Granular Myringitis Research Articles

Endoscopic Broad Palisade Cartilage Graft Without Raising a Tympanomeatal Flap in the Repair of Subtotal Perforation.

Objective: This study evaluated the outcome of a broad palisade cartilage graft in the repair of subtotal perforation. Study Design: Prospective case series. Materials and Methods: This was a prospective study of 43 patients with subtotal perforations who underwent an endoscopic broad palisade cartilage graft procedure that did not include raising a tympanomeatal flap. The patients were followed up for 6 months. Results: The 43 patients (43 ears) included in this study had a mean operation time of 38.6 ± 7.4 minutes. Five (11.6%) patients were lost to follow-up; 38 (88.4%) completed the 6 month follow-up. The graft success rate in the latter was 92.1% (35/38). Audiological testing showed no sensorineural threshold shift. The mean preoperative air-bone gap (ABG) was 28.4 ± 5.1 dB, while the mean ABG at 6 months postoperatively was 13.6 ± 3.1 dB; the difference between these values was significant (P < .05; paired samples t test). According to the audiometry assessment, the successful surgery rate (postoperative ABG ≤ 20 dB) was 89.5% (34/38). No graft-related complications (eg, graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. However, granular myringitis with minimal moistness but without infection was noted in 5.3% (2/38) of the patients. Conclusions: In the repair of subtotal perforation, an endoscopic broad palisade cartilage graft, performed without raising a tympanomeatal flap, is simple and feasible, resulting in a high graft success rate and good hearing restoration.

Outcomes of perichondrium graft covering the epithelium of the tympanic membrane for large-sized perforations: A 3–5-year follow-up study

ObjectiveThe objective of this study was to evaluate the graft outcomes and iatrogenic cholesteatomas for 3 years following cartilage-perichondrium over-underlay technique with perichondrial graft covering the epithelium for large-sized tympanic membrane (TM) perforations. Materials and methodsThis prospective case series enrolled patients with large-sized perforation who underwent endoscopic cartilage-perichondrium over-underlay technique. The graft success rate, hearing outcomes, and development of iatrogenic middle ear cholesteatomas and graft cholesteatomas were assessed at 3 years postoperatively. ResultsThis study included 62 ears of 62 patients. The mean follow-up duration was 47.3 ± 10.8 (38–64) months. Neovascularization was observed in the lateral perichondrium graft in 55 (88.7 %) patients, which inosculated into the TM remnant at 4–5 weeks. However, graft neovascularization was not observed in the four patients with excessive perichondrium graft that migrated into the external auditory canal and the three patients with middle ear infections. The graft failure rate was 6.5 % at 6 months, 11.3 % at 12 months, 6.5 % at 24 months, and the overall graft success rate was 91.8 % at the last follow-up. Granular myringitis developed in 11.3 % (7/62) of the patients. High-resolution computed tomography revealed well-pneumatized mastoids and middle ear at the final follow-up. However, graft cholesteatomas were observed in 3 (4.8 %) patients at 7–24 months postoperatively. ConclusionsThe cartilage-perichondrium over-underlay technique with perichondrial graft covering TM epithelium is safe and effective for the repair of large perforations, with good short- and long-term graft outcomes, minimal risk of graft cholesteatoma development, and no risk of iatrogenic middle ear cholesteatomas.

Towards Optimized Management of Bullous Myringitis: A 5-Year Cohort Study Evaluating Treatment Efficacies, Surgical Risks, and Topical Interventions in Contemporary Practice

