Shunting of the tympanic membrane (tympanostomy) is a type of surgical intervention, as a result of which a small incision is made in the soft membrane to insert the shunt. The purpose of this mini-operation is to equalize the pressure between the inner ear and the external auditory canal. Such a direct message is formed for any specific period of time. As a rule, the procedure is widespread in the field of pediatrics.
A little physiology
The functionality of the middle ear lies in the conductivity of sound by transferring wave-like vibrations of air collected by the auricle into the cavity of the inner ear. The middle ear is located in the temporal bone, and air from the nasopharynx penetrates here through the Eustachian tube. The external auditory meatus and the cavity of the inner ear are separated by a thin, translucent membrane, which everyone knows as a tympanic membrane.
During the development of a disease that is accompanied by a runny nose, in some cases, mucus from the nasal passage through the Eustachian tube enters the cavity of the middle ear. This is called otitis media, and in some cases it is impossible to do without shunting of the eardrum. Also, this disease can begin to develop against the background of adenoiditis.
Pathogenic microorganisms that enter the middle ear cavity along with mucus begin to multiply rapidly. As a result, an acute form of otitis media develops. After some time, in such a confined space there is an accumulation of lymphoid tissue - this is purulent otitis media.
In the language of medical workers, pus is called exudate. Excess of this mass leads to severe pain. The lack of proper and timely treatment ends with the puncture of the eardrum in order to remove purulent mass.
Indications for the procedure
As with any other surgical intervention, the procedure for shunting the eardrum also has certain indications for its implementation. At the same time, the presence of purulent masses in the ear cavity, which is not amenable to conservative treatment, acts as a significant reason.
Direct indications for tympanostomy include the following pathological conditions:
- The acute form of otitis media, in which there is no severe pain, and the eardrum itself is not damaged.
- A purulent form of otitis media against a background of perforation, when there is no way to introduce a medicine and remove purulent masses.
- The development of otitis media with the formation of exudate.
- Sensorineural hearing loss.
- The narrowing of the Eustachian tube.
- Barotrauma of the ear.
In addition to this, there are other, no less serious cases:
- Inflammation of the ear occurs frequently, and medication is not effective.
- Decrease in hearing quality due to the constant accumulation of fluid in the middle ear cavity.
- Imbalance.
- Decrease in auditory functionality, provoking a lag in speech development.
- Patency of the Eustachian tube is broken.
In addition, shunting of the eardrum in adults or children is also carried out with the aim of diagnosing diseases that are difficult to detect in any other way. In this case, tympanostomy is the only option to detect pathology in a timely manner.
Contraindications
In general, the tympanostomy procedure has practically no contraindications, and it is safe for humans. Nevertheless, there are some cases when it is better not to carry out such an operation:
- Neoplasm in the middle ear cavity (neurinoma, meningioma).
- An abnormal development of the vascular system - the internal carotid artery passes through the cavity of the middle ear.
- Slowing down blood coagulation.
Also, such a procedure is contraindicated in cases where it is impossible to conduct a visual examination of the eardrum.
Anesthesia
The procedure for bypassing the soft ear membrane is performed using general or local anesthesia. Some patients do not need pain relief.
The use of local anesthesia to bypass the eardrum has its own advantages. And above all, we are talking about the safety of its use. In addition, the patient recovers in a faster time, which allows him to leave the hospital earlier. The costs here are also lower, there is less bleeding, in addition there are opportunities for surgery in an outpatient clinic. Due to all this, local anesthesia is the preferred option if shunting is necessary.
The eardrum can be anesthetized with local anesthetics or infiltration. For children, their use is permissible only with the consent of the parents or guardians.
Infiltration involves the injection of Lidocaine and Prilocaine (or other local anesthetic) into the subcutaneous layer of the distal external auditory canal. The effectiveness of anesthesia is supported by a vasoconstrictor, which ultimately helps to reduce bleeding during the procedure. Only the injection itself is quite painful and, moreover, can provoke bleeding, which makes access to the eardrum difficult.
This once again proves that the use of local anesthesia is more than justified.
Bypass procedure
Among all operations on the ear, the easiest is bypass surgery of the eardrum, and reviews confirm this. To be more precise, the bypass operation belongs to the category of microsurgical procedures, where a special operating microscope is used. This equipment gives a significant increase, which provides the surgeon with full visual access to the ear membrane.
