adults, a doctor may use only local anaesthetic (numbing drops placed in the ear canal) or light sedation instead.

Before the procedure, the care team will usually ask about current medications, allergies, and any history of breathing or heart problems. Blood thinners and some anti-inflammatory medicines are commonly paused for a period beforehand — the doctor will give specific guidance on this.

If general anaesthesia is planned, the standard fasting rules apply: no food or milk for a set number of hours before the procedure, and limited or no clear fluids closer to the time. The exact fasting window will be given by the hospital or anaesthesia team. Smoking and alcohol should be avoided in the days leading up to surgery, as both affect how the body responds to anaesthesia and how quickly the ear heals.

Tests commonly arranged before the procedure:

• Hearing test (audiogram) — to document baseline hearing level before surgery
• Tympanometry — a quick, painless test that checks how well the eardrum moves and confirms fluid is present behind it
• A physical examination of the ear, nose, and throat
• If general anaesthesia is planned, the anaesthesia team may request blood tests or a review of the child's or adult's overall health

What happens during the procedure itself (steps may vary between hospitals and patients):

• 1. The patient is taken to the operating theatre or procedure room and positioned lying down.
• 2. Anaesthesia is given — general anaesthesia for most children, or numbing ear drops and possibly light sedation for some adults.
• 3. The surgeon uses a microscope or a small camera to see the eardrum clearly.
• 4. A tiny incision (myringotomy) is made in the lower part of the eardrum using a fine surgical blade.
• 5. Any fluid behind the eardrum is gently suctioned out.
• 6. A small ventilation tube (grommet) is placed into the incision so it sits snugly in the eardrum.
• 7. The surgeon checks that the tube is correctly positioned and the ear canal is clean.
• 8. The procedure is usually completed in well under thirty minutes; sometimes both ears are done in a single session.

Recovery from myringotomy and ear tube insertion is usually quick. Most patients — especially children who had general anaesthesia — are monitored in a recovery area for a short time until they are alert and comfortable, then go home the same day. Full recovery from the anaesthesia typically takes a few hours, and most children return to normal activity within a day.

• Water precautions: in most cases, doctors advise keeping water out of the ear while the tube is in place. This usually means using ear plugs or a cotton ball coated in petroleum jelly during bathing, hair washing, and swimming. Your doctor will confirm whether and how strict these precautions need to be.
• Ear discharge: a small amount of clear or slightly coloured fluid from the ear in the days after surgery is normal. If the discharge becomes thick, foul-smelling, or is accompanied by pain or fever, the doctor should be contacted promptly.
• Hearing: many patients notice an improvement in hearing fairly quickly after surgery as the fluid has been removed. If hearing does not improve as expected, a follow-up hearing test will clarify this.
• Pain: most patients experience little to no ear pain after the procedure. Any mild discomfort usually settles within a day or two.
• Follow-up appointments: regular check-ups are important to confirm the tube is still in place and functioning, and to monitor hearing. The doctor will set the schedule — visits are typically arranged every few months.
• Tube lifespan: most short-term tubes fall out naturally within six to eighteen months. Longer-term tubes, used in some cases, may last a few years. If a tube stays in longer than expected, the doctor may discuss removal.
• Repeat procedure: if the underlying problem persists after a tube falls out, another set of tubes may be discussed. In children, adenoid removal (adenoidectomy) is sometimes considered at the same time or later.
• Activity: children can usually return to school within a day or two. Adults can typically return to light work quickly. Heavy physical activity and swimming may be restricted for a short period — the surgical team will advise.