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Abstract
Two studies were performed to determine whether topical phenol is a safe and well tolerated local anaesthetic for grommet insertion. Study 1 was a retrospective examination of audiological outcomes and complications. Data were obtained regarding 71 procedures in 57 patients. One late infection and nine early extrusions were noted. No statistically significant changes between pre- and post-operative bone conduction thresholds were found. Study 2 was a prospective analysis of patients' perceptions of the procedure. Data from 17 patient questionnaires were analysed as follows: pain rating - not painful, three patients; slightly painful, 14 patients. Overall experience rating - pleasant, four patients; slightly unpleasant, 10; unpleasant, three. All patients stated that they would undergo the procedure again. In conclusion, we found no evidence of phenol-induced hearing loss. The complication rate was within normal limits and patients were satisfied with the procedure. Grommet insertion using phenol as a local anaesthetic is safe and acceptable to patients.
Key words: Phenol; Middle Ear Ventilation; Otitis Media with Effusion; Anaesthetics; Local Anaesthesia; Local
Introduction
Grommet insertion in adults is frequently carried out under local anaesthesia. Lignocaine injection and the application of topical preparations are the two main methods of anaesthetizing the tympanic membrane. However, both these methods have significant drawbacks. The injection of lignocaine into the external auditory canal produces consistent and complete anaesthesia of the tympanic membrane. Once injected, it is necessary to wait in the region of 10 minutes for the lignocaine to take effect. The main disadvantage of this method is the discomfort the injection causes: the periosteum and perichondrium of the canal are closely applied to the external auditory canal skin and injection into this area stretches the skin from the underlying tissue, resulting in significant pain. The pain caused by injection can be worse than the discomfort produced by a myringotomy on an unanaesthetized tympanic membrane. Topical preparations used to anaesthetize the tympanic membrane include lignocaine cream (EMLA)1 and tetracaine gel (Ametop).2 The application of such preparations requires the canal to be cleansed before the cream can be syringed into it. Care must be taken not to leave a bubble of air over the tympanic membrane because this area will not be anaesthetized. The EMLA cream is left in place for 40 minutes...