Paracentesis and tympanopuncture of the eardrums - indications for surgery and recommendations for patients. Paracentesis of the tympanic membrane - rational treatment of advanced otitis media in children Care paracentesis

Alternative names: tympanotomy, English: paracentesis of the tympanic membrane.

Eardrum paracentesis is a medical procedure during which an ENT doctor punctures or cuts the eardrum. Paracentesis is performed in case of otitis media, when inflammatory exudate fills the cavity of the middle ear and leads to a significant increase in pressure in it. In such a situation, paracentesis is the only way to treat otitis media and get rid of signs of irritation of the inner ear (headache, nausea, dizziness).

Although paracentesis is a fairly invasive procedure, failure to perform it is fraught with serious complications. Acute otitis media can lead to the following complications: otogenic paralysis of the facial nerve, hearing loss, labyrinthitis, mastoiditis, meningitis, etc.

Indications

Indications for paracentesis are as follows:

1. Acute purulent otitis media.
2. Sluggish otitis media that does not resolve for a long time.
3. Scarlet fever otitis.

Clinical signs in which paracentesis should not be postponed are:

• pain in the ear;
• hyperthermia (high temperature);
• the presence of the above complications;
• bulging eardrum.

Paracentesis of the eardrum - technique

The external auditory canal is first cleaned mechanically - wax and sebaceous secretions are removed, and the skin of the external auditory canal is disinfected with alcohol or another antiseptic.

Paracentesis can be performed without anesthesia, but for emotional people, children and at the request of the patient, the procedure can be performed under local anesthesia. To do this, under visual control, a cotton wool impregnated with a local anesthetic is inserted into the ear canal close to the eardrum and left for 5-7 minutes, after which it is removed.

The patient's position during the procedure is sitting or lying down. The head is fixed by a doctor's assistant to avoid accidental movements. A large ear funnel is inserted into the ear canal. Lighting is provided by a head reflector. Under visual control, a paracentesis needle is inserted into the funnel. Avoid touching the needle to the walls of the ear canal. It is brought to the eardrum, an injection and a vertical incision are made in the posterior part of the membrane.

When paracentesis is performed correctly, the purulent contents of the tympanic cavity begin to drain through the incision. After the procedure, a sterile gauze turundum is inserted into the external auditory canal.

Continuation of antibiotic therapy for otitis media is mandatory. The turunda in the ear is changed every 3-4 hours or as it becomes saturated with purulent discharge. If the amount of discharge decreases, a control otoscopy must be performed. If the edges of the eardrum incision stick together, paracentesis is performed again.

Complications of paracentesis of the tympanic membrane

Complications include:

• trauma to the wall of the ear canal with a paracentesis needle;
• injury to the medial wall of the tympanic cavity that occurs when the needle is inserted too deeply.

When paracentesis is performed by an inexperienced specialist, the procedure may be incompletely performed - an incomplete puncture of the membrane is performed, but only scratching. In this case, the procedure must be repeated.

Additional information

It is a fairly common belief that paracentesis is dangerous for the auditory function of the ear and can lead to hearing loss and deafness. However, this statement is erroneous. Numerous studies have proven that timely paracentesis significantly reduces the risk of developing complications of purulent otitis media. In addition, when treating purulent otitis media with conservative methods, purulent exudate occurs, which is accompanied by the risk of scars and adhesions appearing in the tympanic cavity. And scars and adhesions in 100% of cases lead to hearing impairment.

The presence of a hole in the eardrum after paracentesis does not affect hearing function in any way, and the hole heals on its own after a few days.

Literature:

1. Otorhinolaryngology: National Guide / ed. B.T. Palchuna. - M.: GEOTAP-Media, 2008. - P. 644-651.
2. Luchikhin L.A. Otorhinolaryngology with a course of video and media lectures / ed. B.T. Palchuna. - M.: EKSMO, 2008. - 319 p.

Some patients react extremely negatively to these procedures, arguing that they are afraid of negative consequences. Such a reaction is incorrect and can cause the development of serious pathological conditions, including complete deafness. Therefore, if the doctor considers it necessary to pierce the eardrum, such a procedure must be carried out.

Indications for tympanopuncture and paracentesis – when is surgery necessary?

Both procedures under consideration involve piercing the membranous membrane with a needle in order to collect the contents of the tympanic cavity for examination and/or introduction of drugs into the specified cavity.

The main indications for paracentesis are the following conditions:

• Exudative otitis media.
• Lack of effectiveness from conservative treatment. In this case, such manipulation helps to avoid the development of exacerbations in the form of otoanthritis, mastoiditis, etc.
• Diagnostic measures.
• Symptoms of body intoxication: increased body temperature, headaches, nausea, etc.

With significant accumulation of pus paracentesis combined with bypass surgery. This ensures a regular outflow of fluid, and also makes it possible to administer the necessary medications through the shunt.

Tympanocentesis is considered a more gentle procedure. It is used to treat otitis of non-inflammatory origin.

In addition, through this manipulation, exudate is suctioned for cytological studies and culture.

Video: Eardrum bypass

Preparation for surgery and necessary examinations

After talking with the patient about the presenting complaints and collecting anamnesis, the doctor prescribes the following diagnostic measures:

1. Studying the condition of the tympanic membrane using an otoscope or ear specula. With purulent otitis, this membrane will be swollen, dull, and through it you can visualize the contents of a light yellow color.
2. Tympanometry - testing the sensitivity of the eardrum to sound waves. If exudate accumulates, its mobility will be limited.
3. . It is prescribed extremely rarely, if exacerbations are suspected.
4. Diagnostic tympanocentesis. Performed for special indications when the doctor needs to examine pathological fluid.

These procedures are carried out without any preliminary preparation.

If the manipulations in question are performed using general anesthesia, you should not consume food or any liquid on the day of the operation.

Immediately before surgery, blood and urine are taken from the patient for testing.

Technique for performing paracentesis in children and adults – is anesthesia necessary?

Before carrying out any of the procedures under consideration, the doctor first performs anesthesia.

Today, several methods are used:

• Conduction anesthesia. An injection is made in the area behind the ear, which freezes the nerve. As a result, the eardrum loses its sensitivity.
• Application method of pain relief. Using a cotton swab soaked in an anesthetic, the tympanic membrane is treated from the outside.
• General anesthesia. Relevant for young patients who are unable to stay in one position for a long time. Head movements can cause injury, so when performing tympanopuncture or paracentesis in children, general anesthesia is used as a means of pain relief.

Paracentesis carried out in a stationary mode. After the procedure, the patient remains in the hospital for several days.

Technique for performing paracentesis:

Technique for performing tympanocentesis

In the event that the manipulation in question is the only type of surgical intervention, it can be performed on an outpatient basis, after which the patient is sent home.

However, a situation often arises that hearing problems arise against the background of other ENT diseases, which is clarified during a comprehensive examination. Elimination of a number of such pathologies is carried out in stationary mode, under regular medical supervision.

The algorithm for performing tympanocentesis is as follows:

• Adopting a horizontal position on the operating couch.
• Piercing the tympanic membrane with a special thin medical needle and removing the contents of the cavity. Due to the action of the anesthetic, the patient does not feel pain, but some discomfort is present.
• Pouring a heated hydrocortisone suspension into the surgical site. During this manipulation, the patient may experience slight dizziness.

An integral attribute of this procedure is microscope. Thanks to it, clearer visualization of the surgical site is provided.

Possible complications of paracentesis of the tympanic membrane and tympanopuncture

Exacerbations after the manipulations in question are extremely rare. Often, after the pathological fluid drains away, the mobility of the eardrum is restored, which has a positive effect on hearing abilities.

In addition, signs of intoxication of the body (if any) are stopped: pain decreases, temperature decreases, nausea disappears.

However, sometimes the puncture site overgrows very quickly, and the purulent/serous exudate does not have time to flow out.

There may be several reasons for this phenomenon:

1. Incorrect manipulation technique.
2. The wall of the membranous membrane is too thick. The edges of the mucous membrane may stick together, which requires repeated manipulation or expansion of the existing puncture.
3. Clogging of the perforation site with prolapsed mucous membrane. It can be eliminated quite simply using small medical tweezers.

