What Is Myringotomy With Grommet Surgery?

: Admin : 2022-02-15

What are diseases that affect the ear, nose and throat?

Living organisms need the energy to perform daily physiological processes to sustain life on earth. Food gives this energy.  The burning of molecules of food produces oxygen during the process of oxidation. During oxidation carbon and hydrogen combine with oxygen to form carbon dioxide and water. The utility of oxygen during energy consumption and the production of carbon dioxide plays an important part in every vital physiological function of the body. An organ system evolved in the human body, that could eliminate carbon dioxide from the blood and absorb oxygen from the atmosphere at a rapid pace to satisfy different needs, maintain normal functions of the body. A well defined respiratory system enables the exchange of gases, the passage of oxygen within the body and release of carbon dioxide back into the atmosphere. 

Human beings have a definite unique breathing mechanism, a structured organ system that performs the most vital physiological function of the body termed respiration. The impure air inhaled by human beings enters the lungs through the nose, trachea where it gets purified to transport oxygen to different parts of the body while during this process, carbon dioxide is exhaled. The respiratory system is formed of nose, mouth, throat, trachea and lungs. Ears are connected to the upper respiratory system through a eustachian tube that opens into the nasopharynx. The ears, nose and throat are parts of the upper respiratory tract. The nasal cavity has a mucosal lining that traps microorganisms and other harmful substances before the air enters the lungs. Inhaled air then reaches the pharynx or throat before reaching the lungs where it gets purified, transported with oxygen-rich blood to every organ system. The upper respiratory passageway orifices of the nose and ear are in continuous contact with the atmosphere, so infections are commonly seen in routine clinical practice.

A change in weather conditions often triggers diseases of the upper respiratory tract. Mutations of microorganisms, pollutants, harmful irritants present in the environment cause diseases of the upper respiratory tract. Allergies, tonsillitis, ear infections, sinusitis, streptococcal throat, sleep apnoea and vertigo are common upper respiratory tract diseases. Novel coronavirus infection is now a common upper respiratory tract infectious diseased condition. When any minor ailment is left untreated, the diseased condition travels deep to infect the vital organs such as the lungs. Most of the infections of the ear and nose should produce symptoms that often need medical attention. In patients with lowered immunity, these infections become so severe that they may damage the lungs. It is proved in the past few years that people with strong immunity, a healthy lifestyle and immunization are saved from a critical illness from acute viral or bacterial infections. The invention of vaccines has reduced the incidence of several infections. A vaccination schedule since childhood is a part of paediatric health care because upper respiratory tract infections are highly contagious in nature. India is a country with poverty, unemployment, overpopulation and poor hygiene. The spread of contagious diseases or viral and bacterial infections is common, often at a rapid pace that may cause sporadic, epidemic cases in different parts of the country. However, for centuries diseases of the upper respiratory tract have been a cause of malaise and mortality worldwide.

What are the symptoms of ear, nose and throat infections?

Ear infections cause pain, fever, loss of balance, difficulty hearing, nausea, vomiting and discharge of pus.

Throat infections cause sore throat, difficulty while swallowing, swollen tonsils, fever, body aches and fatigue.

Acute sinusitis, a secondary infection to common cold causes headache, cough, nasal discharge, congestion, fever and prostration. Breathing difficulty is felt when nasal passage gets obstructed. 

The above-diseased states cause accumulation of fluid behind the eardrum from dysfunction of the eustachian tube- a narrow opening that connects the upper respiratory tract to the ears. Fluid behind the drum increases the pressure with hearing loss. Surgery is the choice of treatment to remove the fluid from the ear to treat symptoms from its accumulation.

Otitis media causes the accumulation of fluid in the middle ear which leads to loss of hearing. Recurrent middle ear infections are treated through surgical procedures. An obstructed eustachian tube that drains pus into eardrum that leads to recurrent infections of the ear is the primary pathology that requires surgical treatment procedure.

What is MYRINGOTOMY WITH GROMMET surgery?