Bullous Myringitis (BM) is a pathological condition characterised by the formation of painful blisters on the tympanic membrane, leading to challenges in its management. The present study investigated the effectiveness of BM treatment, the potential risks associated with surgical interventions, and the efficacy of topical therapy. The study consisted of a retrospective cohort analysis spanning a period of five years, involving a total of 50 patients diagnosed with Bullous Myringitis. The study encompassed an examination of various aspects, including demographics, symptoms, treatments, and outcomes. The efficacy of topical treatments was evaluated through a randomised controlled trial (RCT). The application of linear regression was employed in order to ascertain the predictors of treatment outcomes. The present study investigated the participants' quality of life and the occurrence of complications. The most commonly reported complaint, ear pain, demonstrated the greatest efficacy when treated with topical medication. The randomised controlled trial (RCT) demonstrated that the implementation of topical treatment resulted in a notable amelioration of symptoms and an increase in patient satisfaction. The treatment modality was found to be a significant predictor of positive outcomes, while no significant associations were observed between age and gender and treatment outcomes. The application of topical therapy resulted in a decrease in the occurrence of granular myringitis and a reduction in sensorineural hearing loss. The patients indicated an enhancement in their quality of life subsequent to the intervention. Personalised therapeutic strategies, surgical prudence, and topical therapies play a crucial role in the management of BM. This study presents a comprehensive framework for the implementation of evidence-based procedures related to bowel movements. In order to validate these findings, it is recommended that comprehensive, prospective studies be conducted on a large scale.

Endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforations with 3 years of follow-up

ObjectiveThe objective of this study was to evaluate graft outcomes and complications of endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforation with 3 years of follow-up. Material and methodsAdult patients with chronic kidney-shaped perforation underwent endoscopic perichondrium-cartilage H type technique. The graft outcomes and complications were evaluated at 36 months after surgery. ResultsThe total of 51 ears were included in this study. The mean operation time was 31.5 ± 4.1 min. Residual perforation was seen in 2 patients, the graft success rate was 96.1 % (49/51) at postoperative 12 months. Granular myringitis was noted in 8.2 % (4/49) patients in 49 patients with graft success. The mean preoperative ABG was 23.6 ± 3.7 dB, while the mean postoperative ABG postoperatively 12 months was 12.9 ± 5.2 dB (P < 0.05), the functional success rate was 94.1 % (48/51). At postoperative 36 months, only 32 (62.7 %, 32/51) patients were followed up, while 19 (37.3 %, 19/51) patients lost followup. Of the 32 patients with followup of 36 months, the mean follow-up time was 38.2 ± 7.1 (37–46) months, re-perforation was seen in one. All 32 patients performed the postoperative CT examination at last followup, CT revealed the well pneumatization of mastoids and middle ear. ConclusionsEndoscopic cartilage-perichondrium H type technique is an alternative method for repairing chronic kidney-shaped perforations, with a highly successful, short operation time, minimally invasive procedure, and no cholesteatoma.

Role of topical antibiotic ointment in the lateral graft following underlay myringoplasty: a prospective randomised study

ObjectiveThe objective of this study was to compare the graft outcome and postoperative infection of with and without the use of antibiotic ointment following myringoplasty for the treatment of chronic perforations.Study DesignRandomized controlled trial.Material and Methods135 chronic perforations were prospectively randomized to use of antibiotic ointment group (UAO, n = 68) or no use of antibiotic ointment group (NAO, n = 67) following myringoplasty. The graft outcomes and postoperative infection were compared among two groups at 6 months.ResultsAt postoperative 6 months, the graft infection rate was 4.4% in the UAO group and 10.4% in the NAO group, the difference was not significant (P = 0.312).The graft success rates were 92.6% in the UAO group and 91.0% in the NAO group, the difference was not significant (P = 0.979). In the UAO group, 3 patients with purulence ear discharge resulted in a residual perforation although they received ofloxacin ear drops and intravenous antibiotic therapy treatment. In the NAO group, 6 patients with purulence ear discharge resulted in a residual perforation, only one, with mild purulence discharge was successfully treated and closed. In addition, no significant between-group differences were observed pre- (P = 0.746) or post- (P = 0.521) operative air bone gap (ABG) values or mean ABG gain (P = 0.745). However, granular myringitis with minimal moistness but without infection has been noted in 3 (4.4%) patients in the UAO group and in 5 (7.5%) in the NAO group, the difference was not significant (P = 0.699).ConclusionsUse and non-use of antibiotic ointments for lateral packing of graft are both comparable methods following myringoplasty for postoperative infection and graft outcomes.