Another possible negative consequence of tympanopuncture and paracentesis is infection of the operating area.

There may also be several reasons for this:

• Ignoring the rules of asepsis during the procedure.
• Inadequate implementation of recommendations in the postoperative period.

Frequent piercing of the eardrum to ensure the drainage of pus can provoke scarring. This, in turn, leads to hearing loss.

In order to minimize the risk of developing exacerbations after manipulation, it is recommended to adhere to the following rules:

1. Toilet the external auditory canal using antiseptic agents. This will protect the wound surface from infection.
2. Using hydrocortisone to reduce the likelihood of scarring of the eardrum.

The complete absence of outflow of pathological fluid, which is combined with symptoms of intoxication of the body, is a reason for contact your doctor immediately. In this case, additional manipulation may be required to ensure proper drainage. They may also resort to blowing and suctioning of pus.

Paracentesis of the eardrum is a surgical puncture of all layers of the organ in order to normalize the outflow of contents from the middle ear. Prescribed as a prophylaxis for acute otitis in the pre-perforative stage. This procedure improves the general condition of the patient, speeds up the recovery process, and also preserves hearing.

Indications for behavior

All medical punctures are carried out with the aim of eliminating high blood pressure in a limited area. As a rule, this manipulation is indicated for purulent otitis media in the acute stage or during exacerbation of a chronic disease.

The main indications are:

• the presence of effusion or accumulation of purulent contents in the tympanic cavity;
• acute pain in the ear, observed against the background of intoxication and febrile processes.

Important! The most important symptom for which paracentosis is necessary is a pronounced swelling of the eardrum outward, since it is this sign that indicates that there is significant pressure in the area of ​​the tympanic cavity.

The essence of the method

The procedure can only be performed by an otolaryngologist. The intervention is carried out 3-4 days from the onset of the disease. First, hygiene of the ear canal is performed, cleansing it of earwax and other contaminants. To free the tympanic cavity from purulent exudate after tissue dissection, a special small drainage is installed in the ear, which will ensure the outflow of fluid and prevent the puncture from tightening.

Execution technique

After the ear canal has been sanitized, the doctor proceeds directly to the puncture. Usually the procedure is carried out without anesthesia, but people who have increased pain sensitivity, as well as young patients, are given pain relief using one of the methods discussed below.

The patient should take a sitting or lying position; the patient's head should be supported by an assistant to avoid unexpected and sudden movements. The funnel is inserted into the ear canal, the working surface is illuminated using a head reflector. Without touching the walls of the ear canal, a needle equipped with a spear-shaped blade is inserted.

The doctor makes an incision in the area of ​​the anterior inferior or posterior membrane, which should not exceed a few mm. If all the doctor’s actions were correct, purulent contents will immediately begin to flow out of the puncture area.

After this, it is necessary to carry out repeated antiseptic treatment and place a sterile gauze swab in the ear, which will absorb the released exudate. A sterile bandage is applied to the ear, which must be removed on the first day after surgery only to change the gauze pad.

If there is a large accumulation of pus, in order to avoid prolongation of the puncture and the need for a repeat procedure, a drainage tube is inserted into the incision, ensuring a long-term outflow of fluid. The whole procedure takes no more than 15 minutes.

Reference! If the purulent process is very strong, the membrane of the eardrum may thicken, in which case it is difficult and almost impossible to pierce it through and not damage the auditory ossicles. In such situations, the doctor does not completely cut through the membrane, because as pus accumulates, the membrane, whose integrity is already compromised, will break through early.

Pain relief methods

As mentioned above, paracentesis is performed without the use of anesthesia, but if necessary, the following methods of pain relief are used:

1. Conduction anesthesia. The nerves that are responsible for the sensitivity of the eardrum are “frozen.” Their endings are located in the area behind the ear.
2. . A cotton swab is soaked in an anesthetic and then applied as an applique to the eardrum membrane.
3. General anesthesia can be used during the procedure for pediatric patients. Children may be capricious and frightened in unfamiliar surroundings.

Recovery after surgery

In order for paracentesis to lead to a positive effect and for no complications to arise after the operation, the patient must thoroughly and disciplinedly follow the doctor’s recommendations regarding the organization of the recovery period.

