Chapter 21 ■ Tympanocentesis 121

Fig. 21.1. Normal newborn eardrum. View through speculum.

A B

Fig. 21.2. Tympanic membrane in the adult (A) and infant (B).

The portion of the tympanic membrane that may be visualized

through the speculum at one time is within the dotted line.

Fig. 21.3. Tympanocentesis. Aspirating

the middle ear using a 3-mL syringe. Needle

is penetrating eardrum inferiorly.

122 Section IV ■ Miscellaneous Sampling

11. If more drainage is required, a myringotomy blade can

be used to widen the opening. This will close in 48 to

72 hours.

F. Complications

1. Most common is bleeding from canal wall. This usually will stop spontaneously, but is preferably avoided.

2. TM perforation that persists. Initially, this is may be

helpful for drainage and ventilation of the middle ear

space.

3. Disruption of the ossicles from malpositioned needle

(see B1 and D5)

4. Major bleeding from dehiscent jugular bulb or carotid

artery (6); rare.

References

1. Turner D, Leibovitz E, Aran A, et al. Acute otitis media in infants

younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J. 2002;21(7):669.

2. Sakran W, Makary H, Colodner R, et al. Acute otitis media in infants

less than three months of age: clinical presentation, etiology and concomitant diseases. Int J Pediatr Otorhinolaryngol. 2006;70(4):613.

3. Nomura Y, Mimata H, Yamasaki M, et al. Effect of myringotomy on

prognosis in pediatric acute otitis media. Int J Pediatr Otorhinolaryngol.

2005;69:61.

4. Guarisco JL, Grundfast KM. A simple device for tympanocentesis

in infants and children. Laryngoscope. 1988;98:244.

5. Bluestone CD, Klein JO. Otologic surgical procedures. In:

Bluestone CD, Stool SE, Kenna M, eds. Pediatric Otolaryngology.

Philadelphia: Saunders; 1996:28.

6. Hasebe S, Sando I, Orita Y. Proximity of carotid canal wall to tympanic membrane: a human temporal bone study. Laryngoscope.

2003;113:802.