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Management of granular myringitis: A systematic review

Published online by Cambridge University Press:  25 June 2007

L J Neilson  and
S S M Hussain
L J Neilson
Affiliation:
University of Dundee Medical School and the Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
S S M Hussain*
Affiliation:
University of Dundee Medical School and the Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland, UK
*
Address for correspondence: Mr S S Musheer Hussain, Consultant Otolaryngologist, Level 5, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK. Fax: +44 1382 632 816 E-mail: [email protected]
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Abstract

Introduction:

Granular myringitis is a chronic disorder characterised by lateral squamous de-epithelialisation and granulation of the tympanic membrane. Untreated, granular myringitis can lead to post-inflammatory medial external auditory canal fibrosis, acquired canal atresia and inflammatory infiltration of the deep canal.

Aim:

This study aimed to establish optimal management strategies which could be applied to clinical practice, through systematic review of the current literature.

Methods:

Current literature was obtained by searching evidence-based medical databases, the Cochrane database, the Database of Abstracts of Reviews of Effects, the Cochrane controlled trials register, Ovid Medline, the various British Medical Journal imprint journals, individual journal websites and citation indexes, and by hand-searching current journals. Detailed inclusion criteria were set. Data were retrieved from the selected studies and checked for accuracy and consistency. The primary outcome measured was the effect of the proposed intervention on recurrence of granular myringitis, compared with empirical antibiotic therapy.

Results:

Fifty-eight publications were identified, dating from 1964 to 2005; 46 of these were potentially relevant. After assessment using the preset inclusion criteria, only two studies remained. El-Seifi and Fouad (2000) found that surgical excision of granulation tissue resulted in an 80 per cent reduction in recurrence of granular myringitis when compared with conventional antibiotic therapy. However, Jung et al. (2002) demonstrated a 96 per cent reduction in granular myringitis recurrence when managed with dilute vinegar solution.

Conclusions:

There was a reduced recurrence of granular myringitis in both studies' intervention groups, although neither study was randomised or blinded, making it difficult to assess the clinical relevance of the results. However, the following conclusions can be inferred. (1) Conventional topical antibiotic and steroid drops appear to be less efficacious and more likely to lead to recurrence of symptoms, compared with other proposed treatment modalities. (2) Treatment with dilute vinegar solution presents a logical, unharmful alternative to conventional antibiotic drops. Further research of high value is needed.

Keywords

MyringitisOtitisOtitis ExternaTympanic MembraneReview
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 1 , January 2008 , pp. 3 - 10
Copyright
Copyright © JLO (1984) Limited 2007

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References

1Blevins, NH, Karmody, CS. Chronic myringitis: prevalence, presentation, and natural history. Otol Neurotol 2002;22:3–10CrossRefGoogle Scholar
2Ludman, H, Wright, A. Diseases of the Ear, 4th edn.London: Arnold Press, 1998;217Google Scholar
3Kunachak, S. Intractable granular myringitis: possible etiology and management. J Otolaryngol 1992;21:297–8Google ScholarPubMed
4El-Seifi, A, Fouad, B. Granular myringitis: is it a surgical problem? Am J Otol 2000;21:462–7Google ScholarPubMed
5Stoney, P, Kwok, P, Hawke, M. Granular myringitis: a review. J Otolaryngol 1992;21:297–8Google ScholarPubMed
6Jung, HH, Cho, SD, Yoo, CK, Lim, HH, Chae, SW. Vinegar treatment in the management of granular myringitis. J Laryngol Otol 2002;116:176–80CrossRefGoogle ScholarPubMed
7Hwang, JH, Chu, CK, Liu, TC. Changes in bacteriology of discharging ears. J Laryngol Otol 2002;116:686–9CrossRefGoogle ScholarPubMed
8Slattery, WH, Saadat, P. Postinflammatory medial canal fibrosis. Am J Otol 1997;18:294–7Google ScholarPubMed
9Lavy, J, Fagan, P. Chronic stenosing external otitis/post-inflammatory acquired atresia: a review. Clin Otolaryngol 2000;25:435–9CrossRefGoogle Scholar
10Khalifa, MC, Fouly, SE, Bassiouny, A, Kamel, M. Granular myringitis. J Laryngol Otol 1982;96:1099–101CrossRefGoogle ScholarPubMed
11Roland, PS, Dohar, JE, Lanier, BJ, Hekkenburg, R, Lane, EM, Conroy, PJ et al. CIPRODEX AOMT study group. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of granulation tissue in children with acute otitis media with otorrhea through tympanostomy tubes. Otolaryngol Head Neck Surg 2004;130:736–41CrossRefGoogle Scholar
12Lee, KJ. Essential Otolaryngology, 6th edn.New York: McGraw-Hill Professional, 1995;681Google Scholar
13Oxford Centre for Evidence-based Medicine. http://www.cebm.net/levels_of_evidence.asp [9 March 2006]Google Scholar
14Hwang, JH, Tsai, H, Liu, TC. Community acquired MRSA infections in discharging ears. Acta Otolaryngol 2002;122:827–30CrossRefGoogle ScholarPubMed
15Fechner, FP, Cunningham, MJ, Eavey, RD. Laser therapy for refractory myringitis in children. Otolaryngol Head Neck Surg 2002;127:163–8CrossRefGoogle ScholarPubMed
16Hannley, MT, Denneny, JC, Holzer, SS. Use of ototopical antibiotics in treating three common ear diseases. Otolaryngol Head Neck Surg 2000;122:934–40CrossRefGoogle Scholar
17Biomedcentral. http://www.biomedcentral.com/1472-6815/3/1 [10 March 2006]Google Scholar
18Lundy, LB, Graham, MD. Ototoxicity and ototopical medications: a survey of otolaryngologists. