The placement of myringotomy or pressure equalization (PE) tubes is the most common pediatric procedure and is also frequently required in the geriatric population. The Eustachian tube normally opens during swallowing and yawning, replacing the air absorbed through the middle ear mucous membrane while the tube is closed. Failure of this mechanism from immaturity of the tube in children or atrophy of the peritubal muscles in the elderly causes retraction of the tympanic membrane, fluid effusion resulting in hearing loss, and recurrent acute infections.

Myringotomy tubes are placed through a small incision in the tympanic membrane with either topical anesthesia in the office or, for children, a quick general anesthetic.

Usual postoperative course

Expected postoperative hospital stay

Outpatient procedure.

Operative mortality

Negligible and essentially related to anesthesia risk.

Special monitoring required

None.

Patient activity and positioning

Normal activity may be resumed immediately after the procedure.

Alimentation

No limitation.

Antibiotic coverage

As indicated to treat existing otitis.

Expected postoperative course

Tube placement is typically done in the office or as an outpatient procedure. Otorrhea for 2 to 3 days while the effusion clears from the middle ear and mastoid is not unusual. Topical quinolone otic drops are customarily prescribed during this period.

Water precautions

Since water in the ear canal can enter the middle ear space through the tube and initiate an acute infection, the ear should be kept free of water and shampoo. Ear plugs and custom swim molds are helpful in preventing such contamination, but nothing is consistently waterproof.