EAR | Assoc.Prof.Dr.Mete İNANÇLI

Bilateral Myringotomy and Ventilation Tubes (BMV)

Assoc. Prof. Dr. Mete İnançlı believes that parents and guardians can contribute to the success of the surgery. Please read the following information to learn more about the surgery and how you can help.

Facts About BMV

Bilateral myringotomy and ventilation tube insertion is a surgery which a small opening is made in each eardrum and if necessary small ventilation tube is placed in the opening on each side.
BMV is an outpatient surgery that will be done at Same Day Surgery Centers at Kolan British Hospital, Etik Hospital in Nicosia and at MagosaYasam Hospital in Famagusta. Our team for surgery is mobile so due to our schedule the team will be setup for your planned procedure.
BMV requires general anesthesia to make your child sleep during the surgery. Dr. Mete İnançlı has Dr. HamitKalfaoğlu(Anesthesiology and Reanimation Specialist) in his team.
When general anesthesia is needed, there are important rules or eating and drinking that must be followed in the hours before the surgery. These limits will be explained certainly by your doctor.
The surgery takes about10 to 15 minutes; the recovery can take a few hours.
Your child probablyis prescribed medications after the surgery. Prescription can only contain pain killers, but sometimes due to the situation of each patient antibiotics ca be prescribed prophylactic.

What Is BMV?

BMV is a surgery to treat children who have otitis mediaor middle ear infections that won’t go away with medication; middle ear fluid that won’t go away; or hearing loss or speech delays caused by frequent ear infections.

In a BMV, the surgeon will put small tubes in your child’s eardrums to allow air to get inside. When air is able to get behind the eardrum, the fluid inside the ear can flow out or dry up, taking away the pain or pressure your child may have been feeling and making future infections less likely.
An ear tube is made of plastic (green or blue) and looks like a tiny spool. More than 25 of them could fit on the face of a dime. They are so small that you usually cannot see the tubes just by looking into your child’s ear.
In most cases, ear tubes do not need to be removed and usually are pushed out on their own after about 6 to 18 months, as the eardrum heals. If a tube remains in the eardrum for more than 2 or 3 years, however, it may need to be removed by your doctor.

Home Preparation

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, Dr. Mete will remind you the instructions for the preparation.

Mete will ask you about your child’s medical history, current medications and readiness for the BMV. If you have any questions, you may ask the doctor at this time.
Mete will tell you what time you should arrive at the hospital or surgery center. Allow extra time for travel and parking. Arriving late may delay your child’s surgery or cause it to be postponed.
Mete will give you specific eating and drinking instructions for your child based on your child’s operation(Diet list can be found on the web). Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you by Dr. Mete.

For children older than 12 months:

After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee and chewing gum or candy.

For infants under 12 months:

Up to 6 hours before your scheduled arrival time, formula-fed babies may be given formula.
Up to 4 hours before your scheduled arrival time, breastfed babies may nurse.

For all children:

Up to 2 hours before your scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid® and juices you can see through, such as apple or white grape juice.
In the 2 hours before your scheduled arrival time, give nothing to eat or drink.
For the safety of your child, it is important to follow these specific times for eating and drinking. Remember: If your child does eat or drink after the scheduled times, it will delay the surgery or cause it to be rescheduled for another day.

A Parent’s/Guardian’s Role During the Surgery

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

Once your child has been registered for the surgery, a nurse or nurse practitioner will meet with you to take your child’s vital signs, weight and short medical history.
Your child’s surgeon will meet with you just before the surgery to discuss the surgery and answer any questions you might have.
Anesthesiologist Dr. HamitKalfaoğlu, who is very experienced in anesthesia for children, will meet with you and your child to review your child’s medical information.
If you wish, you may stay with your child until just prior to the sleep medication being given, and then you will be taken to the waiting room.
You may bring along a “comfort” item—such as a favorite stuffed animal or “blankie”—for your child to hold during the surgery.

