Puncture (paracentesis) of the eardrum for otitis media

Paracentesis (puncture of the eardrum) - review

Good day to all!
Today I want to tell you my story of paracentesis (puncture) of the eardrum.

It all started with the fact that, having arrived from the sea, I got sick, well, my nose was sore, my throat hurt, I had a fever, and my mother and I didn’t pay any attention to it. Time passed, I gained weight, and I began to develop an allergy to summer flowers, my nose was stuffy, and I was constantly snot-dropping. Mom bought all kinds of nasal drops, from the cheapest to the most expensive. Alas, none of them helped.

One fine day, my right ear began to get clogged, but I didn’t pay any attention to it at all, because I had never encountered anything like this. Gradually I stopped hearing in my right ear, and consequently in my left...

Mom didn’t believe me, they said, it’s just plugs that you can’t wash out yourself.

And now I began to breathe through my mouth constantly, stopped hearing, and began to get lost in space due to hearing loss.

I insisted on a visit to the ENT specialist, so my mother and I went, we barely got a coupon and went.

The ENT prescribed tablets and drops (by the way, 500 rubles for drops is expensive for my mother and me), and sent me to an audiologist to take pictures of the sinuses and adenoids.

Since there was no opportunity to go to the region to see a specialist, we went to the nearest paid clinic that has this doctor.

We came to the appointment (we paid 1100 rubles for the appointment), the doctor listened to all the complaints, gave me an audiogram and made a verdict: BILATERAL ACUTE HEARING LOSS 3 DEGREE

My mother and I fell a little to the bottom from what we heard, because degree 4 is complete deafness and disability..

The audiologist recommended cutting my ears.

We came to our ENT specialist, gave everything that the audiologist prescribed, all the papers, and she gave a referral to the regional hospital.

The sinuses are in normal condition, the adenoids cover 2/3 of the passage - this is the conclusion of the pictures.

They took the pictures, all the certificates and papers, and began to pack their things for the hospital.

We arrived in Volgograd, found our building and went to the emergency department, we were admitted after 1.5-2 hours.

I lay down in my place in the room and lay there waiting for the doctor.

The doctor came and called me for an examination. When she came to the operating room, she looked at the condition of my ears under a microscope and said that get ready, we will do the operation tomorrow morning.

The next day they took blood from a finger and a vein, and took urine tests.

I sat on my bed and calmly awaited my fate.

A doctor comes in and calls, so I obediently followed her, they went into the operating room, I lay down, put my hands under my T-shirt at the seams.

—————————-

I lie there, holding my pants, and shaking. The doctor treated my ear and told me to be patient.

I took an insulin syringe and injected a dose of ice-caine into my ear, it was the most unpleasant thing, well, I can endure it, I’ll tell you this, it’s better than being pierced with money. I felt dizzy and had the taste of ice caine in my mouth.

The puncture is not felt, but I heard the incision of the eardrum itself.

Then they stuck something like a vacuum cleaner into my ear and sucked out the liquid, I thought that my brains were going to be sucked out, because it was very loud, quite tolerable.

The doctor asks 'how do you hear?'

but the brain still didn’t understand what happened.

They put drops in my ears and began to massage them, while asking me to swallow until the drops reached my nose.

We covered everything with cotton wool and proceeded to the other ear.

Everything was similar there.

It’s all over and then they tell me that they will now rinse my nose.

We washed our nose, pierced our ears, the full set.

I was taken to the room and I lay down, but I couldn’t sleep, everything was very loud, my ears became sensitive, the children were screaming, making up, someone was watching a TV series, and unfortunately my bed was at the entrance, and everyone really liked to shake it.

I started crying because my ears hurt (the painkiller was wearing off), I felt nauseous and couldn’t feel any taste at all.

Soon I was able to sleep. And everything went away, it was as unusual as possible to hear well.

In total, she spent 3 days in the hospital.

