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EDUCATION11 April 2026

Myringotomy

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Duration

15-30 minutes

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Downtime

24-48 hours

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Insurance

Covered

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Setting

Outpatient

Overview

Myringotomy is indicated when there is persistent fluid buildup in the middle ear, causing hearing impairment (muffled sounds, much like hearing underwater) and recurrent infections. Your doctor makes a small cut in the eardrum to let fluid exit the middle ear and relieve symptoms. 

When to Consider Myringotomy

Chronic ear fluid: Persistent, thick fluid in the middle ear.

Recurrent acute ear infection: frequent infections that do not respond well to antibiotics.

Delayed speech and learning: in children, this can cause learning difficulties, emotional distress, physical impairment, and poor school performance.

Severe pain and complications: like dizziness. Rosenfeld, R. M., Tunkel, D. E., Schwartz, S. R., Anne, S., Bishop, C. E., Chelius, D. C., Hackell, J., Hunter, L. L., Keppel, K. L., Kim, A. H., Kim, T. W., Levine, J. M., Maksimoski, M. T., Moore, D. J., Preciado, D. A., Raol, N. P., Vaughan, W. K., Walker, E. A., & Monjur, T. M. (2022). Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery, 166(1_suppl), S1–S55. https://doi.org/10.1177/01945998211065662 Spaw, M., Agarwal, N., & Camacho, M. (2025). Tympanostomy Tube Insertion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK565858/

Tube Insertion

Tube insertion is done with myringotomy when there is fluid buildup that has persisted for more than 3 months and when there is recurrent ear inflammation (3 episodes in the last 6 months or 4 episodes in the last 12 months with at least 1 episode in the last 6 months).  Rosenfeld, R. M., Tunkel, D. E., Schwartz, S. R., Anne, S., Bishop, C. E., Chelius, D. C., Hackell, J., Hunter, L. L., Keppel, K. L., Kim, A. H., Kim, T. W., Levine, J. M., Maksimoski, M. T., Moore, D. J., Preciado, D. A., Raol, N. P., Vaughan, W. K., Walker, E. A., & Monjur, T. M. (2022). Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery, 166(1_suppl), S1–S55. https://doi.org/10.1177/01945998211065662 Spaw, M., Agarwal, N., & Camacho, M. (2025). Tympanostomy Tube Insertion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK565858/

Is Tube Insertion Necessary?

Myringotomy alone can drain ear fluid quickly, but it’s usually only used for severe cases that need fast relief. The small opening it creates closes on its own within 2–3 days, so the fluid can return. 

To keep fluid from building up again, doctors place ear tubes. 
These tubes keep the opening open for 6–12 months, allowing long-term drainage and preventing the problem from coming back. Spaw, M., Agarwal, N., & Camacho, M. (2025). Tympanostomy Tube Insertion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK565858/ Searight, F. T., Singh, R., & Peterson, D. C. (2025). Otitis Media With Effusion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK538293/ Nagar, R. R., & Deshmukh, P. T. (2022). An Overview of the Tympanostomy Tube. Cureus, 14(10), e30166. https://doi.org/10.7759/cureus.30166

Benefits

In myringotomy alone, 81.9% of patients had hearing improvement compared to 91.6% in myringotomy with tube insertion.  Tariq, M., Afridi, H., & Khan, A. H. (2024). Myringotomy vs. Myringotomy with Grommet Insertion for Treatment of Secretory Otitis Media with Effusion. Indus Journal of Bioscience Research, 2(02), 1098–1104. https://doi.org/10.70749/ijbr.v2i02.332

The procedure can restore hearing back similar to how it was before Dw, S., Gp, A., M, D., Ch, H., Em, B., & Ta, T. (2017). Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics, 139(6). https://doi.org/10.1542/peds.2017-0125 Rosenfeld, R. M., Tunkel, D. E., Schwartz, S. R., Anne, S., Bishop, C. E., Chelius, D. C., Hackell, J., Hunter, L. L., Keppel, K. L., Kim, A. H., Kim, T. W., Levine, J. M., Maksimoski, M. T., Moore, D. J., Preciado, D. A., Raol, N. P., Vaughan, W. K., Walker, E. A., & Monjur, T. M. (2022). Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery, 166(1_suppl), S1–S55. https://doi.org/10.1177/01945998211065662 Sjövall, A., Laulajainen-Hongisto, A., & Silvola, J. (2023). Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry. International Journal of Pediatric Otorhinolaryngology, 165, 111443. https://doi.org/10.1016/j.ijporl.2023.111443

Common Misconception - Making a tear in my eardrum will affect my hearing ability. 

There were no cases in which myringotomy caused hearing loss. In fact, hearing will improve immediately after the procedure. The benefits of tearing the eardrum and tube placement exceed the risks.

Procedure Types

Cold Knife

  • currency iconLess expensive
  • clock iconFor all age groups

Best for: Chronic recurrent middle ear fluid.  Sjövall, A., Laulajainen-Hongisto, A., & Silvola, J. (2023). Laser, radiofrequency or tympanostomy knife? Comparison of surgical methods in tympanostomy treatment of young children and predictive value of tympanometry. International Journal of Pediatric Otorhinolaryngology, 165, 111443. https://doi.org/10.1016/j.ijporl.2023.111443 Zong, S., Wen, Y., Guan, Y., Liu, T., Luo, P., Qu, Y., Du, P., Chen, P., & Xiao, H. (2019). Efficacy of laser myringotomy compared with incisional myringotomy for the treatment of otitis media with effusion in pediatric patients: A systematic review. International Journal of Pediatric Otorhinolaryngology, 123, 181–186. https://doi.org/10.1016/j.ijporl.2019.05.014

The surgically-made tear stays open without tube for 2-3 days and it closes automatically after that. This technique involves minimal bleeding.

