Paracentese and aerators or tympanic drains
Paracentesis is the act of opening the eardrum performed by the ENT surgeon. This incision is made in the lower and anterior part of the eardrum to limit the risk of touching an ossicle. Tympanic drains or aerators also commonly called Yoyo or diabolos are placed through the eardrum in the paracentesis with one side in the ear canal and one in the middle ear. The purpose of tympanic drains is to ventilate the middle ear, artificially through the tympanic membrane to replace the Eustachian tube, so they are always hollow to let air pass from the outside to the middle ear. The middle ear is a cavity dug into the temporal bone (the part of this bone where the ear is located is called the rock), filled with air coming from the nasopharynx through the Eustachian tube.
There are several types of aerators: The 2 most common are hourglass-shaped diabolos that fall off on their own after a few months and T-shaped tubes that stay in place. The middle ear behind the eardrum is frequently a source of problems, especially in children. Poor ventilation can lead to liquid effusions or retraction of the eardrum which can have long-term repercussions. The purpose of the aerator is not to let the fluid pass from the ear to the outside but rather to allow a draining of the liquid through the eustachian tube and / or to balance the pressures on both sides of the eardrum so that it can vibrate freely.
Find out more about transtympanic aerator from Dr Delagranda, an ENT surgeon in La Roche-sur-Yon in the Vendée.
Public and indication for paracentesis and/or transtympanic drains?
Paracentesis and tympanic drains concerned :
- Adults in preventive especially to avoid tympanic retractions
- Children mainly before 8 years in curative for persistent otitis
Simple paracentesis is indicated in case of :
- Failure of medical treatment to eliminate acute liquid effusion in the middle ear with discomfort and impact on hearing.
- Paracentesis with tympanic aerators is indicated in case of.
- Repeated acute infectious otitis to limit pain.
- Serous chronic otitis (chronic inflammation) to restore hearing.
- Retraction of the eardrum to restore hearing and avoid future complications such as destruction of the ossicles and cholesteatomas.
Middle ear
The middle ear is a cavity of 0.3-1.2 ml in volume, dug into the temporal bone (the part of this bone where the ear is located is called the rock), filled with air from the nasopharynx through the Eustachian tube. It contains the 3 ossicles: the hammer, the anvil and the stirrup. To function at best the eardrum and ossicles need to be free of movement (without liquid effusion in the middle ear) and the gas pressure must be identical on 2 sides of the eardrum. When there is chronic otitis, there may be fluid that interferes with the movements of the ossicles, or a change in gas pressure leading to retractions of the eardrum which induces hearing loss. To supplement the Eustachian tube in its role of aeration, the ENT can resort to the installation of a tympanic aerator.
Objectives of paracentesis and placement of transtympanic aerators
- Avoid long-term complications in adults (tympanic retraction, cholesteatoma, hearing loss).
- Restore hearing, especially for children at a crucial age for language and school acquisition.
The different stages of the intervention
The surgery
The short procedure is performed under general anaesthesia for children, and sometimes under local anaesthesia for adults, on an outpatient basis. Inserted through the external auditory canal, the surgeon makes a 3-mm incision in the tympanic membrane, known as the paracentesis. This small incision enables the liquid behind the eardrum to be aspirated and, if necessary, a sample to be taken for bacteriological analysis. The surgeon then inserts the aerator into the eardrum. It is held in place by its retentive shape.
There are several types of aerator, chosen by the surgeon according to the expected duration of treatment.
Most of the time, aerators are used in conjunction with removal of the adenoids to optimize airflow through the internal orifice of the Eustachian tube. Tonsils may also be removed.
Post-operative convalescence period
The patient is discharged home the same day as part of an outpatient hospitalization program. Pain is minimal and disappears the same day. A more or less dirty or blood-tinged discharge from the ear may occur in the immediate aftermath of the operation.
Ear drops may be prescribed for a few days.
Your surgeon will see you again approximately one month after surgery..
Aerators last from 6 months to two years, sometimes longer depending on the type (diabolo, T Tube). A second installation is sometimes necessary when the pathology recurs.
No visible scar.
48H school absence.
Complications related to paracentesis and transtympanic aerator placement
- The main risk is early expulsion or obstruction of the aerator, leading to a possible recurrence of the initial pathology, which needs to be re-treated. Obstruction of the aerator can be resolved by the use of a product to be placed in the duct at home.
- Certain types of drains carry a risk of residual tympanic perforation, due to their size and depending on the condition of the tympanic membrane at the time of drain insertion. In 2-5% of cases, a small perforation persists after the aerator has fallen out. In most cases, this hole closes naturally and spontaneously over time, without intervention, but if it persists for more than six months, the ENT surgeon may suggest closing it with a tympanic transplant.
- A slight depression of the eardrum may appear where the aerator was located, but this has no impact on hearing.
Please refer to the College of ENT’s explanatory sheet on transtympanic aerators for further details :
➔ Paracentèse et aérateurs transtympaniques : chirurgie des otites de l’enfant
Frequently asked questions
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for transtympanic aerator surgery in La Roche-sur-Yon.
Can I swim with aerators?
This is not recommended, but bathing without head submersion can be tolerated, with protective plugs, a bathing cap and removable Watearproof-type protection.
Do aerators need to be removed?
Some fall out on their own, while others can be removed at the consultation when the ENT doctor deems it useful or necessary.
Fees and payment for the procedure
The fitting of transtympanic aerators is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about the fitting of transtympanic aerators. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vendée.
ENT consultation for transtympanic aerator surgery in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about transtympanic aerator surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.