Surgical management of otitis media

In summary there are four surgical procedures commonly used for treatment of otitis media. Myringotomy and aspiration of the middle ear effusion is indicated for acute otitis media: (1) when a child has persistent or recurrent symptoms while on appropriate antimicrobial therapy; (2) if there is severe otalgia initially requiring immediate relief; (3) when a suppurative complication is present, such as facial paralysis; or (4) whenever a diagnostic tympanocentesis (for microbiology) is indicated, such as for the critically ill child, the neonate or a child who is immunologically compromised. In addition the potential benefit from more liberal use of the procedure initially might decrease the persistence and recurrence. Myringotomy without tympanostomy tube insertion is a reasonable treatment option for infants and children with chronic otitis media with effusion that is unresponsive to antimicrobial therapy if the procedure can be performed without the administration of a general anesthetic; however, if not, then a tympanostomy tube should be inserted since the recurrence rate is high. In addition to chronic otitis media with effusion, myringotomy with tympanostomy tube insertion is indicated for: (1) recurrent acute otitis media, especially if unresponsive to prophylactic antimicrobial therapy; (2) eustachian tube dysfunction, in which one or more of the following is present--otalgia, significant and symptomatic hearing loss, vertigo or tinnitus; (3) severe retraction pocket of the tympanic membrane; (4) suppurative complication to maintain adequate drainage; and (5) at the time of repair of a tympanic membrane defect, i.e. tympanoplasty, when the eustachian tube function is poor.(ABSTRACT TRUNCATED AT 250 WORDS)