Paracentesis (Myringotomy)

Paracentesis (also known as myringotomy) is a precise, minimally invasive procedure in which a microscopic incision is made in the eardrum (tympanic membrane). This intervention allows fluid, pus, or blood accumulated behind the eardrum in the middle ear to be evacuated (drained), immediately relieving pressure and preventing severe complications.

Indications: When is Paracentesis Needed?

An ENT specialist performs paracentesis under the following clinical conditions:

• Acute Suppurative Otitis Media: Significant accumulation of pus behind the eardrum, causing severe throbbing pain, high fever, and a risk of spontaneous rupture of the membrane.

• Serous Otitis Media (Fluid in the Ear): Prolonged retention of thick, sticky fluid behind the eardrum leading to progressive hearing loss (commonly seen in children with an enlarged adenoid / third tonsil).

• Failure of Antibiotic Therapy: When the ear infection does not respond to medical treatment and pain remains severe.

• Barotrauma: Middle ear damage caused by sudden changes in atmospheric pressure (e.g., during air travel or scuba diving).

Procedures at MBAL Varna

• Preparation: Prior to the procedure, the doctor cleans the ear canal and evaluates the condition of the eardrum using an otoscope or operating microscope.

• Anesthesia: For adult patients, the procedure is performed under local anesthesia—a specialized numbing solution or spray is applied to the eardrum, making the sensation completely tolerable. For young children or anxious patients, brief general anesthesia (mask anesthesia) is administered.

• Surgical Technique: Guided visually by an ear microscope, the ENT surgeon creates a fine incision (approx. 1–2 mm) in the lower segment of the tympanic membrane using a specialized thin needle (paracentesis knife). The fluid is then gently aspirated (suctioned out). In chronic cases of serous otitis media, a miniature ventilation tube (grommet) may be inserted into the incision to provide continuous drainage and middle ear aeration.

• Duration: The procedure is exceptionally fast, taking between 5 and 10 minutes.

Postoperative Care and Recovery

• Immediate Relief: The moment the incision is made, middle ear pressure drops and acute pain subsides immediately. Hearing begins to improve progressively.

• Water Protection: The most critical post-procedure rule is to strictly keep water out of the ear during bathing or hair washing. Specialized earplugs or petroleum-jelly-coated cotton balls should be used to prevent secondary infections through the incision.

• Healing: The microscopic incision is reversible—the tympanic membrane possesses remarkable regenerative capacity and typically heals completely on its own within a few days to a week (unless a long-term ventilation tube was placed).

At MBAL Varna, this procedure is performed in the specialized ENT consulting room or in the department's operating theater based on clinical indications.