The first stage of acute otitis media is treated with conservative methods, which usually leads to a complete recovery. But sometimes, with the accumulation of a significant amount of pus, there is a risk of perforation of the eardrum. This condition is manifested by severe pain, insomnia, loss of appetite, and symptoms of intoxication are growing. In this case, you have to resort to the method of paracentesis. The essence of such an intervention is an incision in the eardrum in order to improve the outflow of pus.
Indications for the procedure
Paracentesis of the tympanic membrane is performed if conservative therapy is ineffective. Urgent surgery may be needed if the following symptoms occur:
- throbbing persistent ear pain;
- protrusioneardrum;
- hearing loss;
- increased amount of pus;
- fever;- nausea.
Eardrum paracentesis is performed urgently if there are signs of inner ear irritation 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. During the procedure, a small incision is made in the eardrum with a microscalpel or a special needle, which allows the accumulated exudate to be removed.
Restoring the integrity of the membrane occurs independently. Simultaneously, sanitation of the middle ear cavity is carried out. This is necessary in order to remove pathogenic microflora and clean out pus from hard-to-reach places.
How the procedure is done
This operation was introduced into medical practice in the 19th century and is still used to treat the inflammatory process. Before the procedure, you must pass urine and blood tests, undergo a coagulogram.
Surgical intervention is most often performed on the 3-4th day from the onset of the disease. The main symptoms that require paracentesis are fever, severe shooting pain in the ear, protrusion of the eardrum.
Manipulation is carried out using a spear-shaped needle, which cuts the lower part of the membrane. The doctor makes a puncture like thisso that the needle passes through the entire thickness of the membrane. The paracentesis of the tympanic membrane may be incomplete, as inflammation leads to a significant thickening of the tympanic membrane. If necessary, a shunt is inserted into the puncture site, which facilitates the discharge of accumulated exudate.
Anesthesia techniques
The main question for those recommended for eardrum paracentesis is, does it hurt? Indeed, the procedure is extremely painful, so doctors use several methods of pain relief:
1. Provodnikov. An anesthetic drug is injected into the area behind the ear, which leads to a decrease in the sensitivity of the nerve endings.
2. Application. An anesthetic is applied directly to the eardrum.
3. General. Tympanic paracentesis in children is performed using this type of anesthesia, as it is difficult for a small child to keep his head still during the procedure.
Rehab
After tympanic membrane paracentesis, hygiene rules must be observed. At the end of the procedure, a dry sterile turunda is inserted into the ear canal, which is important to change regularly to prevent the spread of infection. At first, this is done 6-8 times, and after the suppuration decreases - 3-4 times a day. In order to speed up the removal of pus, it is advisable to sleep on the side of the affected ear after the operation.
The wound and the auditory cavity are treated with antiseptic preparations. With thick pus, washings are used 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 spray. Pulling the auricle up and back, direct a stream of water without pressure on the back wall of the ear canal.
In order to quickly free the ear cavity from purulent accumulations, blowing is used. To carry out such a procedure, a Politzer balloon or a catheter is used, while purulent accumulations from the tympanic cavity are pushed into the ear canal. Sometimes a Sigle funnel is used to suck out pus through the external auditory meatus.
After the operation, the patient's condition quickly improves, pain is relieved, the temperature decreases, and hearing is restored. It will take two to three weeks for the membrane to heal. Hydrocortisone is recommended to prevent scarring. This substance promotes better wound healing, the scar formed on its surface will be small and will not affect hearing acuity.
Consequences and forecast
When properly performed, the paracentesis of the eardrum does not have any unpleasant consequences. If the procedure was performed with violations, the following complications may occur:
- incomplete outflow of pus. In this case, the disease can become chronic. In order to get rid of the remaining pus, physiotherapy is used andsuction;
- infection of the wound as a result of the use of non-sterile materials during the procedure or with improper care during the rehabilitation period. With such a complication, the use of broad-spectrum antibiotics will be required;
- hearing loss due to large scarring. Fortunately, these complications are rare.
If the doctor's recommendations are followed, the prognosis is mostly favorable. Do not refuse if your doctor recommends paracentesis of the tympanic membrane to solve your problem. The consequences of spontaneous membrane rupture are much worse, as large scars can form. And it is best not to delay the treatment of otitis media, so that you do not have to get rid of pus using surgical methods.
