Eardrum bypass (tympanostomy) is a type of surgery that involves making a small incision in the soft membrane to insert the bypass. The purpose of this mini-surgery is to equalize the pressure between the inner ear and the external auditory canal. Such a direct message is formed for a certain period of time. As a rule, the procedure is widespread in the field of pediatrics.
A bit of physiology
The functionality of the middle ear lies in the conduction of sound by transferring wave-like vibrations of air collected by the auricle into the cavity of the inner ear. The middle ear is located in the temporal bone, and air from the nasopharynx enters here through the Eustachian tube. The external auditory meatus and the cavity of the inner ear are separated by a thin, translucent membrane, which is familiar to everyone.like an eardrum.
During the development of any disease that is accompanied by a runny nose, in some cases, mucus from the nasal passage through the Eustachian tube enters the middle ear cavity. This is called otitis media, and in some cases a bypass tympanic membrane cannot be avoided. Also, this disease can begin to develop against the background of adenoiditis.
Pathogenic microorganisms that have entered the middle ear cavity along with mucus begin to multiply rapidly. As a result, an acute form of otitis media develops. After some time, in such a closed space, an accumulation of lymphoid tissue occurs - this is already purulent otitis media.
In the language of medical professionals, pus is called exudate. Excess of this mass leads to severe pain. The lack of proper and timely treatment ends up with a puncture of the eardrum in order to remove the purulent mass.
Indications for the procedure
Like any other surgical intervention, the tympanic bypass procedure also has certain indications for it. At the same time, the presence of purulent masses in the ear cavity, which is not amenable to conservative treatment, acts as a weighty reason.
Direct indications for tympanostomy include the following pathological conditions:
- Acute form of otitis media, in which there is no pronounced pain syndrome, and the tympanicthe eardrum is intact.
- Purulent form of otitis media on the background of perforation, when there is no possibility to inject the medicine and remove the purulent masses.
- Development of otitis media with exudate formation.
- Sensory hearing loss.
- Narrowing of the Eustachian tube.
- Ear barotrauma.
Besides this, there are other, no less serious cases:
- Ear inflammation is common and medication is not effective.
- Reduced hearing quality due to persistent accumulation of fluid in the middle ear cavity.
- Disbalance.
- Decrease in auditory functionality, provoking a lag in speech development.
- Eustachian tube blocked.
In addition, bypassing the eardrum in adults or children is also carried out in order to diagnose diseases that are difficult to detect in any other way. In this case, tympanostomy is the only option to detect the pathology in a timely manner.
Contraindications
In general, the tympanostomy procedure has virtually no contraindications and is safe for humans. However, there are some cases when it is better not to carry out such an operation:
- Neoplasm in the cavity of the middle ear (neurinoma, meningioma).
- Abnormal development of the vascular system - the internal carotid artery passes through the cavity of the middle ear.
- Slowing blood clotting.
Also, this procedure is contraindicated in cases where it is impossible tovisual examination of the eardrum.
Pain relief
The procedure for shunting the soft ear membrane is performed using general or local anesthesia. Some patients do not need pain relief.
The use of local anesthesia for eardrum bypass has its own advantages. And above all, we are talking about the safety of its use. In addition, the patient recovers faster, which allows for earlier discharge from the hospital. The costs are also lower, there is less bleeding, in addition, there are opportunities for the operation to be performed in an outpatient clinic. All this makes local anesthesia the preferred option if bypass surgery is needed.
The eardrum can be anesthetized with local anesthetics or infiltration. With regard to children, their use is permissible only with the consent of the parents or guardians.
Infiltration involves the injection of "Lidocaine" and "Prilocaine" (or other local anesthetic) into the subcutaneous layer of the distal external auditory canal. The effectiveness of anesthesia is supported by a vasoconstrictor, which in the end just allows you to reduce bleeding during the procedure. Only the injection itself is quite painful and can also cause bleeding, which makes it difficult to access the eardrum.
This proves once again that the use of local anesthesia is more than justified.
Bypass Procedure
Among all transactionson the ear, the easiest is bypassing the eardrum, and reviews confirm this. To be more precise, bypass surgery belongs to the category of microsurgical procedures, where a special operating microscope is used. This equipment gives a significant increase, which gives the surgeon full visual access to the ear membrane.