1. Take broad-spectrum antibacterial drugs to eliminate pathogenic bacterial flora. In most cases, strong drugs are prescribed that reduce the negative risks that are possible during the recovery period.
2. To avoid relapse of the disease, as well as to prevent the development of a chronic form, the doctor develops a regimen that will strengthen the immune system.
3. In order to prevent the infection from spreading throughout the body immediately after surgery, it is necessary to regularly clean the ear canal from leaking pus. After sanitation, be sure to insert new sterile turundas into the ear canal.
4. To ensure that pus flows out of the tympanic cavity better, patients after paracentesis are advised to sleep on the side of the operated ear.
5. If even minor signs of an inflammatory process are observed - burning, pain, pulsation, increased temperature, decreased hearing, and so on, you must immediately report it to your doctor.

Possible consequences

If the puncture procedure is carried out correctly, the patient does not experience any complications; on the contrary, his condition quickly and significantly improves. The puncture heals over a short period of time (several days), and hearing function is completely restored.

But in some cases, if the doctor did not consider it necessary to insert a drainage tube, and the puncture became overgrown before the purulent exudate flowed out completely, complications in the form of an inflammatory process may occur.

There may be other reasons for this phenomenon:

1. The manipulation was performed technically incorrectly.
2. The membrane turned out to have a too thick wall, and its edges stuck together. In this case, a repeated puncture is performed or the specialist expands the existing one.
3. The perforation site was clogged with prolapsed mucosa. A doctor can fix this quickly and easily using medical tweezers.

Also, the surgical wound can become infected, this is possible for the following reasons:

• failure to comply with aseptic rules during the procedure;
• non-compliance by the patient with the doctor’s recommendations after surgery.

Another complication of paracentesis can be tissue scarring, which leads to decreased hearing function.

Paracentesis is a simple and fairly common procedure, but to this day there are incredible rumors about it. For example, that it hurts, the risk of infection after a puncture increases, a puncture in childhood leads to complications, frequent punctures lead to hearing loss. Regarding the latter, I would like to say that this is partly true, but only if the puncture is repeated at short time intervals. In this case, the tissue becomes scarred and hearing may actually decrease.

Many patients, due to their basic illiteracy, believe them and refuse this manipulation, which leads to a worsening of their condition and the development of dangerous complications. All rumors and fears about a puncture are unfounded. This procedure is not at all dangerous and very simple; moreover, it has been carried out since the mid-18th century - it was the only way to save hopelessly ill people. This means that her technique is honed to the smallest detail. The main thing is that it is carried out by a qualified specialist, and also that the patient subsequently complies with all his instructions.

Paracentesis (puncture of the eardrum for otitis or tympanotomy) is a type of surgical intervention used to empty the tympanic cavity of pus in acute purulent otitis media. After the evacuation of pus from the ear, the patient’s condition normalizes, the symptoms of intoxication decrease, pain in the ear stops, and healing and restoration processes begin. Manipulation is recommended for otitis media, when the accumulation of purulent exudate increases the pressure in the auditory organ.

It should be remembered that ear inflammation is manifested by decreased hearing; if the doctor recommends a puncture, do not hesitate. By its nature, the eardrum is prone to perforation; its strength varies from person to person. In some, in the first stages of otitis, a rupture occurs, in others, on the contrary, purulent exudate accumulates without being accompanied by perforation. The pus does not come out on its own, then complications in the form of purulent meningitis, etc. are possible.

To avoid complications, doctors recommend an incision so that there is somewhere for the exudate to flow out. A puncture is the first aid for severe ear pain. A small scar remains at the site of the rupture, which does not affect hearing. What are the indications for manipulation and methods for carrying it out, we will consider below.

Indications

There are three stages of purulent otitis: pre-perforative, perforative and reparative. In the first, inflammation of the middle ear occurs, accumulation of purulent exudate. Perforative is characterized by a breakthrough of the tympanic membrane and removal of pus to the outside. The third stage is manifested by scarring of the perforation and healing. With a strong tympanic membrane at the second stage, no rupture occurs, pus cannot flow out, the symptoms of the clinical picture worsen, so they resort to paracentesis.