Complications after paracentesis

As a rule, paracentesis is successful, without complications. But if all the rules are not followed during or after the operation, the following unpleasant situations may arise:

the pus will not come out completely and the disease will go into a chronic stage;
an infection will be introduced into the ear (this occurs as a result of non-compliance with sterile conditions during the incision or due to improper treatment during the rehabilitation period);
the child will lose hearing or become hard of hearing due to scarring.

Repeated cuts to the membrane may cause it to shrink or lose its elasticity. It is also possible that the incision will not heal as expected, leaving a hole in the eardrum. This threatens permanent infections and even hearing loss.

Fortunately, such complications are rare, so you need to agree if the doctor prescribes a myringotomy to treat otitis. The consequences of spontaneous rupture of the membrane are much worse, because they can form large scars, and purulent inflammation without surgery can cause mastoiditis, meningitis, labyrinthitis and other serious diseases.

Puncture of the eardrum for otitis media: technique and consequences

In medical practice for the treatment of otitis media, the method of paracentesis of the tympanic membrane is used. To carry it out, it is necessary to have certain symptoms that indicate that conservative approaches to treating inflammation have been ineffective. Some doctors try to avoid such intervention, due to some risks. All this should be discussed in more detail.

The essence of the method, indications for behavior

It’s not hard to imagine what paracentesis is. This is a small puncture of the eardrum, which is indicated for otitis media in case of ineffectiveness of traditional measures to treat the disease.

Essentially, this is a surgical intervention. Paracentesis is also called myringotomy or tympanotomy. A small incision is made using a microscalpel or a special needle.

Thanks to the procedure, it is possible to remove accumulated exudate and restore the mobility of the eardrum. Under normal conditions, the membrane restores its integrity on its own. Myringotomy is a safe alternative to natural membrane perforation.

If necessary, this procedure is combined with tympanoplasty, as well as sanitation of the middle ear cavity. The latter is necessary to remove pathogenic microflora and clean out pus from hard-to-reach places. If this is not done, destructive processes may begin in tissues in contact with an unfavorable environment.

Paracentesis can be performed on the eardrum in both adults and children, which minimizes the negative consequences of prolonged otitis media. A prerequisite is the preliminary implementation of all available conservative therapy measures.

Paracentesis is performed for the following indications:

exudative otitis media;
acute otitis media;
the need to administer medications into the middle ear cavity;
carrying out diagnostic measures;
intoxication of the body with otitis media.

The main reason that requires this procedure is the accumulation of fluid behind the eardrum. In this case, there is a decrease in hearing and an increase in purulent exudate, which is an ideal environment for the growth of bacteria. The discharge puts pressure on the membrane, protruding it outward. Discomfort and pain, intoxication and the spread of inflammation, the transition of the disease to a chronic form - all these are the consequences of delay.

Execution technique

The technique of the operation is quite simple. Paracentesis of the eardrum is performed using anesthesia. Three methods are available:

Conductor. An injection is given behind the ear; the substance used freezes the branches of the nerve that is responsible for the sensitivity of the membrane.
Application. Using a cotton swab, the anesthetic is applied directly to the membrane.
General. For young children, general anesthesia is used, as they are often capricious and cannot hold their head still during surgical procedures. In other cases, local anesthesia is sufficient.

Paracentesis is performed with a spear-shaped needle. A small cut is made at the bottom of the membrane. If necessary, a shunt is inserted into the puncture site, which facilitates the drainage of pus, and the wound remains open for some time.

If natural perforation occurs during purulent otitis, a scar subsequently forms at the site of the rupture. If myringotomy is performed correctly, such side effects are excluded.

Rehabilitation, consequences and prognosis

Correctly performed paracentesis has a good prognosis. In this regard, it is used to treat even the smallest children.

During the rehabilitation process after the intervention, the patient must be provided with comfortable conditions in order to prevent unpleasant consequences or re-development of inflammation. Healing of the membrane occurs on average in 2-3 weeks. A small scar may remain on the surface of the membrane, but it does not pose any threat and does not lead to hearing impairment.

