Information Leaflet: Piercing of ear drum (paracentesis) and insertion of tympanostomy tubes (grommets)
Dear patient, dear parents,
Due to our diagnosis we recommended parancentesis and/or the insertion of a grommet. Any sounds we hear meet the ear drum at the end of the ear canal and make it vibrate. Behind the ear drum there is the so-called tympanic cavity (=middle ear) with its ossicular chain. For a free vibration of the ear drum, good ventilation of the middle ear is required. In general, air gets from the nasopharynx via the Eustachian tube to the tympanic cavity. Any deficiency in the oxygen supply (mostly a result of enlarged polyps of the nasopharynx) quickly leads to the accumulation of fluids in the middle ear. Fluid behind the ear drum prevents the ear drum's vibrations and dampens the sound all of which lead to hearing loss.
In children this can lead in only a few months to delay in the development of speech.
In addition, fluids in the middle ear make patients vulnerable to painful inflammations of the middle ear.
If the fluids persist for a longer period they may even lead to a permanent hearing disorder.
How is this surgery performed?
The purpose of this operation is to correct the deficient oxygen supply in the middle ear via an incision into the ear drum so as to create an artificial ventilation possibility. This incision is made under an operating microscope through the ear canal by means of a very fine knife. This 3-4 mm gap is used to draw fluid from the middle ear. As a rule, this incision will be healing within a few days. For a satisfactory recovery this period is sometimes too short so that new fluids can build up. In order to delay the healing of the ear drum incision, small tubes are inserted into the gap in some cases. These tubes generally maintain the oxygen supply for several months open until they are finally discharged by the body into the ear canal. The insertion of tympanostomy tubes is particularly necessary if a previously executed piercing of the ear drum and removal of polyps have not shown any success.
What are the risks involved as a result of this surgery?
In very rare cases an inflammation of the middle ear occurs and has to be treated by means of antibiotic agents. Of course, this risk increases after the insertion of tympanostomy tubes, particularly if the patient does not respect the bathing prohibition until the tubes are discharged. Only in rare cases an operative removal of the tubes is necessary. Extremely seldom are the risks that tympanostomy tubes slip off into the middle ear, intolerance of materials or a permanent hole in the ear drum. If this is the case, a second operation will be required. In the case of surgeries in adults under local anaesthesia in exceptional cases it may be possible that the narcotic substance causes vertigo or facial paralysis. These symptoms subside after a few hours without the necessity of any further action.
What do I have to do before, during and after the surgery?
As already mentioned, the bathing prohibition must be respected until the tympanostromy tube has been discharged and/or the ear drum has completely healed. In order to detect such discharge or, if necessary, to check for new effusions, regular follow-ups in intervals with shorter or longer periods will be required. Due to possible vertigo symptoms, you should not participate in road traffic after general anaesthetia in the 24 hours following surgery, in the case of local anaesthetia you should wait 5-6 hours.