Eardrum Incision - Paracentesis

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Eardrum Incision - Paracentesis
Eardrum Incision - Paracentesis
Video: Eardrum Incision - Paracentesis
Video: Therapeutic Myringotomy & Suction Clearance of Middle Ear Fluid In Acute Otitis Media 2023, February
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Eardrum incision (paracentesis)

Behind the eardrum is the so-called tympanic cavity. It is part of the middle ear and is usually filled with air. Under certain circumstances, the ventilation of the tympanic cavity may be impaired and fluid may accumulate (tympanic effusion). Then a paracentesis can help: A small incision in the eardrum ensures that ventilation is restored and the middle ear is relieved.

Paracentesis is one of the most common ENT interventions. Sometimes a ventilation tube is also inserted into the eardrum; it ensures that the opening to the middle ear remains long-term. The risk of complications for both measures is low.

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  • Middle ear: anatomy and function
  • When is an eardrum incision performed?
  • How is paracentesis performed?
  • What must be considered after the operation?
  • What complications can arise?
  • Whom can I ask?
  • How are the costs going to be covered?

Middle ear: anatomy and function

Anatomically, the middle ear is divided into three parts: the eardrum, the tympanic cavity and the Eustachian tube (tuba auditiva, ear trumpet).

The eardrum is a wafer-thin membrane made of tight connective tissue. It separates the external auditory canal from the tympanic cavity. It thus fulfills an important protective function: it prevents pathogens and foreign substances from entering the middle ear from outside. The eardrum also plays a key role in hearing. In interaction with the ossicular chain (hammer - anvil - stirrup) it transmits the sound waves coming from outside to the middle and finally to the inner ear.

So that the eardrum can vibrate optimally, the air pressure in front of and behind the eardrum must be the same. This is ensured by the Eustachian tube: this approximately three to five centimeter long passage connects the air-filled part of the middle ear - the tympanic cavity - with the nasopharynx. In this way the tympanic cavity is ventilated, and pressure equalization with the ambient air (as known from flying or diving, for example) can take place.

When the Eustachian tube is misplaced, ventilation problems in the middle ear occur. As a result, a negative pressure forms in the tympanic cavity, which irritates the mucous membranes and leads to inflammatory reactions and secretion formation. The secretion cannot drain through the misplaced Eustachian tube and accumulates - one speaks of a tympanic effusion or serotympanum or seromucotympanum. The eardrum bulges outward due to the effusion and in the worst case can even tear (perforate).

When is an eardrum incision performed?

Paracentesis is a small surgical procedure that can help with ventilation problems in the middle ear or with a tympanic effusion. The eardrum is opened with a small incision and the ventilation of the middle ear is restored. In addition, the secretion can be sucked out of the tympanic cavity through the incision. Sometimes a so-called ear drum is inserted into the eardrum during the procedure, for example if the secretion is particularly viscous and difficult to drain off, or if there has already been a retraction in the area of ​​the eardrum. The procedure is often combined with removal of the pharynx (adenotomy).

Paracentesis is performed for the following ailments / diseases:

  • Existing tympanic effusion for more than twelve weeks.
  • Acute otitis media: an inflammatory secretion forms in the tympanic cavity, which obstructs the Eustachian tube and can cause an effusion. Those affected have severe earache and hearing is impaired. If the tympanic effusion cannot be improved with other therapeutic measures (e.g. decongestant nasal drops, expectorant drugs, antibiotics), paracentesis is performed. You can read more about otitis media here.
  • Hearing loss caused by recurrent middle ear infections.
  • Enlarged tonsils (adenoids): The tonsils are located on the back of the palate near the mouth of the Eustachian tube. An overgrowth of the pharynx can block this mouth. As a result, the tympanic cavity is no longer ventilated, negative pressure is created, fluid collects, and tympanic effusion is the result. More about it here.
  • Mastoiditis: The mastoid process of the temporal bone, ie the bone behind the ear, becomes inflamed. Mastoiditis occurs as a result of a bacterial otitis media; the bacteria spread in the cavities of the mastoid process and lead to inflammatory reactions and accumulations of pus there. In addition to antibiotic therapy, paracentesis is performed to relieve the strain.
  • Labyrinthitis: A purulent inner ear infection can also be the result of an otitis media. Those affected suffer from earache, fever, severe dizziness, nausea and vomiting, and hearing loss. A tympanic effusion is also often present; this can be relieved with a paracentesis.
  • Polyps or tumors in the nose or paranasal sinuses that block the Eustachian tube and cause an effervescence. You can find more about nasal polyols here.
  • Menière's disease: In this disease of the inner ear, those affected suffer from dizziness, hearing loss and tinnitus or ringing in the ears. The causes of Menière's disease are not fully understood, but there is increased pressure in the inner ear and pressure regulation in the middle ear is also impaired. In addition to other therapies, paracentesis can help relieve the symptoms.
  • Cleft lip and palate: This congenital malformation leads to functional restrictions of the Eustachian tube. For anatomical reasons, it cannot open in the required way, which leads to ventilation disorders in the middle ear. The affected children very often suffer from otitis media with tympanic effusion and usually need paracentesis with the insertion of a tympanic tube. You can read more about cleft lip and palate here.
  • Gaping Eustachian Tube (Open Eustachian Tube): Usually the Eustachian tube is closed and only opens when swallowing or yawning to ensure pressure equalization. In certain cases, e.g. after severe weight loss, after radiation therapy or due to hormonal factors, a functional disorder can occur and the Eustachian tube remains open permanently. The consequences are, among other things, a dull feeling of pressure in the ear and distorted hearing, ie one's own voice, breathing, swallowing and chewing are perceived as very loud, while the surroundings are very quiet. In addition to other treatment measures, a paracentesis and a ventilation tube can regulate the pressure and reduce the symptoms.