At the initial stage of the operation (myringotomy), an eardrum is cut. This requires several manipulations with respect to the membrane:
- Dissect and detach the epidermis.
- Muscle fibers are cut and spread in layers.
Thus, an oval-shaped opening is gradually formed, which neatly expands according to the dimensions of the introduced ventilation tube. Through it flows pus or fluid from the middle ear cavity.
After making holes of the required size, they begin to install the shunt. It is precisely thanks to him that the pressure is balanced between the outer and inner cavities of the ear due to the constant flow of air.
The operation takes from 20 to 30 minutes in time. The tube itself is in the ear for a short period of time - usually from 2 to 12 months. After this period, the shunt is removed, and the hole in the membrane closes.
Operation for children
As for very young patients, the shunting of the eardrum in children is carried out at the age of one to three years. This is due to the fact that it is this group that is vulnerable to the purulent form of otitis media. In addition, the purely physiological peculiarity of each child affects - children need specialized medical care to normalize the pressure and outflow of excess fluid from the ear.
The use of general anesthesia for children is justified by the fact that it allows you to fix the head of a small patient in a stationary state. And they, as you know, cannot lie down calmly.
Membrane shunting in children is performed in the same way as for adult patients. In this case, in the case of purulent or exudative otitis media, the operation is limited only by cutting the membrane to remove accumulated pus or fluid. However, if it is a chronic form of pathology, then a shunt is already fixed on the eardrum.
If necessary, the doctor instills an antibacterial agent in the ear for the early healing of the mucosa. The use of ear drops also contributes to a speedy recovery. In order to avoid the consequences of shunting the eardrum in children, it is necessary to strictly adhere to the recommendations of the doctor.
Varieties of shunts
Let's consider this moment in more detail. In fact, the shunt is a small tube, which is made of silicone, polyethylene, ceramics and other bio-inert materials. At the same time, surgeons use two types of shunts:
- Smooth tube.
- Shunt with a flange.
A smooth tube is usually placed for a relatively short period of time, and after completing its task, the doctor easily removes it. Modern shunts do without it - they simply fall out on their own as the eardrum is restored after shunting. And the membrane completely overgrows within 6-12 months.
A shunt with a flange is fixed for a longer time due to its special shape. On the eardrum, he can last up to several years. Such a device is installed in cases where the functionality of the Eustachian tube cannot be restored. It is also relevant for sensorineural hearing loss for the administration of medications.
Postoperative period, or Advice of otolaryngologists
It is worth noting that after the operation, the protection of the middle and inner ear is reduced. In this regard, patients are required to consult, during which they will be explained to them the rules of care and behavior with a tube in the ear. And first of all, it is necessary to avoid getting water on the artificial auditory tube. Otherwise, the re-development of a secondary infection cannot be avoided.
But, of course, this is not a reason to abandon water procedures - just in this case, the operated ear must be covered each time with a cotton swab. It is advisable to pre-soak it with oil. In extreme cases, you can use special devices.
As for swimming in ponds or a pool, then at the time of the installation of the shunt, visits to such places should be limited. It is also necessary to observe a number of precautions:
- When sneezing, it is better to open your mouth, the nose should also be open.
- You should also go out with your mouth open, taking extreme care.
These measures will avoid a serious jump in pressure and injury to the ear septum.
The consequences of eardrum bypass surgery
If the bypass procedure is performed under appropriate conditions and by a qualified specialist, then the likelihood of any complications is minimal. However, there may be different situations. In some cases, perforation of the ear membrane can occur, which is largely due to improper technique of the operation.
However, some complications may be due to the fault of the patient himself. That is, ignoring the doctor’s recommendations may result in a relapse due to water entering the cavity of the operated ear.
In addition, frequent tympanostomy provokes the formation of scars on the membrane. Only this complication can be considered almost harmless, since it does not affect the general health of the patient, unless the appearance is impaired.
Conclusion
Shunting of the auricular membrane gives its results: the risk of developing inflammation is significantly reduced, excess fluid in the ear cavity is not formed, hearing and speech function are restored. But this can only be achieved if all the doctor’s prescriptions are followed after shunting of the eardrum. Otherwise, complications cannot be avoided!