Tetracaine topical anesthesia for myringotomy

OBJECTIVES/HYPOTHESIS: To study the efficacy and safety of topical tetracaine anesthesia for office myringotomy and myringotomy with a tube. STUDY DESIGN: Retrospective review of patients undergoing office myringotomy, with or without tube insertion, performed over a 4-year period. METHODS: A topical solution of 8% tetracaine base in 70% isopropyl alcohol was used in 381 ears. Five to 10 drops of the solution were applied to the tympanic membrane for 10 to 15 minutes and aspirated. Myringotomy was performed either with a myringotomy knife or with a CO(2) laser (OtoLAM). RESULTS: Topical tetracaine was used in all 231 ears (100%) undergoing myringotomy without a tube and 150 of 212 ears (71%) undergoing myringotomy with a tube. Tetracaine alone was effective in providing tympanic membrane anesthesia in 95% of myringotomy without a tube (220 ears) and in 93% of myringotomy with a tube (139 ears). There were six complications, including five cases of severe vertigo and one unusual prolonged, transient facial nerve weakness. CONCLUSION: Topical tetracaine is efficacious and safe for use in office myringotomy.