Recurrent granular myringitis: Medical management revisited

Background: Granular myringitis (GM) is one of the rarer conditions reported in Indian literature. It is defined as a chronic inflammation limited to squamous layer of tympanic membrane. Several names have been given to it such as myringitis granulosa, acute granulomatous myringitis, and chronic myringitis. Aims and Objectives: The objective of our study is to evaluate the results of topical antibiotic with steroids and topical antibiotic alone on disease pathology of GM and its outcome. Materials and Methods: This study was conducted in the department of otorhinolaryngology on 80 patients from the period of September 2020–December 2021 on patients of GM after complete clinical evaluation. This is a prospective study made on two groups of patients. The results were analyzed by visual analog scale. Results: Both the groups after a period of 6 months showed improved results. The outcome with antibiotic with steroid was comparatively faster and superior than antibiotic only ear drops. Conclusion: The result of antibiotic with steroid ear drops is superior to antibiotic only ear drops in the treatment of recurrent GM.

Modified inlay butterfly cartilage myringoplasty: An outpatient minimally invasive procedure for closure of central perforation-graft success rate and hearing outcome

ObjectiveThe objective of this was to evaluate anatomical and hearing results of modified inlay butterfly perichondrium-cartilage myringoplasty for repairing central perforation in an office setting. Material and methodsWe performed a prospective study in 81 patients with chronic central perforations who underwent modified inlay butterfly perichondrium-cartilage myringoplasty in an office setting. The graft success rate, hearing outcome, and complications were evaluated at postoperative 3, 6 and 24 months. Results81 patients with 81chronic perforations were included in this study. The graft success rate was 100.0% (81/81) at postoperative 3 months. At postoperative 24 months, 16 patients lost follow-up, the graft success rate was 98.5% (64/65). The mean preoperative ABG was 23.0 ± 2.6 dB, while the mean postoperative ABG postoperatively 12 months was 11.4 ± 3.1 dB; the difference between these values was significant (P < .05). No graft-related complications (e.g., graft lateralization, graft medialization, graft keratin pearl, middle ear cholesteatoma) were encountered during the follow-up period. In addition, excess perichondrium lateral to the superficial layer of TM remnant became necrotic and crust at postoperative 2–3 months. However, graft keratin pearl and intra-tympanic cholesteatoma/epithelial inclusion cyst weren't found in any patients at postoperative 24 months. Granular myringitis with minimal moistness but without infection has been noted in 6 patients. ConclusionsModified inlay butterfly perichondrium-cartilage myringoplasty is a viable and less invasive option for closure of central perforations in an office setting because this technique does not require tympanomeatal flap elevation and general anesthesia.

Potassium titanyl phosphate laser surface tympanoplasty as a novel treatment for chronic granular myringitis in a series of 14 patients.

Granular myringitis is a chronic and difficult-to-treat condition of the tympanic membrane. This paper presents a minimally invasive treatment technique using the potassium titanyl phosphate laser. A retrospective case review of patients who underwent potassium titanyl phosphate laser treatment between 2015 and 2020 was performed. All patients underwent final telephone follow up in 2020 to ascertain whether they had any ongoing myringitis symptoms, and all were offered further face-to-face follow up. Fourteen patients with myringitis were identified, with one patient having both ears affected. Of the 15 affected ears, 2 required a second treatment, resulting in a total of 17 laser treatment cases. At the first post-operative review, the appearance of the drum had improved in 10 out of 17 treatments (59 per cent). Potassium titanyl phosphate laser surface tympanoplasty may provide safe, quick and effective resolution of myringitis.

Efficacy of diluted vinegar in treating granular myringitis: a randomised controlled trial.

