Lucae Paracentesis Needle — Myringotomy Knife

Lucae Paracentesis Needle — Myringotomy

Lucae’s paracentesis needle is the curved-tipped sharp myringotomy knife with which the tympanic membrane is incised for drainage of acute otitis media with severe pain and bulging tympanic membrane, or for diagnostic middle-ear effusion sampling. The technique pre-dates the modern grommet by a century and remains the right answer in the rural-setting paediatric AOM patient whose pain has failed to settle on antibiotics and analgesia.

The paracentesis indication

Acute otitis media with bulging tympanic membrane and persisting fever after 72 hours of appropriate antibiotic, or with severe pain unresponsive to NSAID and oral analgesia, is the clinical setting in which paracentesis still earns its place. The cut is made at the antero-inferior quadrant — same quadrant as the modern myringotomy — and effusion drains through the cut over 24-48 hours before the membrane closes naturally.

Why a curved tip

The curve lets the operator approach the tympanic membrane through the Hartmann ear speculum at the natural canal angle, enter the membrane perpendicular to its surface, and withdraw without abrading the canal wall. A straight needle approached at the canal angle either skids on the membrane or cuts an oblique slit that does not drain.