Tympanocentesis is a diagnostic and therapeutic procedure in
which a needle is inserted through the tympanic membrane to aspirate
fluid from the middle ear space. The procedure is considered diagnostic
when the material obtained is sent for laboratory and/or
micro-biological analysis. It is considered therapeutic in most
instances because it relieves pressure, thereby reducing pain, and many
times shortens the course of an acute otitis media. The procedure
is quick, simple, and not as frequently performed as it should be.
Note also that authors are calling for culture-directed antibiotic
therapy for otitis media to reduce the need for broad-spectrum antibiotics
and prevent, as much as possible, the emergence of multiresistant
The ear is divided into the external, middle, and inner parts.
The external ear is comprised of the auricle, the external auditory
canal, and the external auditory meatus. The middle ear contains
an air space and mastoid cells ventilated by the eustachian tube,
the tympanic membrane, and the three ossicles. The inner ear is
made up of the cochlea, semicircular canals, fluids, and cranial nerve
VIII. The facial nerve courses through the middle ear space and
mastoid process. It can be affected by a severe infection in these
areas. Facial asymmetry during an acute ear infection is an indication
of an unusually severe infection.
Inspection of the tympanic membrane will usually show it to be
bulging during an acute infection with loss of mobility on pneumatic
otoscopy. Conditions that are more chronic may show color changes
of the tympanic membrane, with or without associated scarring and
Tympanocentesis is performed to obtain fluid for microbiological
culture and antibiotic sensitivity testing to determine the infectious
cause of a middle ear effusion. Tympanocentesis is warranted for
patients with otitis media that is severe, unresponsive to conventional
antimicrobial therapy, or in a child less than 8 weeks
of age to rule out gram-negative organisms. Tympanocentesis is warranted
for patients with an acute otitis media and either an acquired or
congenital immunodeficiency as they will often require directed
therapy. Patients who develop acute otitis media while taking appropriate
antimicrobial therapy should be evaluated for the organism responsible
and its sensitivity to antibiotics. Tympanocentesis is also performed
when the patient has an otitis media associated with unusually severe
pain, signs of toxicity, bullous myringitis, facial nerve palsy, mastoiditis,
meningitis, encephalitis, brain abscess, or dural sinus thrombosis.
There are no absolute contraindications to tympanocentesis. It
should not be performed in a patient who is uncooperative, as secondary
injury may result. Uncooperative patients will require sedation,
procedural sedation, or general anesthesia to perform this procedure.
Tympanocentesis should be performed by an Otolaryngologist if the
landmarks on the tympanic membrane are obscured.
- 21 gauge spinal needle
- 3 mL aspirating syringe
- Ear speculum
- Ear wax curette
- Culture swabs and media
- Laboratory tubes for fluid cell count and differential
- Topical anesthetic solution
- Intravenous extension tubing
- Headlamp or overhead surgical light ...
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