Ear infections cause discomfort, pain, pus and hearing loss. Patients visit an ENT specialist who treats the above symptoms. The patient is asked to do laboratory investigations like blood tests, hearing tests with a tympanogram to locate the site of infection. The external ear and eardrum are examined by the physician through a device called an otoscope. The area of fluid accumulation is scanned by the treating physician before planning the surgery. A blocked, dysfunctional eustachian tube is examined by the ENT specialist.

MYRINGOTOMY is a surgical treatment procedure in which an incision is made in the eardrum to relieve patients from pressure from pus, to drain the fluid from the middle ear in order to improve and restore normal functions of the ear. Loss of hearing, pain, vertigo, tinnitus with an aim to drain pus to treat ear infection is the fundamental principle of myringotomy surgery. Myringotomy originates from the Latin word myringa meaning eardrum and Tomy meaning a cut. So this treatment procedure is done to make a cut or an insertion in the eardrum. The idea behind this surgical technique is to make a hole in the eardrum to drain the fluid, allow it to pass through it, to remove pressure symptoms.  History of myringotomy dates to the early 17^th and 18^th century when research proved that operation with perforation in the eardrum improved hearing in patients who experienced symptoms from diseases of the ear. The obstruction in the eustachian tube could be removed through myringotomy by creating an equal balance or equilibrium in pressure on each side of the tympanic membrane. Later, this procedure was developed with the use of advanced technology to treat or drain pus from middle ear infections. It is a widely recommended surgical treatment procedure in paediatric patients and common in adults having recurrent symptoms from blockage of Eustachian tube in present times.

GROMMET derives its nomenclature from the French word  “gourmet” which means to curb or a rope used for fastening things. A grommet is a tube that is surgically implanted in the middle ear to drain pus from the middle ear. While myringotomy surgery is done to drain the pus through a perforation in the middle ear, it became indispensable to design a tube that could leave it open to enhance, improve the sense of hearing. A grommet or a tympanostomy tube is a small tube inserted in the eardrum that acts as a medium to keep the middle ear ventilated for a longer period of time and prevent fluid accumulation within the cavity.

How is MYRINGOTOMY WITH GROMMET surgery done?

An ENT specialist does this procedure in his outpatient clinic. Paediatric surgery is done using general anaesthesia while local anaesthesia is used in adults. The infected ear is cleansed with an antiseptic and a small incision is made in the eardrum. Pus or fluid present in the cavity is drained out, a grommet or tube is inserted for fluid to continue its flow outside the ear in order to retrieve physiological functions of the ear. The pus that is aspirated is sent for laboratory analysis to diagnose the diseased condition. The operated ear is covered with cotton and petroleum jelly is applied surrounding the area around the incision. Protection of the ear should be continued for a few more weeks using cotton and earplugs to prevent ear infections. 

Laser-assisted tympanostomy is an advanced procedure that uses carbon dioxide laser. It is performed using a computer-operated laser and video to monitor the site or location where a hole is to be made inside the ear cavity. The process does not take much time and saves the nearby tissues surrounding the ear. It is a safe procedure, provides adequate air circulation to the middle ear without the insertion of a tube. However, this method is not adopted by physicians when there are multiple recurrences of infections in children, allergies, thick mucoid pus accumulation, so traditional placement of tube is more effective in treating stubborn ear infections.

Different types of tympanostomy tubes are now made to provide maximum comfort, better treatment potential and promising lifelong results. Metal tubes that were initially used are now replaced by silicon, titanium, stainless steel, gold and fluoroplastic tubes. The most advanced recent ones are coated with antibiotics.

Recovery post myringotomy surgery takes up to four weeks. Incision gets healed without any sutures. Ear tubes or grommet insertion may give the uncomfortable sensation of clicking, popping along with minor pain while chewing food. These minor complications get healed within six to twelve months once the tubes are removed surgically if they do not fall out.

Patients should be aware of any minor symptoms that may recur post myringotomy surgery. Patients should be alert, monitor health for signs and symptoms from infection, fever, pain or bleeding. A follow-up visit to an ENT physician can treat patients from these symptoms and also prevent complications like shortness of breath, chest pain, cough and decreased sense of hearing.