You should also take care to maintain good hygiene. Immediately after the operation, a turund is inserted into the ear canal. With purulent otitis media, it is important to regularly change it to a new sterile one, otherwise the infection will begin to spread again. To speed up the process of removing secretions, it is recommended to sleep on the side of the sore ear for some time. This position facilitates the flow of pus and its release to the outside.

Additionally, the doctor prescribes antiseptic drugs intended for treating the wound and the auditory cavity. Their use is strictly under the supervision of an otolaryngologist.

If paracentesis was performed incorrectly or the rules of the rehabilitation period were violated, the consequences can be very dire. Fortunately, such situations are extremely rare.

Let's look at how incorrect paracentesis can be dangerous:

Partial outflow of pus, while residual discharge provokes a sluggish course of the disease and increases the risk of developing a chronic form of inflammation and other complications.
Infection in the wound, which is possible both when using non-sterile materials during surgery, and when violating the rules of further care.
Hearing loss due to disruption of the auditory ossicles or the formation of large scars.

If the expected result is not achieved, a second puncture, shunting or rinsing of the auditory cavity may be performed. Methods of blowing and heating with a UHF lamp are also used.

In general, the forecast for children and adults remains quite optimistic. If you follow the recommendations of your doctor, recovery will not take long. Still, in any case, it is better to avoid a situation in otitis media where the pus has to be removed surgically.

To speed up the healing process, it is recommended to use antiseptic drugs. In particular, boron powder is sprayed inside to dry the ear cavity. Hydrocortisone is used to prevent scarring. Thanks to this substance, the scar on the eardrum will be almost invisible and will not affect hearing acuity.

There is no need to be afraid of a puncture, especially if in your situation this is the only way to quickly solve the problem of inflammation with excessive accumulation of exudate behind the eardrum. The work of a competent specialist and compliance with recommendations for further treatment ensure complete restoration of the normal condition of the ears.

Preparing for a puncture and contraindications

A puncture is indicated only in severe cases of ear disease, when conservative therapy has not been successful. Protracted otitis media is considered if symptoms return within several months to a year after a full course or two of antibiotic treatment.

The otolaryngologist prescribes this study after a thorough examination of the medical history and taking into account all risks. The doctor determines:

condition of the eardrum;
sensitivity of the membrane to sound vibrations;
if there is a suspicion of complications, send for tomography;
clarifies the presence (absence) of individual drug intolerance.

The puncture is carried out when the main inflammatory process has already been stopped. They refuse to carry out the manipulation if there are scars on the eardrum or you have recently had ear surgery. The intervention is also not performed on children under six months old.

Purulent otitis in a child, is a puncture necessary?

Sent by Zoloto. 30 September 12

We've been going to the ENT for 3 days now, 1st day it was just acute otitis media, the next day it started to become purulent, my hearing began to get worse, they suggested waiting 1 day to donate blood and if the pus doesn't start to resolve, I'll do a puncture, I don't want to puncture the child, I hope it resolves, they started They give AB injections, the next day she stopped complaining about her ear, the temperature dropped and has not risen for the 2nd day, but there is still pus. The ESR is of course high 30, I think I’ll wait another day, the general condition is normal, she eats, plays, but still hears poorly. whose children were so sick, what were the consequences and what did the doctors tell you?

Marisha1709 September 30 - 15:51

I recently visited my goddaughter, they spent 2 weeks in the hospital, they were persistently treated, they gave injections, there were no punctures, as far as I know, the pus was pumped out. If necessary, I will clarify tomorrow. Now pah-pah-pah, everything is fine.

=Northern Lights= September 30 - 15:56

For me personally, the pus broke out on its own, and that’s worse. perforation in the eardrum. a ban on diving for life and the ear hears worse. Only plastic surgery if you do it, but I’ve been walking like this all my life. Can the excess pus still be pumped out? It’s right there, in the middle ear, where the meninges are located—that’s what’s dangerous.

If the pus was pumped out, then it means there was a puncture; otherwise, how to pump it out?

Svet 2 (September 30 - 15:56) wrote:

We already had one purulent one with perforation, it did not affect the hearing in any way and healed well.