Laser/radiofrequency

  • currency iconMore expensive
  • clock iconFor adults

Best for: Acute cases where short-term drainage is required (2-3 weeks) Yousaf, M., Malik, S. A., & Haroon, T. (2016). Laser Myringotomy Versus Ventilation Tubes In Otitis Media With Effusion. Journal of Ayub Medical College, Abbottabad: JAMC, 28(4), 773–775. Zong, S., Wen, Y., Guan, Y., Liu, T., Luo, P., Qu, Y., Du, P., Chen, P., & Xiao, H. (2019). Efficacy of laser myringotomy compared with incisional myringotomy for the treatment of otitis media with effusion in pediatric patients: A systematic review. International Journal of Pediatric Otorhinolaryngology, 123, 181–186. https://doi.org/10.1016/j.ijporl.2019.05.014

The surgically-made tear stays open without tube for 2-3 weeks. It involves no bleeding at all.

Risks

The complications following Myringotomy with tube insertion are usually mild and can be managed easily. These include: 

Complication

Rate

How to treat?

Ear drainage lasting longer than 1-4 days 

16% in the first 4 weeks  

And 26% in the overall tube placement period (6-12 months)  Kay, D. J., Nelson, M., & Rosenfeld, R. M. (2001). Meta-analysis of tympanostomy tube sequelae. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 124(4), 374–380. https://doi.org/10.1067/mhn.2001.113941

Antibiotic ear drops.  

Tube obstruction  

6-12% of the cases.  Uppal, S., Sharma, R., Nadig, S. K., Back, G., England, R. J. A., & Coatesworth, A. P. (2005). A blinded in-vitro study to compare the efficacy of five topical ear drops in clearing grommets blocked with thick middle ear effusion fluid. Clinical Otolaryngology: Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery, 30(1), 29–34. https://doi.org/10.1111/j.1365-2273.2004.00920.x

Manual removal of the blockage or ear drops.  

Granulation tissue (bumpy red tissue results from healing) 

4% of the cases.  Kay, D. J., Nelson, M., & Rosenfeld, R. M. (2001). Meta-analysis of tympanostomy tube sequelae. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 124(4), 374–380. https://doi.org/10.1067/mhn.2001.113941

Antibiotic-steroid eardrops.  

Tube falling out earlier than expected 

 NA  

Needs an assessment for new tube placement. 

An eardrum rupture after tube falling out early. 

1-6% of the cases. Hellström, S., Groth, A., Jörgensen, F., Pettersson, A., Ryding, M., Uhlén, I., & Boström, K. B. (2011). Ventilation tube treatment: A systematic review of the literature. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 145(3), 383–395. https://doi.org/10.1177/0194599811409862

Might require an eardrum repair (tympanoplasty) 

Tube displacement into the middle ear  

~0.5% of the cases.  Hajiioannou, J. K., Bathala, S., & Marnane, C. N. (2009). Case of perilymphatic fistula caused by medially displaced tympanostomy tube. The Journal of Laryngology and Otology, 123(8), 928–930. https://doi.org/10.1017/S0022215108003873

Surgically removed. 

Anesthesia

General anesthesia:

Most commonly used for children. It is administered via mask because the operation time is short. The child will be fully asleep and won't feel anything.

Local anesthesia:

Most commonly used for adults. It numbs the area where the tear is made. Patients will be fully awake but won't feel any pain during the procedure.

Chapter references

  1. 1
    Rosenfeld, R. M., Tunkel, D. E., Schwartz, S. R., Anne, S., Bishop, C. E., Chelius, D. C., Hackell, J., Hunter, L. L., Keppel, K. L., Kim, A. H., Kim, T. W., Levine, J. M., Maksimoski, M. T., Moore, D. J., Preciado, D. A., Raol, N. P., Vaughan, W. K., Walker, E. A., & Monjur, T. M. (2022). Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngology–Head and Neck Surgery, 166(1_suppl), S1–S55. https://doi.org/10.1177/01945998211065662
  2. 2
    Spaw, M., Agarwal, N., & Camacho, M. (2025). Tympanostomy Tube Insertion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK565858/
  3. 3
    Searight, F. T., Singh, R., & Peterson, D. C. (2025). Otitis Media With Effusion. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK538293/
  4. 4
    Nagar, R. R., & Deshmukh, P. T. (2022). An Overview of the Tympanostomy Tube. Cureus, 14(10), e30166. https://doi.org/10.7759/cureus.30166
  5. 5
    Tariq, M., Afridi, H., & Khan, A. H. (2024). Myringotomy vs. Myringotomy with Grommet Insertion for Treatment of Secretory Otitis Media with Effusion. Indus Journal of Bioscience Research, 2(02), 1098–1104. https://doi.org/10.70749/ijbr.v2i02.332
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