How is paracentesis performed?

In children, paracentesis is performed under general anesthesia; in adults, it is also possible under local anesthesia.

The doctor guides the necessary instruments through the external auditory canal to the eardrum and makes a small incision in the anterior lower quadrant of the eardrum under a microscope. Either a scalpel is used for this, or the cut is made using a laser or electric current (electrocautery). The cut is between one and three millimeters long. The secretion is then sucked off with a special suction device.

The procedure only takes a few minutes. The cut in the eardrum closes by itself after about two weeks.

Ear tubes (tympanic drainage)

If the secretion is very thick and cannot be suctioned off, or if the ear effusion keeps coming back, a so-called ear tube is inserted into the eardrum. It ensures that the incision in the eardrum remains open for a longer period of time, that the secretion can drain off completely and that the middle ear is ventilated. The term drum drainage is also often used.

There are ventilation tubes in different materials (eg silicone, gold, titanium, Teflon) and shapes (eg in T-shape). They are between two and three millimeters in size and about 1–1.5 millimeters in diameter.

The fit of the tube is checked at regular intervals after the operation. It remains in the eardrum for between three and twelve months. After that, in most cases it will fall out of your ear by itself. If this is not the case, it is removed again in a minor surgical procedure.

What must be considered after the operation?

After the operation, the secretion can flow out of the middle ear. A discharge of secretion from the ear (otorrhea) is therefore normal. However, if it suddenly increases or a foul odor is noticed, this may be a sign of acute bacterial inflammation in the middle ear. Ear drops that contain antibiotics are often used.

Through the hole in the eardrum or the tympanic tube, there is a general risk that water or germs will get into the middle ear and cause an infection there. However, the recommendations for keeping your ears dry vary widely. Some doctors allow patients with a ventilation tube to bathe, wash their hair or go swimming without ear protection, while others recommend keeping their ears dry at all times to avoid infections.

A few splashes of water, such as those that come into contact with the ear when swimming or bathing, do not seem to be a problem, because in these cases the water hardly gets deep enough into the ear to penetrate the middle ear. Washing hair doesn't seem to be a risk either, as long as you make sure that not too large amounts of (soapy) water get into the ear canal. However, diving should be avoided, because even at shallow water the pressure can be so high that water is pressed into the tympanic cavity. In addition, bathing water in lakes or swimming pools often contains germs that can pose an additional risk of infection.

Closing the ear canal with cotton wool or similar materials seems to be unsuitable in any case; On the one hand, these measures do not seal completely anyway; on the other hand, they can cause injuries or contamination of the ear canal. The most effective way to seal and protect the ear canal is to use individually fitted earplugs (swimming earmolds); they are available from hearing aid technicians, for example. It is unclear whether their use in patients with ventilation tubes is really justified. The current recommendations tend to be against the routine use of precautionary measures in the water. The clinical benefit seems to be disproportionate to the effort involved.

What complications can arise?

Paracentesis with the insertion of a ventilation tube is one of the most frequently performed operations in ENT medicine; the risk of complications is low. Possible are:

  • light bleeding immediately after the procedure, pain is very rare;
  • Injury or change in position of the ossicular chain during the operation; this can lead to impaired hearing;
  • permanent opening of the eardrum, i.e. the incision does not close by itself after the procedure. The defect can be remedied with a so-called tympanoplasty;
  • Otitis media due to infection;
  • a clogging of the tympanic tube (eg by secretion);
  • slipping of the tube into the tympanic cavity;
  • a rejection of the tube (e.g. due to heavy secretion).

Whom can I ask?

Paracentesis is carried out by a specialist in ENT medicine. It is one of the most common surgical procedures in the ENT area.

How are the costs going to be covered?

As a rule, the costs of the treatment are covered by the responsible health insurance company.

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