Marisha1709 September 30 - 16:36

Zoloto (September 30 - 16:22) wrote:

If the pus was pumped out, then it means there was a puncture; otherwise, how to pump it out?

I know that she had a breakthrough, before that there was generally zero emotion. she was capricious, but they blamed it on her teeth, it was the height of it, and when it was discovered, an ambulance was called immediately. It seems to me that you shouldn’t joke with otitis media and it’s best to go to the hospital and have the necessary procedures done. For the first week, ours were kept inseparably in the clinic, and then they were sent home at night, which turned out to be a day hospital.

Kzena September 30 – 18:00

As a child, I had purulent otitis and the pus broke out on its own. But I still suffer with my ears. My hearing has decreased and there is a constant buzzing in my ears. They often hurt. I think a puncture is better#33;

Julichka. September 30 — 18:29

When I was 14, I had 2-sided purulent otitis, I refused to pierce it. I was cured without any consequences.

It’s better to trust the doctor, it won’t get worse. nevertheless, if the doctor uses the opportunity without a puncture, I suffered from purulent otitis media at the age of 18. Triderm helped me without a puncture; it came with some kind of antibiotic and the doctor prescribed it for me and immediately all the pus went away and my ear returned to normal.

Chi♡Li September 30 – 20:19

we injected strong antibiotics, there were droppers, Otipax ear drops, the inflammation went away, the membrane was not pierced

Sunny September 30 - 20:22

We had a one-sided purulent one, it broke out on its own as soon as the temperature subsided, but before that I didn’t complain about my ears, everything looked like an acute respiratory infection. Run to the doctor. There the ear was washed, examined, an antibiotic was prescribed and drops were given in the ear. But they said that the ear doesn’t look that scary. Well, after a couple of days the pus stopped, everything dried up, after a week everything healed and was normal. There were no prohibitions on swimming or diving. But we postponed the trip to the sea for a month just in case. And we dived into the sea - everything was ok.

Thanks for the info, I’m not so afraid of the puncture, how much they suggest doing it under anesthesia, but why would a small child need anesthesia and go to the hospital for 10 days? I myself, at 28 weeks, don’t want to collect purulent snot at all

Nastya has twice the happiness of a mother❦ September 30 - 22:10

Marisha1709 (September 30 - 15:51) wrote:

How did they pump out the pus without a puncture? The puncture is made with a small scalpel - simply cut 1mm of the membrane and wash out the pus. the cut is quickly tightened. The pus must be removed and not left, there is a risk of infection going further, but the brain is close. plus if the pus is left, there is a risk that there will be repeated purulent otitis media. but this can already lead to hearing loss. We had a puncture when we were 8 months old, my daughter didn’t even cry. but they said that the pus had been there for a long time and had not resolved anywhere. and my daughter gave no indication that her ear was hurting or anything else. I ended up in the hospital with an allergy, where an ENT specialist looked at me and made a puncture.

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Perforated otitis: stages of occurrence

Membrane puncture
Membrane with otitis media
Perforation of membrane

Acute purulent otitis media (perforated otitis) is an inflammatory process that occurs in the mucous membrane of the tympanic cavity. A distinctive sign of the disease is the presence of purulent fluid in the middle ear. It is very common in children under three years of age.

In babies, the middle ear cavity can be easily infected by the penetration of microorganisms from the nasopharynx through the Eustachian tube.

The incidence of such inflammatory diseases (eg, sinusitis) peaks in early childhood before the immune system matures. However, this does not mean that adolescents and adults are free from the risk of purulent otitis media.

There are three stages of suppurative otitis media:

Preperforative. It is characterized by the development of inflammation of the middle ear cavity and the accumulation of fluid with its subsequent transformation into pus. Upon examination, a reddened (hyperemic) eardrum is visible.
Perforated. With perforated otitis media, the eardrum ruptures and accumulated pus begins to pour out of the ear. In this case, the patient usually notices a decrease in pain and feels better. Purulent discharge from the ear is initially profuse, sometimes containing blood. During a medical examination, the doctor may observe pus visible through the perforation and pulsating “in time” with the pulse.
Reparative. Healing and scarring of damaged tissue occurs.

