Paracentesis - Eardrum Incision
Incision of the tympanic membrane with the purpose to drain suppurative or nonsuppurative effusion of the middle ear or to provide aeration in case of malfunctioning eustachian tube is defined as "Myringotomy". If small ventilation tube (grommet and other tubes) is inserted in the tympanic membrane this surgical procedure defined as "Tympanostomy". In other words, Paracentesis is defined as tympanic memrane incision.
Myringotomy (Tympanostomy) Indications
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| Myringotomy (Tympanostomy) Indications - Ear Tube Insertion |
General indications for Myringotomy / Tympanostomy) are as follows:
- Chronic serous otitis media- Eustachian tube dysfunction or malfunction
- Atelectatic ear.
- Acute suppurative otitis media with severe earache with bulging tympanic membrane.
- Acute suppurative otitis media incomplete resolution with persistent conductive deafness.
- Complications of acute otitis media, e.g. facial paralysis, labyrinthitis or meningitis with bulging tympanic membrane.
Myringotomy (Tympanostomy) Contrandications
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| Myringotomy (Tympanostomy) Contrandications |
Suspected intratympanic glomus tumour. Myringotomy in these cases can cause profuse bleeding.
Myringotomy (Tympanostomy) Technique
Steps of Myringotomy Operation:
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| Ear Tube Insertion |
- Ear canal is cleaned of wax and debris.
- Operation is ideally performed under operating microscope using a sharp myringotome and a good suction apparatus.
- In acute suppurative otitis media, a circumferential incision is made in the posteroinferior quadrant of tympanic membrane, midway between hundle uf malleus and tympanic annulus, avoiding injury to incudostapedial joint.
- In serous otitis media, a small radial incision is given in the posteroinferior or anteroinferior quadrant and all the effusion sucked out. When ventilation tube is to be inserted, incision should be just enough to admit the tube.
Myringotomy (Tympanostomy) Risks & Complications
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| Myringotomy (Tympanostomy) Risks & Complications |
Possible complications & risks of myringotomy include:
- Anaesthetic complications- Injury to the incudo-stapedial joint
- Damage to the facial nerve
- Injury to jugular bulb with profuse bleeding, if jugular bulb is high and floor of the middle ear dehiscent.
- Perforation of the tympanic membrane
- Middle ear infection
Myringotomy (Tympanostomy) Cost
When the transaction is done in office conditions, the average transaction fee is around 500 US Dollars; When the procedure is done in the hospital, the average processing fee can go up to 1500 US Dollars. This procedure can also be performed under sedation or local anesthesia and it is convenient to be discharged on the same day.
Postoperative Patient Care For Myringotomy (Tympanostomy)
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| Postoperative Patient Care For Myringotomy (Tympanostomy) |
For myringotomy operation, only one week prevention of water contact to the ear is sufficient for care. Eardrum incisions usually heal rapidly. No water should be permitted to enter the ear canal for at least one week.
If a grommet has been inserted (tympanostomy operation performed), entry of water is prevented so long as ventilation tube is in position.
Related Videos
T-Tube Removal from the Eardrum
Ear Ventilation Tube Removal
After myringotomy (tympanostomy), the eardrum usually heals by itself within two weeks!
After the myringotomy, the eardrum usually heals within two weeks if there is no water contact with the ear. Rarely, the hole may remain for up to two months. In case of leakage of water in the ear, since the artificial perforation created in the eardrum will act as a way for water to escape into the middle ear, it may cause the middle ear inflammation and the living epithelial cells on the edges of the perforation to die and the perforation to become permanent. Until your doctor informs you about water contact, the external ear canal should be closed with protective plugs or cotton wool after myrigotomy, during bathing and when walking in rainy weather.
Myringotomy can be done under local anesthesia!
This process, which can be completed with a few seconds of pain in adults and patients who concentrate on not moving their heads, can be performed under local anesthesia. Local anesthetic cotton can be placed in the outer ear canal and the eardrum. Lidocaine can be injected into the postero-superior area of the outer ear canal to prevent patients from feeling pain, and after 5 minutes, the paracentesis knife can be performed by the antero-inferior or postero-inferior dial of the eardrum.