At the initial stage of the operation (myringotomy), an incision is made in the eardrum. This requires several manipulations with the membrane:
- Cut and detach the epidermis.
- Muscle fibers are cut and pulled apart in layers.
Thus, an oval-shaped hole is gradually formed, which gently expands according to the dimensions of the ventilation tube being inserted. Pus or fluid from the middle ear cavity drains through it.
After making a hole of the required size, proceed to install the shunt. It is thanks to him that the pressure is equalized between the outer and inner cavities of the ear due to the constant flow of air.
In terms of time, the operation takes from 20 to 30 minutes. The tube itself is in the ear for a short period of time - usually from 2 to 12 months. After this period, the shunt is removed and the hole in the membrane is closed.
Operation for children
For very young patients, eardrum bypass surgery in children is performed at the age of one to three years. This is due to the fact that this group is vulnerable topurulent form of otitis. In addition, a purely physiological feature of each child affects - children need specialized medical care to normalize pressure and outflow of excess fluid from the ear.
The use of general anesthesia for children is justified by the fact that it allows you to fix the head of a small patient in a motionless state. And they, as you know, cannot lie still.
Membrane shunting in children is performed in the same way as for adult patients. In this case, in the case of purulent or exudative otitis media, the operation is limited only to an incision in the membrane to remove accumulated pus or fluid. However, if we are talking about a chronic form of pathology, then a shunt is already fixed on the eardrum.
If necessary, the doctor instills an antibacterial agent into the ear for the speedy healing of the mucosa. The use of ear drops also contributes to a speedy recovery. To avoid the consequences of bypassing the eardrum in children, it is necessary to strictly adhere to the doctor's recommendations.
Varieties of shunts
Let's take a closer look at this point. In fact, the shunt is a small tube, which is made of silicone, polyethylene, ceramics and other bioinert materials. In this case, surgeons use two types of shunts:
- Smooth tube.
- Flanged shunt.
Smooth tube is usually placed for a relatively short period of time, and afterperforming his task, the doctor easily removes it. Modern shunts do without this - they simply fall out on their own as the eardrum recovers after shunting. And the membrane is completely overgrown within 6-12 months.
The shunt with a flange is fixed for a longer time due to its special shape. On the eardrum, it can last up to several years. Such a device is placed in cases where the functionality of the Eustachian tube cannot be restored. It is also relevant for sensorineural hearing loss for the administration of medications.
Postoperative period, or advice from otolaryngologists
It is worth noting that after the operation, the protection of the middle and inner ear is reduced. In this regard, patients are required to undergo a consultation, during which they will be explained the rules of care and behavior with a tube in their ear. And above all, it is necessary to avoid getting water on the artificial auditory tube. Otherwise, the re-development of a secondary infection cannot be avoided.
But, of course, this is not a reason to refuse water procedures - just in this case, the operated ear must be covered with a cotton swab each time. It is advisable to pre-soak it with oil. In extreme cases, you can use special devices.
As for swimming in water bodies or a pool, visits to such places should be limited during the installation of the shunt. It is also necessary to comply withPrecautions:
- When sneezing, it is better to open your mouth, your nose should also be open.
- You should also blow your nose with your mouth open, with extreme caution.
These measures will avoid a serious pressure surge and injury to the ear septum.
Effects of eardrum bypass surgery
If the bypass procedure is performed under the right conditions and by a qualified specialist, then the likelihood of any complications is minimal. However, there may be different situations. In some cases, perforation of the ear membrane may occur, mostly due to improper surgical technique.
However, some complications may be the fault of the patient himself. That is, ignoring the doctor's recommendation may result in a relapse due to water entering the cavity of the operated ear.
In addition, frequent tympanostomy provokes the formation of scars on the membrane. Only this complication can be considered practically harmless, since it does not affect the general state of he alth of the patient, except that the appearance is disturbed.
Conclusion
Shunting the ear membrane gives its results: the risk of developing inflammation is significantly reduced, excess fluid in the ear cavity is not formed, hearing and speech function are restored. But this can only be achieved if all the doctor's prescriptions are followed after bypassing the eardrum. Otherwise, complications cannot be avoided!