Puncture of the eardrum with otitis media: signs and symptoms

What is a perforated eardrum?
A tear in the membrane (the thin membrane that separates the external auditory canal from the middle ear) is called a perforation (puncture) of the eardrum. A puncture of the eardrum during otitis media is often accompanied by decreased hearing and sometimes leakage of fluid (pus). Perforation caused by injury or infection is usually accompanied by pain in the eardrum that burst. Symptoms and signs of a ruptured eardrum may include:

painful (sometimes unbearable) sensations in the ears;
discharge of purulent fluid (possibly with blood) from the ear;
partial or complete hearing loss;
ringing in the ear(s);
feeling of dizziness and associated nausea or vomiting.

You can see what a ruptured eardrum looks like in the photo above.

Contact an otolaryngologist, an ENT specialist, if any of the above-described signs or symptoms of a puncture of the eardrum due to otitis occur. The middle and inner ear are very sensitive to damage or infection. Quick and correct treatment will help preserve your hearing.

If you think you have a punctured eardrum, do not get your ears wet to avoid infection.

Don't swim.
To protect your ear, use a shower cap or place a cotton ball covered in Vaseline in your outer ear when showering or bathing.
When the eardrum is punctured, some drops, as well as folk remedies (for example, aloe for otitis) can only cause harm and increase pain.

Eardrum with otitis media: diagnosis and effect on hearing

Diagnosis of eardrum damage is carried out by examining the ear using an otoscope.

Visually, the perforation looks like a triangle-shaped gap with torn edges.
Perforation most often occurs in the lower quadrant of the eardrum.

Typically, the size of the perforation determines the level of hearing loss—a larger hole causes more hearing loss than a small hole.

If the eardrum during otitis media has been damaged as a result of severe trauma (for example, a fracture of the skull) and this is accompanied by disruption of the inner ear, then hearing loss can be serious, including deafness.
The result of chronic infection due to damage to the eardrum due to otitis media can be long-term deterioration or loss of hearing.

Perforation of the eardrum due to otitis media - stages of treatment

Important!

A hearing test should be performed before any perforation repair is performed.

The benefits of closing a perforated eardrum for otitis media include:

preventing water from entering the middle ear during water procedures, which can worsen the patient’s condition;
improved hearing;
reduction of tinnitus;
preventing the occurrence of skin cysts in the middle ear, which can lead to the development of a protracted infection and damage to the structure of the ear.

If the perforation is very small, an otolaryngologist (ear, nose, throat, and throat doctor) may choose to monitor it over time to see if the damage heals on its own. The doctor may also try to “patch” the patient’s eardrum in the hospital and prescribe ear drops containing pain-relieving ingredients. Do not use ear drops for otitis media that are not prescribed by your doctor.

To ensure that the injury heals faster and does not become infected, it is covered with tissue paper.
If your doctor feels that tissue paper will not provide quick or adequate closure of the hole in the eardrum, or if this method does not work, surgery may be necessary. It is usually quite successful in treating eardrum perforation due to otitis media.

Typically, hearing improves after the eardrum heals.

gajmorit.com

Paracentesis of the tympanic membrane - rational treatment of advanced otitis media in children

Paracentesis (tympanotomy, myringotomy) is a type of surgical work, the meaning of which is to perforate the eardrum. The main goal of the operation is to improve the outflow of purulent contents accumulated in the ear. The main indication for its implementation is acute otitis media of the middle ear. Doctors resort to surgery in children when antibiotic treatment has been unsuccessful.

Symptoms that require immediate surgical intervention are:

effusion of the eardrum;
damage to the facial nerve;
inner ear irritation;
constant nausea;
throbbing ear pain;
persistent pain and suppuration;
stable body temperature, rising to 37.5 – 38°C.

The doctor may also suggest making a puncture for otitis media if there is a suspicion of meningitis, brain damage and mechanical damage to the organ.