Often a puncture is performed for acute otitis media or exudative otitis media. In the case of acute otitis, paracentesis is done when drug therapy has not given the desired result. With purulent inflammation, the pain symptom is mild, but another problem appears - the accumulation of fluid in the tympanic cavity. Signs that should not delay paracentesis are:

• high body temperature;
• swelling, strong protrusion of the tympanic membrane;
• intense pain

A puncture for otitis media allows you to quickly free the tympanic cavity from purulent exudate. It is also possible to improve well-being, lower the temperature and restore hearing to a child or adult. It is necessary to insert a small drain into the ear so that the hole in the membrane does not tighten. This will help the liquid drain completely.

Performing paracentesis

Treatment with this procedure is determined by an otolaryngologist. To improve the swelling of pus, manipulation is done on the 3-4th day of the disease. Initially, the ear canal is cleaned of wax and other contaminants. Using antiseptics, the external auditory canal is disinfected. The manipulation is performed without anesthesia, but people with hypersensitivity or children are given one of the proposed types of pain relief:

• conductive, using a puncture behind the ear, a substance is injected that “freezes” the nerve endings;
• local, apply a cotton swab moistened with lidocaine to the eardrum for 10 minutes;
• ethereal, for troubled children.

Patient position sitting or lying down. An assistant should hold your head to avoid sudden and unexpected movements. A funnel is inserted into the ear canal. Illuminate the work surface using a head reflector. A needle with a spear-shaped blade is carefully inserted without touching the walls of the ear canal.

An injection and incision are made in the area of ​​the lower anterior or posterior part of the membrane. The incision should not exceed a few millimeters. When the manipulation is carried out correctly, the pus begins to drain. After paracentesis, it is necessary to insert a sterile gauze turunda into the ear.

After such an intervention, careful ear hygiene with Furacilin or Boric alcohol is necessary for a speedy recovery for several days. To prevent premature scarring of the eardrum, catheterization is performed with the introduction of hydrocortisone and antibiotics. A dry turunda is placed at the puncture site and covered with a cotton-gauze bandage; it must be changed 3 times a day.

Complications of paracentesis

After surgical treatment, careful care of the tympanic cavity is indicated. Be sure to change the turundas in a timely manner and clean the ears. If the amount of purulent discharge decreases, otoscopy should be performed. If the edges of the incision stick together, paracentesis is performed again.

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Complications include injury to the ear canal with a needle, damage to the medial wall of the eardrum due to its deep insertion. The procedure is also repeated if the puncture was performed by an inexperienced doctor (not completed). If purulent contents are not completely removed, ear infection or hearing loss may occur. The remaining exudate in the membrane cavity is removed using physiotherapy or suctioned out. Complete elimination of the infection occurs with the help of broad-spectrum antibiotics.

There is an opinion that treating the ear with paracentesis leads to hearing loss or deafness. This theory is erroneous; if tympanotomy is applied at an early stage of treatment, it will have a beneficial effect on the course of the disease. Surgical treatment in the near future in combination with medication and physiotherapy will speed up the healing process.

After carrying out such manipulation, you need to protect your ears from hypothermia, drafts or water ingress. It is recommended to limit swimming in open water until complete healing. For the first time, you can place a cotton wool in your ear, this will protect against water or dust (taking into account that the cotton wool will be constantly changing). If you feel discomfort, consult a doctor. Take care of yourself, be attentive to your health.

If otitis media comes to visit, then such uninvited visitors should be dealt with immediately. Unbearable pain in the ear, purulent discharge may indicate the development of purulent otitis media. This inflammation develops especially quickly in children. You shouldn’t even try to get rid of it yourself; it can be very dangerous for the child’s health.

When visiting a doctor, in some cases, he may prescribe an ear piercing for otitis media of this form. You shouldn’t be afraid of this; this is a common measure in the treatment of advanced forms of otitis in children and adults. Let's take a closer look at what this operation is and how it is carried out.

Treatment prescribed by a doctor must be carried out in compliance with one very important condition - complete rest and bed rest to prevent complications from occurring. Approximate complex therapy scheme, written out by a specialist, looks like this:

• nasal drops with a vasoconstrictor effect;
• antibiotics;
• antihistamines, anti-inflammatory and antipyretic drugs;
• vitamin complex;
• compresses;
• physiotherapy.