This study aimed to evaluate the outcome of granular myringitis treatment of 1 per cent diluted vinegar ear drops or 1 per cent chloramphenicol ear drops and to assess the side effects of 1 per cent diluted vinegar. Twenty-four patients aged over 18 years and diagnosed with granular myringitis grade I or II within 90 days of symptom onset were included. Patients were equally randomised into either the 1 per cent diluted vinegar group or the 1 per cent chloramphenicol group. Outcome of treatment and side effects were compared between groups. The main outcome measure was completely epithelialised tympanic membrane at the eight-week period. Eleven of 12 patients treated with 1 per cent diluted vinegar had complete recovery. In the 1 per cent chloramphenicol group, 8 of 12 patients recovered. The difference between groups was not statistically significant (p = 0.156). The observed side effects of diluted vinegar included dizziness and mild external auditory canal irritation. One per cent diluted vinegar is an interesting option for granular myringitis. Other comparative advantages of 1 per cent diluted vinegar include its low price and no induction of antimicrobial resistance.

Granular Myringitis Treatment at Siriraj Hospital

Objective: To review the clinical features and management of patients diagnosed with granular myringitis at Siriraj Hospital, during 2014–2016, and their applications in clinical practice.Methods: The clinical data of 115 patients diagnosed with myringitis at the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, between September 1, 2014, and September 30, 2016, were retrospectively reviewed. Patients who were lost to follow-up after the first visit or patients who were diagnosed with other diseases, such as bullous myringitis, were excluded, leaving 96 patients included in the study. Patient information and data, including age, gender, underlying disease, history of ear disease and surgery, symptoms, duration, type of treatment, outcome, total follow-up time, complications, and recurrence rate were recorded.Results: In total, 96 patients (27 men (28.10%) and 69 women (71.90%)) were included in the study. Their ages ranged from 3 to 90 years old (mean, 52.88). Sixty-two patients (64.60%) were diagnosed by otologic staff. The average duration of symptoms from onset was 5.6 months (range, 0.03–60.80 months). The most frequent symptom was otorrhea (55.3%). There were 38 treatment regimens applied. The most common medications used were topical antibiotics with steroids (28.11%), topical antibiotics (24.91%), and diluted vinegar (17.08%). There was no significant difference in the curative rate between these regimens (p = 0.261).Conclusion: Granular myringitis is a poorly understood condition and there is no standard treatment regimen. While there is a great variation in the treatment of granular myringitis at Siriraj Hospital, this retrospective review showed there was no statistical significant difference among the different regimens. Further high-value research is needed to further assess the management strategies.

Granular myringitis as a differential diagnosis for chronic ear discharge

Granular myringitis is a localized chronic inflammation on the lateral surface of the tympanic membrane. It is characterized by the presence of granulation tissue over the involved area in the absence of middle ear disease. It is a poorly understood disease and has received relatively little attention in the literature and easily mistaken for chronic otitis media due to similarity in clinical symptoms and findings. We reported a case of granular myringitis in a 25-year-old female that represents diagnostic and therapeutic challenges of the disease.

PHILOSOPHY AND CONCEPT OF TOTAL ANNULUS EXCISION (TAE): A NOVEL APPROACH FOR TYMPANOPLASTY

Tympanic membrane perforation is a common pathology encountered by an ear surgeon. The surgical repair and reconstruction of these defects of the drumhead has been addressed by two popular techniques - viz., the common and popular underlay technique and the lesser known interlay technique. In underlay technique of tympanoplasty, mucosalization of the graft many a times leads to continuous or intermittent discharging ear despite an intact tympanic membrane - and this has been called the “Red Drum Conundrum”. Total annulus excision (TAE) implies that the entire annulus is removed along with remnant of tympanic membrane during the procedure to surgically reconstruct a diseased membrane. TAE is an essential step of a broader technique of interlay technique. This novel Interlay technique’s basic premise is that - Once the graft is placed, there must not be any mucous membrane lateral to the graft and no epithelium medial to the graft. One very important benefit of TAE is neovascularization around the graft. Total annular excision is a new emerging technique of tympanoplasty as it gives patient a three layered physiologically and anatomically near natural membrane with good vibratory function without possibility of weeping membrane or granular myringitis. Key Words: Annulus, tympanoplasty, interlay, middle ear, tympanic membrane, Myringoplasty

