Paracentesis of the tympanic membrane: consequences

The first stage of acute otitis is treated with conservative methods, which usually leads to complete recovery. But sometimes with the accumulation of a significant amount of pus there is a risk of perforation of the tympanic membrane. This condition is manifested by severe pain, insomnia, loss of appetite, and the symptoms of intoxication are increasing. In this case it is necessary to resort to the method of paracentesis. The essence of such an intervention is the incision of the tympanic membrane in order to improve the outflow of pus.

Indications for the procedure

Paracentesis of the tympanic membrane is performed in the event that conservative therapy has proved ineffective. Urgent surgical intervention may be necessary if the following symptoms occur:

- pulsating non-passing ear pain;
- protrusion of the tympanic membrane;
- hearing loss;
- increase in the amount of pus;
- fever;
- nausea.

Parenteresis of the tympanic membrane is performed urgently with signs of irritation of the inner ear or brain damage such as vomiting, dizziness, severe headaches, etc.

The essence of the method

Paracentesis (myringotomy, tympanotomy) is a small surgical operation that is necessary if conservative methods of treatment do not help. When performing the procedure in the tympanic membrane, a small incision is made with a microscalpel or a special needle, which allows to remove the accumulated exudate.

Restoring the integrity of the membrane occurs on its own. At the same time, the middle ear cavity is sanitized. This is necessary in order to remove pathogenic microflora and to clean pus from hard-to-reach places.

How to proceed

This operation was introduced into medical practice in the XIX century and is still used to treat the inflammatory process. Before the procedure, it is necessary to pass urine and blood tests, pass a coagulogram.

Surgical intervention is usually performed 3-4 days after the onset of the disease. The main symptoms that require paracentesis are fever, severe shooting pain in the ear, and protrusion of the tympanic membrane.

Manipulation is carried out using a spear needle, which cuts the lower part of the membrane. The doctor makes a puncture in such a way that the needle goes through the entire thickness of the membrane. Paracentesis of the tympanic membrane can be incomplete, since the inflammation leads to a significant thickening of the eardrum. If necessary, insert a shunt into the puncture site, which facilitates the departure of the accumulated exudate.

Methods of anesthesia

The main question of those to whom the paracentesis of the tympanic membrane is recommended, is it painful? Indeed, the procedure is extremely painful, so doctors use several methods of anesthesia:

1. By the conductor. Anesthetic drug is injected with a prick into the area behind the ear, which leads to a decrease in the sensitivity of the nerve endings.

2. Applicative. The substance for analgesia is applied directly to the membrane.

3. Common. Parenteresis of the tympanic membrane in children is performed using this type of anesthesia, since it is difficult for a small child to restlessly hold the head during the procedure.

Rehabilitation

After paracentesis of the tympanic membrane, hygiene rules must be observed. At the end of the procedure, a dry sterile turunda is inserted into the auditory canal, which is important to regularly change to prevent the spread of the infection. In the beginning, it is done 6-8 times, and after the puss is reduced 3-4 times a day. In order to accelerate the excretion of pus, after surgery it is desirable to sleep on the side of the patient's ear.

The wound and auditory cavity are treated with antiseptic drugs. With thick pus, rinsing is applied using a warm solution of rivanol, furacilin, hydrogen peroxide, after which the ear canal is dried with a cotton swab. The procedure can be carried out once or twice a day. For washing, use a rubber can. Pulling the auricle up and back, direct the stream of water without pressure on the back of the ear canal.

To purge the ear cavity faster from purulent clusters, purging is used. To carry out such a procedure, use a POLITZER balloon or catheter, while purulent accumulations from the tympanic cavity are pushed into the ear canal. Sometimes a Ziegle funnel is used, with which pus is drained through the external auditory meatus.

After the operation, the patient's condition improves rapidly, the pain is relaxed, the temperature decreases, and hearing is restored. It will take two to three weeks to heal the membrane. To prevent the formation of scars, it is recommended to use hydrocortisone. This substance contributes to better wound healing, the scar formed on its surface will be small and will not affect the acuity of hearing.

Consequences and Forecast

With proper carrying out of the paracentesis of the tympanic membrane, there are no unpleasant consequences. If the procedure was performed with violations, such complications can arise:

• Incomplete outflow of pus. In this case, the disease can go into a chronic form. In order to get rid of the remaining pus, physiotherapy and suction are used;
• Infection of the wound as a result of the use of non-sterile materials during the procedure or with improper care in the rehabilitation period. With this complication, the use of broad-spectrum antibiotics is required;
• Hearing impairment due to the formation of large scars. Fortunately, such complications are rare.

If you follow the recommendations of the doctor, the forecast is mostly favorable. Do not give up if the doctor recommends a paracentesis of the tympanic membrane to solve your problem. The consequences of spontaneous rupture of the membrane are much worse, since it can form large scars. And it's best not to delay with the treatment of otitis, so you do not have to get rid of pus with the help of surgical methods.