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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Do not perform myringotomy alone as treatment for middle ear disease. Myringotomy alone is ineffective in managing otitis media with effusion or acute otitis media.

When is the procedure indicated?

Myringotomy provides little benefit when performed without placing a middle ear ventilation tube (MEVT) into the tympanic membrane.

There are certain circumstances where myringotomy as a diagnostic procedure (without MEVT) may be indicated.

Tympanocentesis (passing a needle through the tympanic membrane into the middle ear cleft) has a range of indications such as delivering medications to the middle ear cleft but is used in only a very limited and specific range of conditions, generally under the care of a specialist ENT surgeon.

Best care recommendations

An ‘active observation period’ of middle ear disease for a period of three months should occur before considering intervention.

During the active observation period, advice on educational and behavioural strategies to minimise the effects of hearing loss should be offered.

Persistent bilateral middle ear disease (longer than three months) should indicate the need for a hearing assessment. Further management and intervention should be discussed with a healthcare provider. 

Evidence

Berkman ND, Wallace IF, Steiner MJ, Harrison M, Greenblatt AM, Lohr KN, et al. Otitis media with effusion: comparative effectiveness of treatments. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 May. Report No.: 13-EHC091-EF.

Bluestone CD, Paradise JL, Beery QC. Physiology of the eustachian tube in the pathogenesis and management of middle ear effusions. Laryngoscope. 1972;82(9):1654-1670.

Cohen-Kerem R, Uri N, Rennert H, Peled N, Greenberg E, Efrat M. Acute mastoiditis in children: Is surgical treatment necessary? The Journal of Laryngology and Otology. 1999;113(12):1081-5.

Coronini-Cronberg S, Bixby H, Laverty AA, Wachter RM, Millett C. English National Health Service’s savings plan may have helped reduce the use of three ‘low-value’ procedures. Health Affairs. 2015 Mar 1;34(3):381-9.

Department of Health. Section D: Medical management of otitis media. Canberra (ACT): Australian Government; 2020. [cited 2020 Jun 25]. 

Luntz M, Brodsky A, Nusem S, et al. Acute mastoiditis—the antibiotic era: a multicenter study. International Journal of Pediatric Otorhinolaryngology. 2001;57(1):1-9.

Mandel EM, Rockette HE, Bluestone CD, Paradise JL, Nozza RJ. Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion. The Pediatric Infectious Disease Journal. 1992;11(4):270-7. 

National Collaborating Centre for Women’s and Children’s Health. Surgical management of otitis media with effusion in children. Clinical guideline. London (UK): RCOG Press; 2008 Feb.

Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: tympanostomy tubes in children. Otolaryngology—Head and Neck Surgery. 2013 Jul;149(1_suppl):S1-35.

Page last updated: 23 Dec 2020

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