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Myringotomy with Tube
Placement

K. J. Lee

♦ Surgical Technique

• Myringotomy and pressure-equalizing (PE) tube insertion is mostly easily performed under general anesthesia in infants and children, whereas local anesthesia is effective for most adults. If local anesthesia is used, two options are available for use:
  
  
  
  • Ear canal injection 1 cc of 1% lidocaine (Xylocaine) with epinephrine 1:100,000 is injected into the canal wall skin at four to six equal positions at the chondroosseous junction. This is best accomplished with an angled 25-, 27-, or 30-gauge, 1.5 inch needle to provide optimal visibility while injecting. The bevel of the needle should abut the canal wall bone (under the periosteum). To reduce pain, infiltration should begin in previously anesthetized regions after the first injection. Injection should be done slowly so that the solution does not enter the middle ear. Do not inject the tympanomeatal flap. Anesthetic in the middle ear can produce 25 minute delayed vertigo if the solution crosses the round window membrane or temporary facial paralysis in a patient with a dehiscent facial nerve.
    
  • Topical phenol Gives adequate anesthesia for myringotomy and does not give any postoperative complications.
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