DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20150900

Granular myringitis: current status of management

Mohan Bansal

Abstract


The Granular Myringitis (GM) is not uncommon though in medical literature it has been reported among the rarer conditions. The aim of this article is to review the clinical features and management of Granular Myringitis (GM). GM is characterized by granulation tissue on the outer surface of the Tympanic Membrane (TM) with or without the involvement of deep bony External Auditory Canal (EAC). The granulations are either localized or diffuse. The granulations over tympanic membrane continue to grow slowly for years. The ensuing fibrosis in patients with granulations of deep bony meatal wall can result into an atresia of the deep bony EAC. The presenting symptom of GM is an ear discharge which may be foul-smelling. However many patients have a sensation of fullness, irritation, mild pain or itching in the ear. If perforation occurs the underlay perichondrium or temporalis fascia grafting is done. In some of the refractory cases granulations are removed and the raw area is covered with skin. Many patients respond well to meticulous microscopic aural toilet and topical antibiotic and steroid ear drops. If patients do not respond then application of topical caustic agents are employed.


Keywords


Granular myringitis, Tympanic membrane, External auditory canal, Granular otitis externa, Otitis

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References


Pulec JL, Kinney SE. Diseases of the tympanic membrane. In: Paparella MM, Shumrick DA, eds. Otolaryngology. 2nd ed. Philadelphia PPA, USA: WB Saunders Company; 1973: 55-74.

Wolf M, Primov-Fever A, Barshack I, Polack-Charcon S, Kronenberg J. Granular myringitis: Incidence and clinical characteristics. Otol Neurotol. 2006;27(8):1094-7.

Puls T. Myringoplasty: is molded collagen xenograft a valid alternative for fresh temporalis fascia? Acta Otorhinolaryngol Belg. 1996;50(2):111-4.

Stoney P, Kwok P, Hawke M. Granular myringitis: a review. J Otolaryngol. 1992;21(2):129-35.

Boedts D. Myringitis granulosa. Acta Otorhinolaryngol Belg. 1995;49(2):187-9.

Hoshino T, Ueda Y, Mukohdaka H, Mizuta K. Acute granulomatous myringitis. J Laryngol Otol. 1998;112(2):150-3.

Blevins NH, Karmody CS. Chronic myringitis: prevalence, presentation, and natural history. Otol Neurotol. 2001;22(1):3-10.

Hwang JH, Chu CK, Liu TC. Changes in bacteriology of discharging ears. J Laryngol Otol. 2002;116(9):686-9.

Hwang JH, Tsai HY, Liu TC. Community-acquired methicillin-resistant Staphylococcus aureus infections in discharging ears. Acta Otolaryngol. 2002;122(8):827-30.

Kunachak S. Intractable granular myringitis: possible etiology and management. J Otolaryngol. 1992;21:297-8.

McLaurin JW. Trauma and infections of the external ear. In: Paparella MM, Shumrick DA, eds. Otolaryngology. 2nd ed. Philadelphia PPA, USA: WB Saunders Company; 1973: 24-32.

DeWeese DD, Saunders WH, Schuller DE, Schleuning AJ. Infection and inflammation of the ear. In: DeWeese DD, Saunders WH, Schuller DE, Schleuning AJ, eds. Otolaryngology - Head and Neck Surgery. 7th ed. St Louis USA: The C.V. Mosby Company; 1988: 395-425.

Kim YH. Clinical characteristics of granular myringitis treated with castellani solution. Eur Arch Otorhinolaryngol. 2011;268(8):1139-46.

Makino K, Amatsu M, Kinishi M, Mohri M. The clinical features and pathogenesis of myringitis granulosa. Arch Otorhinoloryngol. 1988;245:224-9.

Neilson LJ, Hussain SS. Management of granular myringitis: a systematic review. J Laryngol Otol. 2008;122(1):3-10.

Jinnouchi O, Kuwahara T, Ishida S, Okano Y, Kasei Y, Kunitomo K, et al. Anti-microbial and therapeutic effects of modified Burow’s solution on refractory otorrhea. Auris Nasus Larynx. 2012;39(4):374-7.

Jung HH, Cho SD, Yoo CK, Lim HH, Chae SW. Vinegar treatment in the management of granular myringitis. J Laryngol Otol. 2002;116(3):176-80.

Fechner FP, Cunningham MJ, Eavey RD. Laser therapy for refractory myringitis in children. Otolaryngol Head Neck Surg. 2002;127(3):163-8.

Zhang Z, Liu X, Chen S, Zheng Y. Combined tympanic epithelial layer avulsion and overlay myringoplasty for diffuse granular myringitis. J Laryngol Otol. 2010;124(8):842-5.