Granular myringitis

1. Granular myringitis
Definition: Granular myringitis is a specific form of external otitis, It is characterized by granulation
tissue on the lateral aspect of the TM with possible involvement of external auditory canal. Various
name granulomatous otitis externa, granulomatous myringitis, acute granulomatous myringitis &
chronic myringitis.
Some auther suggested two distinct entities: myringitis externa granulosa & granular myringitis.
1)Myringitis externa granulosa has granulation tissue on the lateral surface of the drum & medial
part of the ear canal skin.
2)Granular myringitis has granulation only on the drum.
Pathology
Oedematous granulation tissues with capillaries & diffuse infiltration of chronic inflammatory cells.
Aetiology
The incidence of granulation myringitis is not related to sex, age, systemis disease or season.
High ambient temperature.
Swimming
Lack of hygiene
Local irritation
Foreign body
Complications of TM repair.
All have been causative factors, a bacterial & fungal infection is present in the affected ear.
Symptoms
The dominant symptom is a foul-smelling discharge from the affected ear.
Little or no pain,
Sensation of fullness or irritation in the ear.
Mild hearing impairment
Some patients can be asymptomatic.

2. Signs
Foul smelling purulent discharge,
Most comomly the granulation tissue situated posteriosuperior on the drum & may affect the
adjacent canal wall.A slight raised carpet of granulations which cover the TM is seen in the diffuse
form.
D/D
CSOM with diffuse external otitis.
Investigations
Inspection of the ear canal using microscope is essential for diagnosis & treatment.
Pneumatic otoscopy & tympanometry should be used to confirm that middle ear is normal & no
perforation is present.
C/S for bacteria(gram negative bacteria pseudomonas aeruginosa, proteus species, staphalycoccocus
aureus are common organism)
Candida albicans are most commomly cultured.
Biopsy for histopathological examination should be carried out to exclude carcinoma.
Outcomes ,natural history & complications
Since many patients are asymptomatic , the natural history is hard to clucidate. Granulation tissues
healing may happen spontaneously . sometimes leads to replacement with proliferating granulation
tissues >fibrosis> atresia of medial part of EAC.> fibrosis & atresia extended laterally.>atresia of EAC.
Management options:
In localised form; 1)meticulous microscopic debridement,
2) Antibiotic and steroid and/or antifungal agents.Treatment should be continued
for a longer time than otitis externa.
In the diffuse form;
Topical chemical cautery with silver nitrate, Laser evaporation of granulations.