The list of drugs is individual for each specific case ear inflammation diseases. In some severe cases, surgical intervention may be performed in the form of ear piercing for otitis media in children and adults.

Ear piercing for otitis - basic information about the operation

Ear puncture, paracentesis, tympathomy, myringotomy– all these concepts are united by only one type of surgical intervention during otitis, which consists of perforation of the eardrum.

If otitis media is confirmed during a visit to the otolaryngologist's office, then a puncture of the eardrum may be suggested. You shouldn’t be scared or refuse right away, because this method is very effective in treating this disease.

The main task of such an operation– this is to ensure improved release of accumulated purulent fluid from the middle ear, which alleviates the patient’s condition and further promotes complete recovery.

The main indication for implementation such an event is purulent otitis of the middle ear with an acute form of the course. Surgical intervention of this type in children is carried out only in a situation where antibacterial therapy has not brought the desired results.

It is worth noting that the younger the baby, the more this treatment method is considered more preferable in eliminating the purulent inflammatory process.

Paracentesis is performed when the course of otitis is purulent

Immediate incision of the eardrum necessary in the presence of such signs indicating general intoxication of the body from an inflammatory process in the ear:

• prolonged increase in body temperature (37.5-38°C);
• ear pain;
• effusion of the eardrum;
• severe headaches;
• nausea.

In particular, a specialist may prescribe tympathomy if there is suspected meningitis and mechanical hearing damage.

Paracentesis of the eardrum in children - performing the procedure

The younger the child’s age, the more preferable this procedure is for purulent otitis media.

A puncture for otitis in children for better release of purulent masses is usually carried out on the 3rd or 4th day of the disease.

In childhood, the procedure is performed in cases of acute pain in the ear, elevated temperature and a membrane that is bulging under the influence of pus.

To ensure that the child’s operation is painless, the doctor uses one of the types of anesthesia(depending on the age of the child):

• conductor– a drug is injected through a puncture behind the ear, which “freezes” the sensitivity of the nerves;
• appliqué– the membrane is treated with an anesthetic substance from the outside;
• ether anesthesia– for active kids who need a puncture.

Then the membrane incision itself is made. It is performed using a special needle with a spear-shaped blade at the end.

The specialist determines the puncture site in the anterior lower or posterior lower membrane section. The size of the incision is no more than a few millimeters.

The action is done so that the needle pierces the membrane of the eardrum the first time. This is fundamentally important because the membrane can become thickened due to inflammation of the mucous membrane of the middle ear.

After the puncture is performed, a dry sterile turuntula is placed in the ear secured with a cotton swab. In order for the child to recover quickly after surgery, the affected ear is cleaned twice a day.

To avoid scarring of the eardrum the puncture is supplemented by catheterization of the inner tube with the introduction of an antibacterial drug and hydrocortisone into the cavity.

Bandaging is also used to absorb purulent masses. The event looks like this:

1. A dry turuntula is applied to the incision site.
2. The tip of the turuntula is brought out onto the auricle.
3. A dry bandage made of gauze and cotton wool is applied to the ear, which is changed three times a day.

After child's surgery lay the sore ear on a pillow, which promotes better outflow of pus from the ear cavity.

But the treatment does not end there. Purulent masses from the ear are taken for bacteriological studies. In accordance with the research results obtained, a course of treatment is selected aimed at preventing the negative consequences of the disease. It may consist of antibacterial, antihistamines and painkillers.

Incision of the eardrum for otitis media: reviews

People who have undergone this operation speak only for its effectiveness

Many people are afraid of this operation, although in fact there's nothing scary about it.

Moreover, it is considered the best way to treat purulent otitis media.

Many doctors are of the opinion that it is better to perform a paracentesis of the eardrum than to wait until it ruptures under the pressure of pus.

An incision made by a doctor with a sterile instrument will be smooth and will not cause any problems with healing, but after an independent breakthrough, a wound with uneven edges may heal worse, even to the point of scarring.

To form a final opinion about this procedure for readers, we present