Going To Sleep

If your child is very scared or upset, the anesthesiologist will let you be in the operating room with your child to support him or her. We do not recommend preoperative sedatives to be given in these short surgical procedures because they prolong the recovery time.
Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake.
Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line.
If the child lets us prepare an intravenous line it is the best way to go to sleep for surgery. Recovery by IV line is also as normal as you wake up in the morning.

While Asleep

While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
Your child might be given an injection (shot) of pain medication and/or antibiotic if needed.

The Surgery

Using a microscope, the surgeon will gently clean inside your child’s ears, make a tiny opening in the eardrum(can be done either by conventional technique or by laser) and insert the tube. The surgery itself will take only about 10 to 15 minutes.

Waking Up

When the surgery is over, the medications will be stopped and your child will begin to wake up.

When your child is moved to the recovery room, you will be called to the bedside so that you can be there as he or she wakes up. It is OK to hold your child in your arms or on your lap.
Your child will need to stay in the recovery room to be watched until he or she is alert and his or her vital signs are stable. The length of time your child will spend in the recovery room may be different from other patients because some children take longer than others to wake up after anesthesia.
Children coming out of anesthesia have a variety of reactions. Your child might cry, be fussy or confused, feel sick to his or her stomach, or vomit. Very young children and infants might cry and “arch” their backs. These reactions are normal and will go away as the anesthesia wears off.
You might notice a Band-Aid and a little red mark on your child’s arm from the injection of pain medication. IV line will stay in your child’s arm until the recovery is done.
Your child will have no memory of the surgery.
In the recovery room, he or she will be encouraged to drink or to eat an ice pop.

Going Home

After your child is discharged and goes home, he or she may still be groggy and should take it easy for the day.

Your child may resume normal activities at the rate he or she is comfortable with.
Your child may begin to eat and drink a little at a time and resume normal eating and drinking as long as he or she is feeling well. Clear liquids and bland foods may be given if he or she has an upset stomach.
You can call Dr. Mete directly if you have any questions and if unexpected situation happened at home.

Ear Care At Home

If the surgeon prescribed ear drops after the surgery, follow the schedule. You can “pump” the drops into your child’s ear canal by gently pushing on the stiff part of the outer ear that covers the entry to the canal.
Ear drainage may be gently cleaned from the OUTSIDE of the ear with cotton swabs dipped in hydrogen peroxide, or by using a washcloth with soap and water.
The doctor might suggest that you use earplugs or a neoprene “ear band” cover when your child bathes or swims to keep dirty water out of the ear drums.
NOTHING should be put directly into the ear canal except eardrops, and only as directed by the surgeon.
You might be asked to follow up with Dr. Mete, or your pediatrician, to have the ear tubes checked after the surgery.

Common Symptoms After BMV

After the BMV surgery, you may notice some of the following signs. These symptoms are normal:

Fluid draining from your child’s ears. Fluid may be any color and may even be a little bloody. Ears may drain for several days.
Mild pain. You may give a non-aspirin pain reliever, such as Tylenol or acetaminophen, as directed for your child’s age.

Warning Signs After BMV

Although most children recover quickly from the BMV surgery with no problems, you should call Dr. Mete or pediatrician right away if your child has any of the following symptoms:

Large amounts of bright red blood
Severe pain, especially if your child holds his or her head or tugs his or her ears
Fever higher than 38° C
Severe nausea or vomiting, or can’t keep clear liquids down
Breathing trouble
Rashes anywhere on his or her body.

Assoc. Prof. Dr. Mete İNANÇLI

Ear Nose Throat Specialist

Tympanoplasty / Paper Patch Myringoplasty

Facts AboutTympanoplasty and Myringoplasty

Tympanoplasty and myringoplasty are surgical procedures to repair a hole in a child’s eardrum (tympanic membrane).
Tympanoplasty and myringoplasty are outpatient surgeries that will be done at Same Day Surgery Centers at Kolan British Hospital, Etik Hospital in Nicosia and at MagosaYasam Hospital in Famagusta. Our team for surgery is mobile so due to our schedule the team will be setup for your planned procedure.
Tympanoplasty and myringoplastyboth require general anesthesia to make your child sleep during the surgery.
When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery.
Myringoplasty usually takes between 10 and 30 minutes.
Tympanoplasty usually takes from 2 to 3 hours.
Recovery from general anesthetic can take several hours.
Your child might be prescribed medications after the surgery.

