Bilateral myringotomy with tympanostomy tube placements using the operating microscope, and tonsillectomy and adenoidectomy

PREOPERATIVE DIAGNOSES:  Chronic otitis media and tonsil and adenoid hypertrophy.

POSTOPERATIVE DIAGNOSES:  Chronic otitis media and tonsil and adenoid hypertrophy.

PROCEDURES:  Bilateral myringotomy with tympanostomy tube placements using the operating microscope, and tonsillectomy and adenoidectomy.

ANESTHESIA:  General.

COMPLICATIONS:  None.

ESTIMATED BLOOD LOSS:  Minimal.

DESCRIPTION OF PROCEDURE:  The patient was taken to the operating room and placed upon the operating room table.  General anesthesia was induced via an endotracheal tube.  The operating microscope with a 250-mm lens was placed over the patient's left ear.  A speculum was placed in the external auditory canal and a cerumen curette was used to remove wax that was present.  A myringotomy knife was used to make an incision in the anterior-inferior quadrant.  Effusion was evacuated from the middle ear cleft with the suction.  An Armstrong grommet tympanostomy tube was placed in the myringotomy incision, followed by Ciprodex Otic drops.  The identical procedure was then performed on the opposite ear, with similar findings.  The head of the bed was turned 90 degrees and a shoulder roll was placed under the patient.  A Crowe-Davis mouth gag was placed into the patient's mouth and elevated on a Mayo stand.  The soft palate was palpated and no submucous cleft was present.  A red rubber catheter was placed through the left naris and brought out through the oral cavity.  The left tonsil was grasped at the superior pole with an Allis clamp and retracted medially.  Coblation was used to dissect along the tonsillar pillar until the capsule was identified.  Dissection continued from a superior to inferior direction until the entire tonsil was separated from the tonsillar fossa.  The identical procedure was then performed on the opposite tonsil, with similar findings.  Hemostasis was obtained bilaterally using the bipolar cauterization setting of the Coblation wand.  The adenoid pad was visualized with a mirror and was noted to be hypertrophic.  The adenoid was obliterated with the Coblation technique, and hemostasis was obtained using the bipolar setting of the Coblation wand.  The bilateral nares were irrigated and the stomach was suctioned with an orogastric tube.  The  patient was reversed from anesthesia and taken back to the recovery room in stable condition.