Paracentesis (tympanotomy) of the eardrum

Acute purulent otitis media is accompanied by unbearable, “shooting” pain in the ear, high fever, and a feeling of fullness. This happens because pus accumulates in the middle ear and puts strong pressure on the eardrum. If conservative treatment (drops, antibiotics) does not help, ENT doctors at St. Luke’s Clinic use paracentesis (tympanotomy) of the eardrum.

This is a small but vital microsurgical manipulation during which the doctor makes a microscopic incision in the eardrum to drain the pus. The procedure brings immediate relief and prevents dangerous complications.

The myth of “puncture”: why is paracentesis better than spontaneous rupture?

Many patients and parents of young children are frightened by the word “puncture,” believing that it will permanently damage hearing. In reality, the opposite is true!

If there is too much pus, the eardrum can rupture spontaneously. Spontaneous rupture has ragged, uneven edges that heal very slowly and poorly, forming a coarse scar (this can permanently impair hearing). In contrast, surgical paracentesis is a perfectly even micro-incision (about 1-2 mm) made with a special thin needle or scalpel in a safe area. Such an incision completely and seamlessly heals on its own within a few days, fully preserving hearing.

When does an ENT doctor prescribe paracentesis?

The procedure is an emergency aid and is most often performed for acute purulent otitis media. Indications for immediate paracentesis are:

• Severe, unbearable ear pain that is not relieved by painkillers.
• Bulging (severe protrusion) of the eardrum, which the doctor sees during examination (otoscopy).
• Persistent high fever and worsening general condition (especially in children).
• Lack of effect from antibiotic treatment within 48-72 hours.
• Appearance of signs of complications: dizziness, severe headache, suspicion of facial nerve inflammation, or spread of infection to the meninges.

How is the procedure performed at St. Luke’s Clinic?

We understand that the patient (especially a child) is already exhausted by pain, so we act as delicately and quickly as possible.

1. Anesthesia: The procedure is performed under local anesthesia. The doctor treats the eardrum with special drops or spray that “freeze” sensitivity. For small and restless children, short-term medical sleep may be used.
2. Puncture: Under visual control, the doctor makes a neat micro-incision in the lower quadrant of the eardrum.
3. Cleaning: The pus that was under pressure immediately flows out (or is removed with a special aspirator). The pain disappears almost instantly!
4. If necessary, a pus sample is taken for laboratory analysis (to accurately select the most effective antibiotic).

Recovery after tympanotomy

Immediately after the procedure, the patient’s condition sharply improves: fever drops, and the feeling of fullness disappears. A sterile cotton swab is inserted into the ear, which will need to be changed regularly, as pus may continue to drain for another 1-3 days.

Important rules for the healing period:

• It is strictly forbidden to wet the ear (during bathing, cover it with cotton wool with petroleum jelly).
• Be sure to complete the full course of antibiotic therapy prescribed by the doctor.
• Do not warm the ear.

Do not tolerate acute ear pain and do not risk your hearing! Seek urgent ENT care from the specialists at St. Luke’s Clinic.