What Is a Tympanostomy?

Tympanostomy, operation name. Applicable to exudative otitis media, middle ear effusion, bullous otitis media.

Tympanostomy

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Tympanostomy, operation name. Applicable to exudative otitis media, middle ear effusion, bullous otitis media.

Chinese name

Tympanostomy

Foreign name

myringotomy tympanotomy

Tympanic puncture

Tympanostomy for acute otitis media

Otolaryngology / Middle Ear Surgery / Acute Otitis Media and Chronic Otitis Media Surgery

20.0901

Tympanic puncture is suitable for exudative otitis media, middle ear effusion, bullous otitis media:

1. Acute suppurative otitis media Those with tympanic congestion, edema or papillae.

2. Acute suppurative otitis media with small perforation of the tympanic membrane, poor drainage, ear pain and fever, which are not relieved after treatment.

3. Acute catarrhal otitis media, barotitis media, and secretory otitis media are not effective through tympanic puncture.

1. If you are newly suffering from secretory otitis media, you can perform tympanic puncture first.

2. Jugular spheroid tumor (tympanic type).

3. Severe heart disease or blood disease.

1. Prepare the surgical instruments. The basic instruments are a set of otoscope, tympanostomy knife, cotton roll, and thin suction tube.

2. The external ear canal and tympanic membrane surface are disinfected with 75% ethanol.

Anesthesia: Infants do not need anesthesia. Children over 1 and a half years use general anesthesia. Adults usually use local anesthesia. Wet tympanic anesthesia with cotton or cotton pads. The tympanic anesthesia consists of equal amounts of pure phenol (Carbonic acid), menthol crystal and cocaine The crystals are mixed, and the tympanic membrane is directly anesthetized for 10-15 minutes. After the tympanic membrane becomes white, surgery can be performed. Adults who are nervous may also use general anesthesia.

Position: Adults with local anesthesia can take a seat. Children with general anesthesia are the same as those with ear surgery. When the child does not need anesthesia, straighten the child's upper limbs and close to the sides of the torso, lower limb extension, and wrap the child tightly with a sheet. An assistant fixed the child's head. Another assistant fixed the child's body to perform the operation.

1. Disinfect the skin of the external auditory canal with 75% ethanol. If there is pus in the external auditory canal, it should be completely absorbed.

2. Expose the tympanic membrane to a proper size otoscope so that the tympanic membrane can be seen clearly.

3. Fix the otoscope with the thumb and index finger of one hand, and perform the tympanostomy operation with the other hand.

4. After seeing the tympanic membrane, use a tympanic membrane incision in front of the tympanic membrane, make a curved incision in the lower or posterior part of the tympanic membrane, or make a vertical incision in the posterior and lower part of the ear.

5. After the tympanic membrane is cut, a little blood serum or pus overflows from the incision, and it is removed with a cotton swab or aspirator, and sent for bacterial culture and antibiotic sensitivity tests.

6. Dropping or injecting antibiotics or adrenal corticosteroids, you can use Siegel's otoscope to pressurize the liquid into the middle ear cavity, and plug the external auditory canal with a sterile cotton ball.

1. The eardrum incision knife must be sharp (a sharp knife can cut the eardrum to the point of painlessness) to prevent tearing of the eardrum.

2. If the whole tympanic membrane is involved, the incision should be in the lower part of the tympanic membrane; if the lesion area is in the upper part of the tympanic membrane, the incision should be made in the front and top; Except in special cases, incision of the tympanic membrane in front of, under or behind the tympanic membrane will not damage important structures in the middle ear cavity.

3. The position of the incision should not be too close to the edge of the eardrum to avoid incision of the external ear canal wall.

4. The tympanic incision knife should not penetrate too deep, so as not to damage the inner wall of the middle ear cavity, just cut the tympanic membrane with the tip of the knife. Because the middle ear cavity is very narrow, under normal circumstances, the distance from the eardrum to the eardrum is only 2mm, and the lower tympanum is 4mm, which is narrower when the eardrum is invaded.

5. Pay attention to aseptic operation to avoid causing infection.

6. If the extract is thick, you can inject 1mg chymotrypsin into the tympanum to prevent middle ear adhesion.

7. When puncturing the tympanic bullae, you only need to puncture the bullae and extract the liquid.

1. It is best not to use ear drops during the drainage period, especially sticky ear drops, so as not to affect the drainage. If you need to use ear drops, you can use 5% chloramphenicol propylene glycol or 3% hydrogen peroxide or Talipitol ear drops to help dissolve viscous secretions to facilitate drainage. Prohibit powder during the drainage period to avoid obstructing the drainage.

2. If there is inflammation in the nose, you can also drip astringent anti-inflammatory drugs into the nasal cavity after the tympanic membrane is opened. Antibiotics are used systemically in patients with acute otitis media.

3. Careful observation of local and general conditions, X-ray film of the mastoid, or CT scan of the temporal bone, can understand whether the lesion has developed or subsided. If there is still fever after surgery, tenderness, swelling, mastoid X-rays, or temporal bone CT, and significant bone changes in the mastoid region, mastoid surgery should be considered.

4. Dermatitis of the external ear canal and auricle skin due to pus stimulation can be topically applied with 10% zinc oxide ointment or miconazole cream.

1. The tympanic incision tip penetrates too deeply, which easily hurts the vascular nerve plexus on the surface of the mucosa of the eardrum in the middle ear cavity.

2. The incision in the upper quadrant of the tympanic membrane is likely to damage the ossicular chain, causing anxiety or dislocation of the patellar foot plate.

3. The baby's middle ear cavity bone wall is not fully developed, which may hurt the bottom of the middle ear cavity, or because of the abnormal position of the jugular bulb, the protrusion is too high, and the injury may cause massive bleeding when the tympanic membrane is opened.

4. Facial paralysis is rare, and incision in the upper quadrant behind the eardrum should be absolutely avoided.

5. Severe cochlear vestibular syndrome, if the surgical ear has performed type II or type III tympanoplasty, the sacrum floor or sacrum is directly connected to the tympanic membrane by the elevated bone column. If you do not understand before surgery, the tympanic membrane is cut. When opening, there may be a danger of pushing the sacrum floor into the vestibule by directly applying force on the elevated bone column.