Bechara Y. Ghorayeb, MD, PA
Otolaryngology-Head & Neck Surgery                                                                 Phone: 713 464 2614
1140 Business Center Drive, Suite 560
Houston, TX 77043                                    
Myringotomy and insertion of Tympanostomy Tubes
(PE Tubes, Pressure Equalizing Tubes)
Informed Consent 
Myringotomy with or without tympanostomy tube insertion is the most commonly performed ear operation. It is extremely safe and effective. Complications are minor and usually in the form of infection, which may be treated with antibiotics. The tube usually remains in place for several months, although it may be rejected sooner or remain in place for years. As long as there is a tube in the ear, care should be taken to avoid water contamination, especially bath water, by the use of ear plugs or, if desired, a bathing cap. Occasionally the tympanic membrane fails to heal after tubes have been removed, and the resulting perforation may require surgical repair. In some cases, particularly when there is a family history of chronic ear disease, tympanostomy tubes may need to be replaced. Hearing improvement is usually immediate after fluid has been removed from the ear. Failure to improve hearing indicates a second problem in the middle or inner ear. 

​I have discussed the risks, benefits and alternatives of the procedure/treatment to the patient/patient representative. I answered the patient’s/patient’s representative’s questions regarding the procedure/treatment.

I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of no treatment, the procedures to be used, and the risks and hazards involved, and I/we have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/we understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees. 

Patient / Legal Guardian 

Date:___________________________          Time:___________________________