Surgical versus Conservative Management of Granular Myringitis: A single-centre Randomized Control Trial

Background: Treatment of granular myringitis (GM) is diverse with no definitive management.&#x0D; Objective: The aim of the present study was to see the effectiveness of different interventions for treating granular myringitis.&#x0D; Methodology: This was a single centred, parallel, randomized control trial. This study was done at the Specialized ENT Hospital of SAHIC, Dhaka from July 2010 to June 2012. Patients presenting with granular myringitis of 18 years of age or more with both sexes were included. All patients were divided into two groups by simple random sampling method of which patients of group A were treated by surgical treatment and that of group B were treated by medical treatment. Medical treatment was given in the form of topical ear drops and surgical treatment was performed by surgical debridement of granulation tissue followed by chemical cauterization. Repeated follow up was performed up to 6 months in both groups of treated patients. The primary outcome was the resolution of granulation tissue. During follow-up the secondary outcome variables were recurrence, perforation of the TM and any other complications or complain from the patients.&#x0D; Results: A total number of 60 patients were studied of which 30 patients were treated medically and 30 patients were treated surgically. The cure rate was higher in surgical treatment (80%) than conservative (16.7%) (p=0.011). The recurrence rate (17.24%) is also less in surgical group compared to medical treatment group (77.27%) (p=0.001).&#x0D; Conclusion: Surgical treatment is a more successful treatment modality for granular myringitis.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 64-68

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

Abstract Objective Does the severity of disease influence outcomes in patients with granular myringitis (GM)? There is no classification and staging system on the severity of GM although it is not a very rare disorder. The aim of this study was to propose a novel classification and staging system for the patients with GM according to the type, extent, and sequelae of the lesions so that indications of various modalities of treatments for the different classes of the disease and their outcomes could be studied. Methods Data were retrieved from PubMed, Embase, and Cochrane Library. Relevant articles were also sought by a hand search review of references, books, and journals. The databases were searched using the keywords “granular myringitis,” “granular otitis externa,” “myringitis granulosa,” and “myringitis.” Data from the relevant articles were extracted using a pre-defined data-extraction form. Results After reviewing the various otoscopic findings, the study proposes a clinical and surgical GAS classification and staging of granular myringitis, which is based on the type of G ranulating lesion, A rea of involvement, and S equelae of the disease. On the basis of GAS classification, patients with GM are grouped into four stages that indicate the overall severity and prognosis of the disease and can be used for selecting various modalities of treatment and their outcomes. Conclusion The GAS classification is simple, descriptive, and comprehensive and would provide practical basis for the indications of different modalities of management and outcomes research in patients with GM. This would facilitate in knowing the prognostic impact of extent of granulations. This study has a 1a type level of evidence.

Clinical Efficiency of Castellani Solution for the Treatment of Granular Myringitis

This study is designed to observe the clinical efficiency of Castellani solution for the treatment of granular myringitis (GM). We have included 20 patients among which 15 men and 5 women of mean age, 49.7 years; range, 9–77 years; they were diagnosed with GM and treated with Castellani solution. Topical treatment using Castellani solution and otoendoscopy of tympanic membrane were performed and the follow-up period ranged from 3 to 72 months and the mean follow-up period was 14.4 months. 13 patients showed complete resolution of GM after treatment with Castellani solution. However, one patient had a persistent, small, wet lesion residual lesion. Topical application of Castellani solution is a simple and effective treatment for GM. This study confirms the use of Castellani solution for treatment of granular myringitis.

