Methods for restoring the eardrum

Indications and contraindications

To cope with pathological changes in the ear, experts suggest surgical intervention. Ear surgery for otitis media is performed in a hospital, as prescribed by an ENT specialist.

Indications for surgical intervention:

• Accumulation of a large amount of purulent exudate, fluid released from tissues and vessels during inflammatory processes.
• Severe pain in the ear area.
• Perforation, rupture, eardrum.
• Rapid deterioration of hearing.
• Significant increase in body temperature.
• Inflammatory processes of the ear are of a chronic nature, with the presence of suppuration in the middle ear.

Surgery for suppurative otitis media will help prevent further infection, ensure the drainage of purulent contents and help restore normal functioning of the ear. Read more about otitis media →

Contraindications for surgery:

• The patient's serious condition.
• The period of exacerbation of chronic processes.
• Absolute deafness.
• The patency of the Eustachian tube is impaired.
• The presence of sepsis is a serious disease that occurs due to the spread of infection throughout the body through the bloodstream.

Main indications for surgical treatment of pathology

If a disease such as otitis media develops, then surgery may be required for the inflamed organ, the disease of which has reached an advanced stage, while conservative methods of therapy are ineffective.

In certain cases, this method is the most effective for eliminating intense painful sensations and inhibiting destructive reactions in the body.

If the ear bone tissues are affected, further spread of the infectious process occurs, a radical treatment option is a necessity.

Typically, this method of therapy is suitable for getting rid of a chronic type of disease. For chronic otitis media, surgical treatment helps eliminate the accumulation of purulent contents that cannot come out on their own.

Surgical treatment of otitis is necessary when the following clinical manifestations appear during the development of the disease:

• Hyperthermia that does not subside even after starting treatment with antibacterial drugs;
• The presence of abundant purulent contents;
• Intensely expressed painful syndrome;
• The presence of carious processes in bone tissue;
• Rupture of the eardrum;
• The presence of a chronic inflammatory process in the organ cavity with an intense process of suppuration;
• Significant deterioration in the quality of sound perception;
• Dysfunctions in the location and functioning of some parts of the hearing aid.

Before carrying out any interventions, diagnostic measures must be prescribed, which include: otoscopy, computed tomography, and other important examinations.

The simplest intervention is to incise the eardrum so that the contents can be drained out without hindrance. With timely surgical therapy, the disease progresses more easily, and recovery occurs quickly. In addition to the fact that this procedure helps remove exudate, it helps restore the quality of sound perception and prevent the risk of infection.

Preparation

Any surgical intervention involves a small preparatory stage. Carrying out ear surgery for otitis media is no exception. First of all, it is necessary to find out the general condition of the body, the type of pathological process and the characteristics of the organ on which the operation is to be performed.

To do this, instrumental methods and laboratory analysis are used:

• A general blood test will allow you to assess how strongly the inflammatory process is developing, what the hemoglobin levels are and the erythrocyte sedimentation rate.
• A general urine test will assess kidney function.
• Biochemical blood test, blood for Rh factor and blood group. Determining your blood type and Rh factor will help if you need a blood transfusion during surgery. This is a common medical practice, a method of reinsurance.
• Culture of the fluid secreted from the ear will help identify the type of pathogen.
• An otoscopic examination is performed by an ENT doctor using special equipment. Helps determine the condition of the diseased ear.
• X-ray image of the temporal bone. It will allow you to determine the individual structural features of the organ and the localization of the pathological process.
• A study using computed tomography will provide more detailed data on the structure of the organ and the pathological process. Often prescribed as an alternative to radiography.
• Consultations with a therapist or neurologist are prescribed according to individual indications to exclude chronic or concomitant diseases.

If there is a perforation of the eardrum, it is necessary to protect the ear from water leakage. When taking a shower or washing your hair, insert a cotton pad soaked in Vaseline into the ear canal. For the same reason, it is prohibited to swim in a pool or open water. A short course of antibiotics may be prescribed before surgery. During the preparation period, you should strictly follow all medical recommendations.

Kinds

Several decades ago, the goal of surgical treatment of suppurative otitis media was to sanitize the affected organ and prevent the development of complications. But with the advent of modern technologies, the situation has changed dramatically. Step-by-step operations allow you to restore the hearing aid, eardrum and auditory ossicles.

Surgical procedures are performed under local anesthesia or using safe short-term and not deep Rausch anesthesia.

Sanitizing (radical) operation

Carrying out ear surgery for purulent otitis will clear the source of inflammation from purulent contents and destroyed tissue. This helps to avoid the spread of the inflammatory process to neighboring organs (sinuses, facial nerve, brain).

The operation is carried out as follows:

1. Opening the mastoid process - anthrotomy.
2. Excision of the posterior wall of the external auditory canal and the lateral wall of the attic.
3. Removal of defective tissues and exudate.
4. Ensuring communication between the resulting cavity and the outer ear.

Gauze turundas are inserted into the cavity, with the help of which anti-inflammatory drugs are administered.

Myringotomy and tympanostomy tubes

The operation is performed in a hospital. The specialist makes a puncture or incision in the eardrum into which a tympanostomy tube is inserted. This allows for the drainage of purulent contents or exudate.