Swimming after myringotomy
It is appropriate to wait for the eardrum to heal after the myringotomy and then to start water sports such as swimming and diving. Although the incision area on the eardrum heals, usually within a few weeks; It is appropriate to wait a little longer for diving and swimming. For example, it is appropriate to wait for at least one month, or even after the second month and to start diving after your doctor examines the eardrum. If water is leaked into the external ear canal before the hole in the eardrum is closed, infection may occur in the middle ear and eardrum. For this reason, the hole may become permanent or even enlarge, and eardrum surgery may be required for treatment.
Exercise after myringotomy
Dizziness may occur for a few days after the myringotomy. There may be earache for a few days. If you do not have any complaints, there is no harm in walking or jogging. However, it is appropriate to start exercises such as lifting dumbbells by bending down, which may cause pressure straining, after 1 month and after your doctor says it is appropriate. A newly healed eardrum hole can be reopened during pressure straining (when the Valsalva maneuver is more vigorous), preventing the hole in the eardrum from closing. During the exercise, sweat should not get into your ear where the myringotomy procedure was performed. It is ideal to use barrier ear cushions to the outer ear canal during sweating.
Do not move your head during Myringotomy under local anesthesia!
The myringotomy procedure is quite simple and consists of creating an artificial hole by making a few mm long incision in the eardrum. When the procedure is performed under local anesthesia, if there are sudden head movements while the patients feel pain, the paracentesis blade, which is slightly wider than the needle in your doctor's hand, may sink into the middle ear and deeper, causing unnecessary destruction of the middle ear ossicles and even damage to the inner ear. Informing patients about head movement is important to prevent unnecessary complications.
If your ear pain is getting worse and your hearing is decreasing after myringotomy, inform your doctor!
Pain may be felt for a few days after the myringotomy procedure and usually the pain gradually subsides and disappears. On the contrary, if the ear pain gradually increases, hearing loss occurs and gradually increases, if inflammatory discharge from the ear begins, this may indicate that an infection has started in the eardrum and it may be useful to consult your doctor and be examined. When water is accidentally leaked into the ear after the procedure, these symptoms usually occur and an eardrum infection may begin.
Does hearing decrease after myringotomy?
When the myringotomy procedure is performed in the case of middle ear fluid or retraction in the eardrum, as written in the above indications, there may be an increase in hearing in a very short time after the middle ear ventilation will return to normal after the procedure. In addition, since the hole in the eardrum is usually opened a few mm, the vibration surface of the eardrum does not decrease much and hearing loss due to the hole is not expected. If the hole opened during the myringotomy is widened too much, a decrease in hearing may occur.
Headphone use after myringotomy
Although it is not inconvenient to use headphones after the myringotomy procedure; It may be useful to be careful on the first day when a small amount of blood may come from the ear. In addition, if earpods that completely cover the outer ear canal are used for a long time, moisture may accumulate in the outer ear canal and the natural cleaning of earwax may be adversely affected. After using the earpode, it may be beneficial to dry the external ear canal by turning on the hair dryer at a low setting.
What can be done if water accidentally gets into the ear after myringotomy?
Immediately after the myringotomy procedure, bath water, rain, sweat may sometimes accidentally enter the external ear canal. In this case, it is appropriate to dry the external auditory canal immediately (use a hair dryer instead of cotton buds and napkins!), and to drip antibiotic ear or eye drops into the external auditory canal. You can learn drug names by consulting your own doctor. If, as written above, earache, decreased hearing and ear discharge occur after the water escapes, you should definitely consult your otolaryngologist who performed the myringotomy.
What is the most useful method for protecting the ear from water contact after myringotomy?
The following methods can be used to protect the ear from water contact after the myringotomy procedure:
- placing ready-made plugs in the external ear canal
- placing cotton balls impregnated with Vaseline in the external ear canal (it will be sufficient to place them at the entrance)
- use of tight caps while swimming
- use of off-the-shelf swim plugs
Link group where you can find detailed information about myringotomy on this website >> https://www.ent-istanbul.com/search?q=myringotomy
Source links:
Myringotomy and Tympanostomy Tubes - American Academy
Clinical Indicators Myringotomy and Tympanostomy Tubes
Myringotomy/Tympanotomy - Intermountain Healthcare
Ear Tubes Procedure/Surgery Risks, and After Care - MedicineNet
Myringotomy - eMedicine World Medical Library - Medscape
Myringotomy - Yahoo Health
Myringotomy with and without tympanostomy tubes for chronic otitis ...
Bilateral Myringotomy and Tympanostomy
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Source links:
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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