Paracentesis (eardrum incision) is one of the most common surgeries in otolaryngology. It is a surgical procedure that involves an incision of the eardrum (the eardrum is a vibrating membrane that captures and transmits sound vibrations in the ear) to relieve pressure and effusion, which is used to restore middle ear ventilation usually in cases of a blocked eustachian tube (Eustachian tube). In addition, a drainage tube (synonyms: tympanostomy tube; tympanic drainage) made of plastic, titanium or gold may be inserted. This procedure may be necessary, for example, in cases of recurrent (recurring) otitis media (middle ear infection).
Indications (areas of application)
- Acute otitis media (inflammation of the middle ear).
- Chronic tympanic membrane retraction (eardrum retraction).
- Gaping Eustachian tube – The junction of the nasopharynx and middle ear is too wide open, allowing air to enter the middle ear
- Mastoiditis – Wart process inflammation; inflammation of the aerated bone cells of the mastoid process (mastoid process).
- Persistent tympanic effusion (synonym: seromucotympanum) – accumulation of fluid in the middle ear (tympanum); > 3 months; depending on the degree of hearing loss even earlier).
- Transtympanal gentamicin treatment – antibiotic treatment for Meniere’s disease (disease of the inner ear characterized by attacks of rotational vertigo, unilateral hearing loss, and ringing in the ears).
- Tube ventilation disorders in Meniere’s disease.
Contraindications
- Bulbous hyperplasia – venous vascular anomaly in the middle ear region.
- Glomus tumor in the middle ear
- Carotid artery anomaly (altered course of the carotid artery).
Before surgery
Before the operation, a detailed medical history is taken and the patient is informed about the risks of the operation. The patient should discontinue anticoagulant medications such as acetylsalicylic acid (ASA) seven to ten days before surgery.
The surgical procedure
The procedure is performed under local or general anesthesia. If local anesthesia is used, the patient is in a sitting position with the upper body leaning back and the head immobilized by an assistant. If the patient is under anesthesia, he is placed in a supine position and the head is placed in a lateral position and fixed. The surgeon gains transmeatal (via the external auditory canal) access to the eardrum. To ensure the best possible view, the largest possible ear funnel is used. The surgeon performs the procedure with the aid of a microscope, which allows a thorough visual inspection. The tympanic incision is made in the anterior inferior quadrant of the tympanic membrane and passes radially from central to peripheral (following the radius from the center outward). Following this, any secretions present in the middle ear are aspirated. To allow longer-term drainage of secretions, a tympanic drainage can be performed using a small drainage tube placed through the tympanic membrane. Alternatively, paracentesis can be performed using laser or monopolar caustic (cutting using electricity).
After surgery
The patient should not drive after the procedure. If a tympanic drain was placed, the patient should not dive for the duration of the tympanic drain, as germs and pathogens may enter the middle ear. Daily washing (including hair washing) can usually be done with caution.
Possible complications
- Acute otorrhea* (leakage of secretions from the external auditory canal; most common complication).
- Slipping of the drainage tube into the tympanic cavity.
- Rejection of the tube
- Permanent perforation of the tympanic membrane
- Otitis media (inflammation of the middle ear)
- Injury to the ossicular chain
* Local therapy with hydrocortisone-bacitracin-colistin ear drops was superior to oral amoxicillin/clavulanic acid preparation (30 mg amoxicillin + 7.5 mg clavulanic acid/kg/day). After two weeks, only 5% of children treated with ear drops versus 44% of children on oral antibiotic therapy suffered from otorrhea. Additional notes
- Chronic otitis media and tympanic effusion showed no significant advantage over a wait-and-see strategy in the longer term. Hearing was also not improved in the long term (after one or two years).
- Weak evidence was shown for the use of tympanostomy tubes in recurrent otitis media (recurrent middle ear infection) to reduce further episodes.
- Choosing Wisely recommendation: do not use tympanostomy tubes in otherwise healthy children with a single episode of tympanic effusion for less than three months.