In cases where the installation of a tube is not necessary, the incision of the eardrum is closed with a gauze pad.

Myringoplasty

This type of operation is performed after the sanitation of the inflammatory process with purulent otitis media. The goal is to repair the perforated eardrum, which will allow you to regain the ability to hear. Preserved auditory ossicles, not affected by the inflammatory process, are one of the conditions for intervention.

When does an ENT doctor suggest a patient undergo paracentesis?

Indications for paracentesis are the presence of the following symptoms: sharp pain in the ear, especially if it is accompanied by a severe headache, high fever and protrusion of the eardrum - limited or diffuse.

Most often, paracentesis is performed for acute otitis media and exudative otitis media .

For otitis media , this operation is performed when conservative treatment does not help, when ear pain persists despite antibiotic therapy. Also, an incision of the eardrum may be necessary immediately if there is severe intoxication against the background of otitis media. The appearance of signs of irritation of the inner ear or meninges (severe headache, dizziness, nausea, chills, etc.) is an indication for urgent paracentesis.

In acute otitis media, pain is caused by the pressure of the inflammatory fluid on the walls of the tympanic cavity and on the membrane. Paracentesis allows you to release pus from the confined space of the tympanic cavity and relieve tension inside the ear. A properly executed incision can often provide almost immediate relief from ear pain. Soon after the pain disappears, the temperature usually drops. In addition, we note that otitis media is sometimes the cause of general intoxication, especially in children. In such cases, the indications for paracentesis are expanded.

With exudative otitis media , as a rule, there is no pain, but fluid accumulates in the tympanic cavity, which limits the mobility of the eardrum. Because of this, hearing decreases. Paracentesis allows fluid (exudate) to be released out and thereby restores the mobility of the eardrum. If necessary, a shunt (tube) can be inserted into the tympanic cavity through an incision so that the hole in the membrane does not close for a while and the outflow of the contents of the tympanic cavity is more effective.

After the cessation of suppuration from the ear, the edges of the incision heal on their own.

Rehabilitation period

Operations for purulent otitis media are a proven process. A competent specialist will carry out the intervention carefully, which will ensure a fairly short recovery period. For better rehabilitation, the patient should strictly follow all the doctor’s prescriptions and recommendations.

Throughout the recovery period, it is necessary to avoid situations associated with sudden changes in pressure: flying in airplanes, diving. You should be careful when sneezing and blowing your nose, as these simple actions increase pressure in the ear. Avoid getting water into the ear canal.

After the operation, the patient will need to remain in the hospital for some time. The duration depends on the type of surgery and the general condition of the patient, and varies from 7 days to 3 weeks. All this time, the specialist will monitor the condition of the operated ear, replace gauze swabs, and instill ear drops. To relieve any inflammatory symptoms and complications after surgery, antibiotic therapy is prescribed as a course of treatment for 7-10 days.

The recovery period can last from three weeks to several months.

Possible complications

If the patient strictly follows all the ENT doctor’s prescriptions, then postoperative complications can be avoided. In very rare cases, the following complications may occur after ear surgery:

• Facial nerve paralysis.
• Re-infection.
• The appearance of bleeding from their ear.
• Hearing loss.

If these or other symptoms appear, you should immediately consult your doctor.

Price

Otitis surgery is carried out both in public hospitals and private clinics. The procedure for restoring hearing organs is a very delicate and painstaking work, which affects its cost:

• General cavity (radical) surgery on the middle ear – from 80,000 rubles
• General cavity (radical) surgery on the middle ear (reoperation) – from 90,000 rubles.
• Atticoantrotomy (separate) for chr. purulent otitis – from 67,000 rubles.
• Myringoplasty – from 65,000 rubles.
• Tympanoplasty (hearing improvement surgery) - on average 75,000 rubles.
• Shunting of the tympanic cavity for exudative otitis – from 26,000 rubles.
• Removal of exostoses of the external auditory canal – from 65,000 rubles.
• Inspection of the tympanic cavity – from 30,000 rubles.

Otitis is a disease that often requires surgical treatment. It is necessary to strictly monitor compliance with all medical recommendations. This is what ensures the best treatment result.

Author: Nadezhda Mustafaeva, doctor, especially for Moylor.ru

Carrying out the operation

The operation required by chronic purulent otitis media is aimed at removing the source of inflammation and preventing further accumulation of discharge. Leathery pockets inside the middle ear cavity often cause purulent secretions to accumulate in it. Due to the disruption of fluid outflow, a favorable environment is created for the development of pathogenic microorganisms.

An operation performed for otitis in a child is not much different from an operation in an adult, but one can highlight such a nuance as the underdevelopment of the hearing organs, which is associated with the ongoing growth processes of the body.

Chronic purulent otitis media of the middle ear is surgically treated as follows. To drain the pus, the eardrum is cut and then a drainage tube is inserted. After sanitation of the ear cavity, damaged areas of the epithelium are removed.

If the disease has affected the inner ear, more complex manipulations are performed on those parts of the organ that have undergone changes.