The clinical features and pathogenesis of myringitis granulosa

Abstract

Myringitis granulosa is not a rare pathologic condition of the tympanic membrane. However, the condition can be misdiagnosed as chronic suppurative otitis media, since intermittent purulent discharge is the commonest symptom in both disorders. Although the clinical features of myringitis granulosa have been well described by several authors, its pathogenesis is still obscure. In this study, 40 cases of myringitis granulosa were examined in detail to clarify the clinical features and the pathogenesis present. No drum perforations, no hearing impairments and normal X-ray findings indicated that myringitis granulosa had no relation to chronic suppurative otitis media. The other areas of the affected tympanic membrane, except for the site of granulation, showed such pathologic conditions as atrophy, clouding and calcifications. In these pathologic tympanic membranes, epithelial migration was disturbed to a high degree. We suggest that the granulation process on the tympanic membrane should be divided into two stages: (1) injury reaching the lamina propria of the tympanic membrane; and (2) disturbed epithelization of the tympanic membrane. The disturbance of epithelial migration of the tympanic membrane occurs with both stages.

Granular Myringitis

“…Recurrent episodes of GM were not observed by both Kunachak (10), who followed up 40 patients during 1 year of follow-up, and Makino et al (5), who had no recurrences at all. However, whereas Johnston (9) described recurrent GM in 1 (7%) of 13 patients, El-Seifi and Fouad (12) noted a recurrence in all patients being treated conservatively in contrast to patients being surgically treated.…”

“…It is defined by de-epithelization of the TM with formation of granulation tissue without involvement of the middle ear cleft (1,2). Makino et al (5) suggested a mechanism of impaired epithelial migration provoking a nidus of infection that induces local trauma that reaches the lamina propria of the TM Bpromoting^a granulating process, with suppression of re-epithelialization that delays recovery. Pathogenesis of GM is still obscure and is assumed to be related to local trauma or infectious agent.…”

“…Symptoms are usually mild, mainly aural fullness and discharge (2,5). Granular myringitis may be focal or diffuse and may appear as a discrete shallow ulcerated lesion or as a polypoid mass arising from the TM.…”

Granular myringitis: current status of management

“…The bony external ear canal contains purulent secretions and granulations. 14 The aural toilet will reveal whether the granulations are localized or diffuse. In cases of primary idiopathic GM, perforation of TM is not present, hearing is not impaired and there is normal movement of the tympanic membrane on pneumatic otoscopy.…”

Clinical characteristics of granular myringitis treated with castellani solution

“…Schuknecht [11] described the focal or diVuse replacement of the dermis of the tympanic membrane and adjacent canal wall with granulation tissue as a characteristic of GM. Because of the incidence of this minor illness is low [4, [12][13][14][15], GM is poorly understood and has received little attention in the medical Weld. Moreover, it is diYcult to establish a standard treatment protocol since the clinical features of GM, including diagnosis and treatment, are controversial.…”