paracentesis in otorhinolaryngology

From Big Medical Encyclopedia

PARACENTESIS in otorhinolaryngology (paracentesis; grech, para near + kentesis drawing pricks, piercing) — the operative measure consisting in creation of an artificial opening in a tympanic membrane with the medical or diagnostic purpose.

The first attempts of use of P. became at the beginning of 19 century of hl. obr. for the purpose of treatment of relative deafness and deafness. The isolated cases of improvement of hearing as a result of P. celebrated by E. Cooper (1800) served as the reason of a wide spread occurance of this operation in some cases without the bases, sufficient to that, what led to its temporary discredit. In 1862 to H. Schwartze applied P. at acute purulent average otitis to drainage of a drum cavity again.

Indications

carry out P. at acute purulent average O., and also at hron, not perforative otitises which are followed by formation of exudate in a drum cavity when, despite treatment, temperature remains high, ear pain accrues, diffusion or limited protrusion is noted tympanic membrane (see). At the same time indications to urgent P. are signs of irritation of an inner ear or a meninx (dizziness, nausea, vomiting, a severe headache, etc.), and also defeats of a facial nerve.

It is more difficult to establish indications to P. at children of chest age, than at adults since the hyperemia of a tympanic membrane at the baby can arise at shout, a toilet of outside acoustical pass. Children have a tympanic membrane sometimes and normal can be muddy. Besides, local symptoms of an acute inflammation of a middle ear at the baby can be expressed not so brightly, as at the adult.

In doubtful cases resort to the trial diagnostic Item. Timely P. promotes release of a middle ear from patol, contents, elimination of inflammatory process and consequently, to preservation of acoustical function.

The equipment

a number of mestnoanesteziruyushchy mixes, e.g. Acidi carbolici of 0,3 — 0,5 ml, Cocaini hydrochloridi of 1 — 2 ml, Glycerini puri of 10 ml is developed For P.'s carrying out. However they not always provide sufficient anesthesia. Therefore in nek-ry cases, to especially uneasy children, it is necessary to give a short-term anesthesia.

the Diagrammatic representation of options of cuts of a tympanic membrane at a paracentesis: 1 — a section across Shvarttsa; 2 — on Grubera and Benningkhausa; 3 — across Passov.

For P.'s carrying out use a paracentesis needle (knife), edges consists of the handle, the core (bent at an angle bayonet shaped or direct) and a sharp-pointed lanceolated tip. Items carry out under control of sight (see. Otoskopiya ). Though in a conversation with the patient or his parents speak about «puncture» of a tympanic membrane and the tool used at P. is called a paracentesis needle, actually make not a puncture, but a section of a tympanic membrane, a so-called tympanotomy. When limited protrusion of any part of a tympanic membrane is observed, the section is done in the place of its greatest protrusion. At uniform protrusion or at its absence P. make in the typical place. The sizes and a form of a section are various. So, across Shvarttsa, do a direct section in a zadnenizhny quadrant of a tympanic membrane (fig). Some doctors do a section in the same site, but in the form of the arch opened to the center of a tympanic membrane. On Grubera (Y. Gruber) and Benningkhausa (S. of Bonninghaus), make the semicircular section taking both lower quadrants of a tympanic membrane. A. Passow offered the long section taking both back quadrants of a tympanic membrane.

Initial in a stake of a needle do through all thickness of a membrane in the bottom of an estimated section, and then cut a tympanic membrane from below up. Reliable fixing of the head of the patient since the section shall be made very precisely both concerning other formations of a tympanic membrane, and on depth of introduction of the tool to a drum cavity is necessary.

When P. make apropos hron, exudative average otitis, enter the special shunt for the purpose of ventilation of a middle ear or administration of medicines in it into a section.

After P. enter sterile tampons into outside acoustical pass, to-rye change in process of treatment separated. In the subsequent make ear inflations (see), and also a systematic toilet of outside acoustical pass, antibiotics and physiotherapeutic procedures appoint.

P.'s kind is the puncture of a drum cavity by means of the special curved hollow needle connected to the syringe (see. Tympanopuncture ).

Complications

Complications at correctly made paracentesis happen seldom. Bleeding as a result of damage of an upper bulb of an internal jugular vein in the presence of impression of the lower wall of a drum cavity and protrusion of a bulb in a gleam of a cavity concerns to them. Points the blue color of a zadnenizhny part of a tympanic membrane changing during the pressing on area of an internal jugular vein on a neck to existence of this anomaly. At severe bleeding make a dense tamponade of outside acoustical pass, appoint antibiotics.



Bibliography: Levin L. T. Surgical diseases of an ear and their operational treatment, book 1, M. — L., 1936; Preobrazhensky Yu. B. Experience of topical administration of penicillin by an injection in a drum cavity at treatment of acute purulent otitises at children, Vestn, otorinolar., No. 1, page 22, 1951; Hals-Nasen-Ohren-Heilkunde, hrsg. v. J. Berendes u. a., Bd 3, T. 2, S. 1023, 1049, Stuttgart, 1966; Handbuch der Hals-Nasen-Ohren-Heilkunde, hrsg. v. A. Denker u. O. Kahler, Bd 7, T. 2, S. 102, B. — Miinchen, 1926; Shambaugh G. E. Surgery of the ear, Philadelphia — L., 1959.


Yu. B. Preobrazhensky.

Яндекс.Метрика