OtoRhinoLaryngology Portal

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Therapeutic Myringotomy in Acute Otitis Media



In this video, a small cut was made into an inflamed and bulging left eardrum in a patient having persistent and intolerable ear pain due to acute otitis media.  The fluid was drained with dramatic relief of pain and restoration of hearing.  The earlier part of fluid sample was aspirated and sent for culture and sensitivity.






 Sequential shots of endoscopic myringotomy and suction clearance of middle ear fluid in acute otitis media.






Carbon Dioxide (CO2)-Laser Tympanostomy

                                 Before                                                              After


CO2-laser tympanostomy is an alternative method to the standard myringotomy and grommet insertion.  It is ideal for the purpose of short-tem middle ear ventilation for example in subacute middle ear effusion, barotrauma, and acute otitis media.  It has the advantages of simplicity, precision, good homeostasis, and low risk of non-closure.  Obviously, no grommet is left in-situ;

thus avoiding tube-related issues.


Video of CO2-laser tympanostomy procedure.

Grommet Inserter

Figure 1 


Figure 2 

 Figure 3

Figure 1: Inserter device in engaged position shown separately from the grommet in used.

Figure 2: Inserter device in engaged position with the grommet in used attached.

Figure 3: Inserter device in disengaged position with the grommet completely released. 

Endoscopic-Assisted Myringotomy & Grommet Insertion



Tympanostomy Tube Insertion by using a T-Tube Introducer for An Atelectatic Eardrum

Myringoplasty - Harvesting Temporalis Fascia Graft


           Temporalis fascia layer (Star)

Sutured scalp.

                Excised temporalis fascia         Pressing to thin-out and making

                                                                the fascia even and broader

                                                               [If graft thick & small initially]

Large central perforation.

View after perforration edges refreshened and tympanomeatal flap raised.  (ME middle ear, F - flap)


Tympanomeatal flap (F) raised upward.  (ME - middle ear mucosa, OM-osseous meatus)


View after temporalis fascia in place with flap re-draped.

Gelfoam (G) in place.

Surgicel applied along flap incision line.

Endoscopic view 4 weeks after surgery showing healed myringoplasty.  The temporalis fascia graft (F) will become thinner over time similar to the adjacent eardrum.



Video of myringoplasty temporalis fascia harvesting


Healed temporalis fascia harvest incision site.

Tragal Cartilage Graft

Harvesting tragal cartilage graft (arrow) with or without its covering perichondrium for eardrum perforation closure. 

Cartilage Button Graft

CO2 Laser Refreshening of Eardrum Perforation Edges in Myringoplasty