What Are Tympanoplasty and Myringoplasty?

A hole in the eardrum or “perforated eardrum” can come from a bad ear infection; a surgical procedure, such as placement of an ear tube; or from injury, such as sticking something inside the ear canal. Although some holes heal on their own, if they last for more than 3 months without infection or drainage, they are unlikely to close by themselves. The decision on how to surgically close a perforation depends on a variety of factors, including the patient’s age, and the size and location of the eardrum hole.

The simplest repair is called a myringoplasty. It works best with relatively small holes. In this surgery, the hole is covered with a small piece of special paper or gel foam that temporarily seals the hole, encouraging the body’s normal healing processes. Sometimes fat from the child’s ear lobe is used as the patch.

Another common surgery for repairing a hole in the eardrum is called a tympanoplasty. The hole is patched with a graft of the patient’s own tissue, either a connective tissue called fascia or perichondrium that come from underneath the skin.

In tympanoplasty, the surgeon slips the new tissue behind or on top of the hole in the eardrum. To hold the tissue in place, the surgeon packs a tiny wad of special material behind it. This material slowly dissolves over the next 2 to 3 months while the eardrum heals.

Sometimes a tympanoplasty can be performed completely through the ear canal. But when the ear canal is too small or the hole is too large to be completely seen through the ear canal, the surgeon must reach the eardrum through an incision behind the ear. Because the incision is behind the ear, no scar is visible after it heals. Packing sometimes also is placed in the ear canal to hold the patch in place during healing.

Home Preparation

Mete will ask you about your child’s medical history, current medications and readiness for the BMV. If you have any questions, you may ask the doctor at this time.
Mete will tell you what time you should arrive at the hospital or surgery center. Allow extra time for travel and parking. Arriving late may delay your child’s surgery or cause it to be postponed.
Mete will give you specific eating and drinking instructions for your child based on your child’s operation(Diet list can be found on the web). Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you by Dr. Mete.

For children older than 12 months:

After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee and chewing gum or candy.

For infants under 12 months:

Up to 6 hours before your scheduled arrival time, formula-fed babies may be given formula.
Up to 4 hours before your scheduled arrival time, breastfed babies may nurse.

For all children:

Up to 2 hours before your scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid® and juices you can see through, such as apple or white grape juice.
In the 2 hours before your scheduled arrival time, give nothing to eat or drink.
For the safety of your child, it is important to follow these specific times for eating and drinking. Remember: If your child does eat or drink after the scheduled times, it will delay the surgery or cause it to be rescheduled for another day.

A Parent’s/Guardian’s Role During the Surgery

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

Once your child has been registered for the surgery, a nurse or nurse practitioner will meet with you to take your child’s vital signs, weight and short medical history.
Your child’s surgeon will meet with you just before the surgery to discuss the surgery and answer any questions you might have.
Anesthesiologist Dr. HamitKalfaoğlu, who is very experienced in anesthesia for children, will meet with you and your child to review your child’s medical information.
If you wish, you may stay with your child until just prior to the sleep medication being given, and then you will be taken to the waiting room.
You may bring along a “comfort” item—such as a favorite stuffed animal or “blankie”—for your child to hold during the surgery.

Going To Sleep

If your child is very scared or upset, the anesthesiologist will let you be in the operating room with your child to support him or her. We do not recommend preoperative sedatives to be given in these short surgical procedures because they prolong the recovery time.
Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake.
Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line.
If the child lets us prepare an intravenous line it is the best way to go to sleep for surgery. Recovery by IV line is also as normal as you wake up in the morning.

