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Shunting of the tympanic cavity consists in installing a shunt (ventilation tube) in the organ of hearing. The procedure is carried out to maintain aeration of the middle ear, long-term administration of medications into the organ cavity and to prevent the accumulation of fluid (exudate) in the tympanic cavity. Manipulation is advisable to carry out in the acute stage of hearing loss, purulent and inflammatory processes, exudative otitis media.
Features of shunting of the tympanic cavity
In the normal state, oxygen enters the middle ear, its alignment is carried out through the auditory tube, which connects the tympanic cavity with the pharynx and nose. In case of violation of the patency of the auditory tube, a negative pressure of oxygen is observed in the ear cavity, as a result of which the tympanic cavity is filled with liquid, adhesions occur, stiffness of the auditory bones develops and hearing is impaired.
The operation is performed to equalize the oxygen pressure in the ear. The tube allows oxygen to pass into the middle ear, and unnecessary fluid flows out. This technique effectively fights against serious diseases of the organ of hearing. Children aged 1-3 years are most susceptible to ear diseases, less often adult men and women.
The procedure must be carried out in a hospital setting under local anesthesia. For small children, and sometimes for adult patients, manipulation is performed under general anesthesia. To install a metal or plastic shunt, the doctor makes an incision in the middle ear, into which the tube is inserted. The maximum period for which a shunt is placed is six months, after which it should be pulled out. It happens that while wearing a shunt, it can fall into the external auditory canal without permission, in which case it is necessary to contact your doctor.
After installing the tube, a specialist must observe the patient for 15-30 minutes, and only then the patient can be free. Experts recommend that the patient stay for several days in the hospital in order to avoid complications and side effects. After 3-6 months the shunt is removed. The tympanic cavity is restored after manipulation in 15-30 days. For successful rehabilitation, you need to follow the doctor’s recommendations and take care of your immunity.
Indications for the purpose of the operation
Surgery is indicated if a person has inflammation in the tympanic cavity several times a year, which cannot be completely cured with antibiotics and other drugs. Manipulation is prescribed if the patient’s hearing progressively decreases, chronic accumulation of fluid in the middle ear is diagnosed, and the work of the balance organ is disrupted.
Shunting is indicated for:
- hearing loss, which negatively affects a person’s speech;
- pathological changes and congenital anomalies that violate the patency of the auditory tube;
- narrowing of the auditory tube;
- the risk of rupture of the tympanic cavity due to pressure fluctuations;
- barotrauma that occurred during diving or air travel;
- mechanical trauma to the middle ear.
If the patient is diagnosed with exudative otitis media, then this is a direct indication for bypass surgery. Manipulation allows you to release the eardrum from the accumulated fluid and normalize the functioning of the hearing organ. It is advisable to carry out the operation with the ineffectiveness of conservative treatment: blowing, catheterization, the use of medications. With this disease, the shunt is installed from 2 to 3 months.
Stages of the operation
An ear shunt is installed during the operation, which is performed by an experienced specialist. This surgical intervention in medicine is called myringotomy or tympanostomy. During the manipulation, the surgeon makes an incision in the tympanic cavity with a special sterile microsurgical scalpel. If you simply release the exudate from the middle ear and do not put a shunt, then after a week the incision site will begin to heal.
During shunting, the patient should not move his head, so if the child is being manipulated, the parents hold his head, or the baby is given mild anesthesia. Older children and adults undergo surgery under general anesthesia.
During the manipulation, first of all, a myringotomy is done, then if there is exudate in the tympanic cavity, it is removed from there. Next, the specialist installs a tube into the ear hole. After the operation, the doctor prescribes ear drops and other drugs that have an anti-inflammatory effect. The patient should take medication for 5-7 days.
The duration of surgery varies from 15 to 30 minutes. If any complications arise during the procedure, the manipulation can take much longer – up to 60 minutes. If the doctor detects adenoids during shunting, he performs an adenotomy. After shunting and adenotomy, the risk of pus in the organ of hearing is minimized.
Rehabilitation period
At the end of the surgical intervention, it is advisable for the patient to stay in the hospital for 2-3 days. In the absence of complications, the patient is discharged and he can go home. After the procedure, the patient should not feel severe discomfort or pain at the incision site. Some people experience a little pain in the ear during the rehabilitation period, this is considered normal for 2-3 days after the operation.
After anesthesia, the patient may feel dizzy and experience nausea, so bed rest is recommended. In people after surgery, irritability and aggressiveness are sometimes observed, which immediately arise and just as quickly pass. As a result of manipulation, hearing is completely restored in almost 90% of patients.
Some people complain that all the surrounding sounds are very loud. In this case, the doctor prescribes appropriate sedative medications. To avoid bacteria and infection entering the tympanic cavity, the organ should be protected from moisture and water. The duration of the postoperative period varies from 7 days to 1 month, depending on the human immune system and the implementation of all the recommendations of a specialist.
Possible complications
Surgery is used to treat people all over the world. The operation is performed by an otolaryngologist or surgeon. Manipulation is considered absolutely safe and extremely effective. Sometimes patients experience complications: infectious processes in the middle ear, scarring (does not lead to hearing loss), adhesions, premature tube prolapse (due to this, the inflammatory process in the organ may aggravate and a shunt may need to be re-installed), perforation of the tympanic cavity (sometimes it is required plastic surgery on the tympanic cavity).
Rarely, after the tube is removed, the hole in the middle ear does not heal, in which case a small additional operation is necessary. The doctor sews up the hole with threads that dissolve themselves.
Alternative to tympanic bypass
An alternative treatment for middle ear disease is paracentesis. A distinctive feature of the procedure is that after the doctor makes an incision in the tympanic cavity, a tube is not inserted into it, and the exudate is removed through the incision.
Alternative manipulation is done most often in children with exudative inflammation or purulent otitis media. Surgery helps to remove fluid from the ear cavity through an incision, which closes on its own within 1-2 weeks. The installation of a shunt is not required, since after the removal of purulent formations, further treatment is carried out with the help of drugs and conservative therapy.
Manipulation reduces pain in the ear and alleviates the general condition of the patient. If paracentesis fails, the patient should undergo a bypass. In the case of persistent dysfunction of the ear canal, middle ear surgery should be performed to eliminate the underlying cause of the disease.
Surgical intervention, both bypass and paracentesis, is performed on patients at any age. After a detailed examination by a doctor, familiarization with the patient’s medical record and obtaining the results of the tests, the specialist prescribes a comprehensive and most appropriate treatment for the disease.
The therapy with the installation of a shunt in the tympanic cavity is very effective, since it reduces the risk of inflammation in the organ of hearing, reduces excessive accumulation of exudate, minimizes the likelihood of scarring and adhesions in the ear cavity, partially or completely restores hearing, improves speech, eliminates imbalances. Many patients note that after the procedure, sleep normalizes and pain in the ears ceases to bother.