Features of tympanotomy

To improve the outflow of pus from the ear in children, paracentesis is performed on the 3rd – 4th day of illness. The procedure is suggested for severe shooting pains and high body temperature. Protrusion of the membrane is also a reason for immediate intervention.

To ensure paracentesis of the eardrum is painless for a small patient, the otolaryngologist uses one of the types of anesthesia:

conduction, in which a substance is injected behind the ear through a puncture that “freezes” the sensory nerves;
application, which involves external treatment of the membrane with an anesthetic;
ether anesthesia for a restless child who requires paracentesis.

The manipulation is performed using a special needle with a spear-shaped blade. For the incision site, the doctor selects the anterior inferior or posterior inferior quadrant of the membrane. The length of the incision is several millimeters.

The puncture is made so that the instrument immediately passes through the entire thickness of the eardrum. An incision is needed to allow the purulent-bloody fluid to drain out. When performing an operation, the doctor must remember about the possibility of the membrane thickening tens of times, which is caused by inflammation of the mucous tissue of the middle section of the ear. In this case, paracentesis may be incomplete. However, there is no need to rush the needle into the cavity, since the puncture itself accelerates the perforation of the membrane and provides the necessary effect.

After the puncture is made, the external auditory canal is filled with dry sterile turunda, which is secured with cotton wool. In the postoperative period, to quickly improve the condition of children, they clean the ear canal several times a day (take Furacilin or boric alcohol).

In order to prevent scarring, paracentesis of the eardrum is supplemented by catheterization of the internal tube with the introduction of hydrocortisone and an antibacterial drug into the cavity. Bandaging is used to absorb pus. The manipulation looks like this:

dry turunda is placed on the puncture;
the tip is released in the scaphoid cavity;
the ear is “sealed” with a dry cotton-gauze bandage (to be changed 3 times a day).

Next, the child is placed with the affected ear on a pillow. This position promotes better release of pus from the tympanic cavity.

A separate area of otiatric therapy is the improvement of the nasopharynx and auditory tube. The treatment regimen includes installations, irrigation with antiseptics and vasoconstrictor aerosols. Medicines are administered carefully, avoiding accidental injury to the eardrum. Careless actions are dangerous by creating increased pressure and spreading the infection beyond the middle ear.

Paracentesis: possible complications in children

An unsuccessful puncture can cause a chain of adverse consequences. For example, incomplete drainage of pus will cause infection of the organ. A more serious complication will be hearing loss. The pus remaining in the tympanic membrane is removed through physical therapy and suction.

A persistent infectious process is eliminated with broad-spectrum antibiotics. For a child prone to repeated inflammation, schemes to strengthen the immune system are being developed.

Our specialist comments

Remember that acute otitis media is dangerous due to a sharp decrease in hearing. If the doctor suggests paracentesis to treat your baby, do not refuse the operation.
Correctly performed paracentesis promotes the flow of exudate and restores the mobility of the tympanic membrane. To prevent the hole from closing quickly, a tube is inserted into the puncture.
Watch how your baby blows his nose. Simultaneous sniffing with both nostrils leads to stagnation of infected mucus. A puncture will help remove it.

Rehabilitation

After a puncture of the eardrum in a child or adult, postoperative care is required. A sterile gauze pad is inserted into the ear to absorb pathological secretions; it needs to be changed every 2-3 hours; the hearing aid itself with the tampon is covered with a bandage. For the first few days, the ear must be treated with a solution of Furacilin or another antiseptic drug.

The patient must be prescribed broad-spectrum antibiotics or for specific pathogens that cause otitis media and other pathologies. The patient may need anti-inflammatory and painkillers for the first few days. During the first week, the puncture will heal completely, then for another 7-10 days you should protect your ear from cold and drafts, and do not use headphones.

Remember that you should not use any folk recipes; drops and herbal tinctures, which are recommended to be instilled into the ears, can be especially dangerous. Necessary medications and physical therapy are prescribed only by a doctor.