While Asleep

While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
Your child might be given an injection (shot) of pain medication and/or antibiotic if needed.

The Surgery

Using a microscope, the surgeon will gently clean inside your child’s ears, make a tiny opening in the eardrum (can be done either by conventional technique or by laser) and insert the tube. The surgery itself will take only about 10 to 15 minutes.

Waking Up

When the surgery is over, the medications will be stopped and your child will begin to wake up.

When your child is moved to the recovery room, you will be called to the bedside so that you can be there as he or she wakes up. It is OK to hold your child in your arms or on your lap.
Your child will need to stay in the recovery room to be watched until he or she is alert and his or her vital signs are stable. The length of time your child will spend in the recovery room may be different from other patients because some children take longer than others to wake up after anesthesia.
Children coming out of anesthesia have a variety of reactions. Your child might cry, be fussy or confused, feel sick to his or her stomach, or vomit. Very young children and infants might cry and “arch” their backs. These reactions are normal and will go away as the anesthesia wears off.
You might notice a Band-Aid and a little red mark on your child’s arm from the injection of pain medication. IV line will stay in your child’s arm until the recovery is done.
Your child will have no memory of the surgery.
In the recovery room, he or she will be encouraged to drink or to eat an ice pop.

Going Home

After your child is discharged and goes home, he or she may still be groggy and should take it easy for the day.

Your child may resume normal activities at the rate he or she is comfortable with.
Your child may begin to eat and drink a little at a time and resume normal eating and drinking as long as he or she is feeling well. Clear liquids and bland foods may be given if he or she has an upset stomach.
You can call Dr. Mete directly if you have any questions and if unexpected situation happened at home.

Ear Care At Home

If your child’s ear is draining, you can gently set a sterile cotton ball in his or her ear to absorb drainage, especially for the first 3 to 5 days.
NOTHING, except eardrops, should be put directly into the ear canal, and only when directed by your surgeon.
Ear drainage may be gently cleaned from the OUTSIDE of the ear with cotton swabs dipped in hydrogen peroxide, or by using a washcloth with soap and water.
If your child had an incision behind his or her ear, keep the incision dry for at least 7 days after the surgery.
Before your child showers or takes a bath, dip cotton balls in antibiotic salve (such as Neosporin® or bacitracin) and gently place them in his or her ear to keep water out.
After a bath, gently pat or dab the area behind the child’s ear–do not rub it. If there are Steri-Strips — little tape-like strips — on your child’s skin, leave them there. They will dry up and fall off by themselves.
Your child should not go swimming or fly in an airplane until the surgeon approves it.
Some types of packing must be removed, and others will dissolve.
It is very important to keep the follow-up appointments for packing removal and checkups for healing of the eardrum.

Common Symptoms AfterTympanoplasty and Myringoplasty

After a tympanoplasty and myringoplasty surgery, you might notice some of the following signs. These symptoms are normal:

Your child might have bloody discharge or drainage from the ear canal for a few days after surgery.

Your child might have mild ear pain and soreness after surgery. These symptoms should go away during the first 3 to 5 days after surgery. You may give your child non-aspirin pain reliever, such as Tylenol® or acetaminophen with or without codeine, as directed for your child’s age.

Warning Signs AfterTympanoplasty and Myringoplasty

Although most children recover quickly from tympanoplasty and myringoplasty surgery with no problems, you should immediately call Dr. Mete, pediatrician or Children’s surgery nurse if your child has any of these symptoms:

Large amounts of bright red blood
Severe pain
Fever higher than 38° C
Severe nausea or vomiting, or can’t keep clear liquids down
Breathing trouble
Rashes anywhere on his or her body
Weakness of the face
Dizziness/vertigo

Assoc. Prof. Dr. Mete İNANÇLI

Ear Nose Throat Specialist

10 Hasan ArsevenSokak, Akay Plaza, Daire No: 1, Ortaköy, Nicosia, North Cyprus.

Ear Nose Throat Clinic