MYRINGOTOMY

Below is a complete, reasoning-based explanation of Indications, Incisions, and Complications of Myringotomy, exactly matching the points in your images but with deeper logic so you really understand why each line exists.

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⭐ MYRINGOTOMY — FULL EXPLANATION WITH REASONING

A myringotomy = creating a small surgical opening in the tympanic membrane to drain fluid/pus or equalize pressure.

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🔵 INDICATIONS — WHY & WHEN WE DO MYRINGOTOMY

1️⃣ Acute Suppurative Otitis Media (ASOM)

Here the middle ear is filled with acutely infected pus, causing rapid pressure build-up.

• Severe earache with bulging tympanic membrane & impending rupture

• Pus accumulation raises pressure → TM bulges.
• This causes severe otalgia.
• If pressure continues, TM will rupture spontaneously, causing uncontrolled perforation + scarring.
• A controlled myringotomy prevents a large traumatic rupture and relieves pain.

• Incomplete resolution despite antibiotics + opaque drum + conductive deafness

Reasoning:

• Even after antibiotics, the thick pus may not drain if Eustachian tube is blocked.
• So pus stays trapped → TM becomes opaque → persistent conductive hearing loss.
• Myringotomy ensures mechanical drainage.

• Complications of ASOM: facial palsy, labyrinthitis, meningitis

These occur when infection spreads because pressure is high and bone barriers are thin.

Myringotomy helps by:

• Rapidly reducing pressure → prevents further spread.
• Letting pus drain → reduces bacterial load.

• Recurrent ASOM

Repeated infections = repeated pressure build-ups.

Myringotomy reduces frequency and improves aeration.

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2️⃣ Serous Otitis Media (SOM) / Otitis Media with Effusion (OME)

This is not pus, but sterile mucoid / serous fluid due to Eustachian tube dysfunction.

Why myringotomy?

• To relieve negative pressure and suction out fluid.
• To break the cycle of effusion → hearing loss.

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3️⃣ Aero-otitis media (Air travel / diving-related barotrauma)

• Rapid pressure changes cause Eustachian tube block → retraction + effusion.
• Myringotomy equalizes pressure immediately.

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4️⃣ Atelectatic Ear

Here TM is sucked inward (severely retracted) due to chronic negative pressure.

Reasoning:

• Chronic Eustachian tube dysfunction → vacuum → TM collapses.
• Myringotomy + grommet insertion allows long-term ventilation and prevents cholesteatoma.

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❌ Contraindication: Suspected Glomus Tympanicum

Because:

• Glomus tumor = vascular paraganglioma.
• Incising membrane may cause massive bleeding.
• Diagnosis must be confirmed first → NEVER incise blindly.

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🔵 INCISIONS — WHICH TYPE & WHY

This is where most confusion occurs.

Below is detailed reasoning clearly matched to your diagrams.

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1️⃣ For Acute Suppurative Otitis Media → CIRCUMFERENTIAL incision in POSTEROINFERIOR quadrant

📌 Why POSTEROINFERIOR quadrant?

• Safest area → far from chorda tympani nerve, umbo, handle of malleus.
• Avoids incudostapedial joint, which sits posterior-superior, NOT postero-inferior.
• Pus gravitates downward → maximum drainage.

📌 Why CIRCUMFERENTIAL incision?

• Pus is thick and plentiful.
• Needs a larger dependent opening so drainage continues over hours.
• A radial incision closes too fast → pus again accumulates.
• Circumferential incision heals slower → better for ASOM.

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2️⃣ For Serous Otitis Media → RADIAL incision in ANTEROINFERIOR quadrant

📌 Why ANTEROINFERIOR quadrant?

• Safest + far from ossicles.
• Long-term grommet insertion is easier here.
• Serous fluid collects anteriorly.

📌 Why RADIAL incision?

• SOM fluid is thin, not pus.
• Only a small opening is needed for suction.
• Heals quickly and neatly, minimizing scarring.
• If a grommet is inserted, radial slit fits better.

Distinction from Serous Otitis Media (SOM)

In contrast, for serous otitis media (OME/SOM), the myringotomy has a different goal: long-term pressure equalization and ventilation using a tympanostomy tube (grommet). The anteroinferior quadrant is preferred for tube insertion because the goal is a temporary opening that heals spontaneously after the tube extrudes. This area is avascular and safe from the ossicles, and the resulting perforation has a lower chance of becoming permanent after the tube falls out. Placing a tube in the posteroinferior quadrant in SOM could lead to a higher rate of a persistent residual perforation, which is undesirable. 

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🔵 COMPLICATIONS — WITH REASONING

1️⃣ Injury to incudostapedial joint or stapes

Reasoning:

• A wrong-site incision (especially posterosuperior) can hit the ossicular chain.
• This can cause:
• conductive hearing loss
• vertigo (from footplate trauma)

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2️⃣ Injury to jugular bulb → profuse bleeding

Reasoning:

• Some individuals have a high-riding jugular bulb.
• If the middle ear floor is dehiscent, even a normal myringotomy can nick the bulb → torrential bleeding.
• This is why preoperative evaluation is important.

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3️⃣ Middle ear infection

Reasoning:

• Any incision allows external flora to enter.
• If asepsis is not adequate → secondary infection may occur.
• Usually prevented with antibiotic drops.

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🔵 FINAL SUMMARY (Very High-Yield)

Condition	Area	Incision Type	Why
ASOM (pus)	Postero-inferior	Circumferential	Pus drainage + prevent rupture
SOM (serous)	Antero-inferior	Radial	Small incision, quick healing, grommet-friendly

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If you want, I can create:

✅ A memory-trick for incisions

✅ A diagrammatic quadrant breakdown

✅ A 2-minute exam-ready summary or MCQ practice

Just tell me!