Granular myringitis: is it a surgical problem?
OBJECTIVE
An attempt to settle the controversies associated with granular myringitis (GM) including incidence, etiology, pathology, presentation, relation to chronic otitis media, and treatment.


METHODS
Retrospective.


METHODS
Tertiary referral center and private otology practice.


METHODS
94 patients presenting with GM over 28 years.


METHODS
Diagnosis by otoscopy, audiometry, radiology, and bacteriology; long-term follow-up (6 months to 12 years); assessment of treatment results.


METHODS
The pathologic states of the affected tympanic membranes were studied in both active and quiescent stages. The results of conservative versus surgical management were evaluated.


RESULTS
The disease presents with chronic painless otorrhea, normal hearing and mastoid pneumatization, and granular areas, which may be patchy, diffuse, or segmental. The latter is the most frequent and is most commonly posterosuperior. The infecting organism is Pseudomonas aeruginosa. The pathologic process affects all drum layers and can cause a perforation. The most important predisposing factor is disturbed epithelial migration, which may be exaggerated by eustachian tube dysfunction. Of 26 cases treated conservatively, none healed without recurrence. Of 48 cases treated surgically, there were 2 recurrences.


CONCLUSIONS
Pathologically, the disease affects all drum layers. It presents with an active stage, which may be misdiagnosed as chronic otitis media or cholesteatoma, and a quiescent stage when it may be overlooked. Although distinct from chronic otitis media, it can cause a perforation. The disease responds readily to medical treatment, but recurrence is common. Radical surgery offers a curative measure in refractory cases.
Department of Microsurgery, The Military Medical Academy, Cairo, Egypt.
A
A
El-Seifi
B
B
Fouad
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015984:Causality; D002648:Child; D003131:Combined Modality Therapy; D003475:Curettage / Q000379:methods*; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D015994:Incidence; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D010032:Otitis Externa / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014432:Tympanic Membrane
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids