The first stage of acute otitis media is treated using 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, symptoms of intoxication increase. In this case, you have to resort to the method of paracentesis. The essence of such an intervention is to cut the eardrum in order to improve the outflow of pus.
Indications for the procedure
Paracentesis of the tympanic membrane is carried out if conservative therapy has been ineffective. Urgent surgery may be necessary if the following symptoms occur:
- throbbing persistent ear pain;
- protrusion of the eardrum;
- hearing loss;
- an increase in the amount of pus;
- elevated temperature;
- nausea.
Paracentesis of the eardrum is carried out urgently in the presence of signs of irritation of the inner ear or brain damage, such as vomiting, dizziness, sharp 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 you to remove the accumulated exudate.
The restoration of membrane integrity occurs independently. At the same time, the middle ear cavity is rehabilitated . This is necessary in order to remove the pathogenic microflora and clean out the pus from hard to reach places.
How to carry out the procedure
This operation was introduced into medical practice as early as the 19th century and is still used to treat the inflammatory process. Before the procedure, it is necessary to take urine and blood tests, go through a coagulogram.
Surgical intervention is most often carried out on 3-4 days from the onset of the disease. The main symptoms that require paracentesis are fever, severe shooting pain in the ear, and protrusion of the eardrum.
Manipulation is carried out using a spear-shaped needle, which cuts the lower part of the membrane. The doctor punctures so that the needle passes through the entire thickness of the membrane. Paracentesis of the tympanic membrane can be incomplete, since inflammation leads to a significant thickening of it. If necessary, a shunt is inserted into the puncture site, which facilitates the discharge of accumulated exudate.
Anesthesia methods
The main question for those who are recommended paracentesis of the eardrum is it painful? Indeed, the procedure is extremely painful, so doctors use several methods of pain relief:
1. Conducting. Anesthetic drug is injected into the area behind the ear, which leads to a decrease in the sensitivity of nerve endings.
2. Application. The substance for pain relief is applied directly to the membrane.
3. Common. Paracentesis of the eardrum in children is performed using this type of anesthesia, since it is difficult for a small child to hold his head still during the procedure.
Rehabilitation
After paracentesis of the eardrum, hygiene is necessary. At the end of the procedure, a dry sterile turunda is inserted into the auditory canal, which is important to change regularly to prevent the spread of infection. At first, this is done 6-8 times, and after suppuration decreases 3-4 times a day. In order to accelerate the removal of pus, it is advisable to sleep on the side of the affected ear after surgery.
The wound and the auditory cavity are treated with antiseptic drugs. When thick pus is used, washing with a warm solution of rivanol, furatsilina, hydrogen peroxide, after which the auditory canal is dried with a cotton swab. The procedure can be performed 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.
To quickly release the ear cavity from purulent congestions, blowing is used. To carry out such a procedure, a Politzer balloon or catheter is used, while purulent congestions from the tympanic cavity are pushed into the ear canal. Sometimes a Siegle funnel is used, with which pus is sucked out through the external auditory canal.
After the operation, the patient's condition quickly improves, pain is weakened, the temperature decreases, and hearing is restored. It takes two to three weeks to heal the membrane. To prevent scarring, 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 hearing acuity.
Consequences and forecast
With proper conduct, paracentesis of the eardrum does not have any unpleasant consequences. If the procedure was performed with violations, such complications may arise:
- incomplete outflow of pus. In this case, the disease can become chronic. 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 will be required;
- hearing loss due to large scarring. Fortunately, such complications are rare.
Subject to doctor's recommendations, the prognosis is generally favorable. Do not refuse, if the doctor recommends paracentesis of the eardrum to solve your problem. The consequences of spontaneous rupture of the membrane are much worse, since large scars can form. And the best thing is not to delay the treatment of otitis media so that you do not have to get rid of pus using surgical methods.