Granular myringitis: current status of management

Abstract

<p class="abstract"><span lang="EN-US">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.</span></p>

Management of myringitis: Current concepts and review

“…Chronic myringitis was stated to induce tympanic membrane perforation . However, evidence for this appears to be lacking, and the mechanism of the perforation of the tympanic membrane observed in myringitis is also uncertain.…”

“…Chronic myringitis was stated to induce tympanic membrane perforation. 25 However, evidence for this appears to be lacking, and the mechanism of the perforation of the tympanic membrane observed in myringitis is also uncertain. Myringitis tends to show very unconverted features regardless of the type (e.g., granulomatous or ulcerative).…”

Why Cannot We have an Etiological Classification for the Patients with Granular Myringitis?

“…The author has observed that once the patients give up the habit of self cleaning of ear and resist the desire of scratching EAC the number and frequency of their visits reduce significantly and they recover fully with conservative medical treatment (meticulous microscopic aural toilet and topical antibiotic and steroid ear drops). Only few patients needed application of topical caustic agents (such as chromic acid, formalin, or silver nitrate) or surgical excision of granulation tissue and reconstructive ear-microsurgery [23].…”

A Novel Classification and Staging System to Address Prognosis and Treatment Decisions for Patients with Granular Myringitis

“…2 Various modalities of treatment have been employed in the management of this disorder. 3 GM is not rare 4 and has various types of lesions, which vary in extension and can have important bearing on the line of treatment and prognosis. It can affect not only TM but can also extend to deep bony external auditory canal (EAC).…”

“…4,7,8 Medical and surgical intervention is varied and often does not lead to permanent resolution of the disease. 3,9 Untreated GM can lead to inflammatory infiltration of the deep EAC and post-inflammatory medial EAC fibrosis and its atresia. 10 In spite of all these varied otoscopy findings, sequelae (causing hearing impairment), and diverse treatments, currently there is no classification and staging system of GM.…”