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

Though granular myringitis (GM) is not a very rare disease it does not have any classification. Its exact etiology is not known. The granulations on tympanic membrane also occur in association with other lesions of external auditory canal (EAC) and middle ear. The aims of this study were to know the etiological factors of GM and classify the disease according to its etiological factors and associated disorders of EAC and middle ear. Data were retrieved from the search of four electronic databases: PubMed, EMBASE, Cochrane Library, and Google scholar. Relevant articles were also sought by a hand search review of reference books. The databases were searched using the key words otitis externa, external otitis, granular myringitis, granular otitis externa and myringitis. Data were extracted using a pre-defined data-extraction form. The following data were recorded (1) etiological and predisposing conditions; (2) pathological features; (3) associated disorders of external and middle ear. The study proposes the etiological classification of GM. It suggests two major groups: primary and secondary. The primary GM is basically idiopathic and these patients do no have evidences of any other types of otitis media and otitis externa. In the secondary GM the cause is obvious and the patients usually have associated otitis media and/or lesions of external ear canal. Author speculates that habit of self ear cleaning/scratching is a specific etiological factor in cases of primary GM but more studies are required to confirm this theory.

Granular myringitis after middle ear surgery?

Granular myringitis after middle ear surgery?

Granular myringitis: current status of management

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;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.&lt;/span&gt;&lt;/p&gt;

Review of Otorrhea Microbiology

Identification of a causative pathogen in otologic infections assists in maximizing therapy efficacy particularly in refractory and chronic cases. Current standards for treatment of otologic infections focus on targeted species (spp.) that are assumed to be the most common pathogens. Corynebacterium spp. may play a pathogenic role but are not routinely speciated or included in antibiotic susceptibility analysis. Our objective is to investigate the prevalence and pathogenicity of nondiphtheroid Corynebacterium spp. in commonly encountered purulent and mucopurulent otologic infections. Retrospective case review. Academic tertiary referral center. Review of 140 microbiology cultures from adults and children presenting with purulent and mucopurulent otologic infections from 2010 to 2012. Clinical history, demographics, and microbiology cultures with speciation and antibiotic susceptibility analyses. Microbiologic speciation and census, species association with clinical characteristics, antibiotic susceptibility to oral and systemic agents, therapy frequency and agent selection. Corynebacterium spp. was the second most common bacteria isolated from patients with clinically significant otologic infections. Corynebacterium spp. were found in 24 (33.3%) unique patients with otologic infections and were the only pathogen isolated in six (8.33%) patients. Corynebacterium-positive infections were significantly associated with the use of hearing aids, a diagnosis of chronic granular myringitis, and less otalgia. Corynebacterium isolates were highly resistant to first-line fluoroquinolone therapy. The majority of patients with Corynebacterium-positive infections harbored at least one resistant strain, and patients with strains resistant to first-line topical therapy had a nonsignificant trend to an alteration in antibiotic therapy after antibiotic susceptibility data became available. Corynebacterium spp. may be underestimated in their potential to cause clinically significant otologic infections. Our results indicate a potential need for expanding surveillance for Corynebacterium spp.

Syringocystadenoma Papilliferum of the Bony External Auditory Canal: A Rare Tumor in a Rare Location

Tumors originating from ceruminous glands are rare lesions of the external auditory canal. The lack of specific clinical and radiological signs makes their diagnosis challenging. We report the case of an exceptionally rare benign tumor, a syringocystadenoma papilliferum (SCAP), in an atypical location in the bony segment of the external auditory canal with uncommon clinical signs. The special traits of the case included the following: the most lateral component of the tumor was macroscopically cystic and a granular myringitis with an obstructing keratin mass plug was observed behind the mass. The clinical, audiological, radiological, and histological characteristics of the neoplasm are consequently presented. Intraoperative diagnosis of the epidermal cyst was proposed. The final diagnosis of SCAP was determined only by histological analysis after the surgical excision. The educational aspects of the case are critically discussed.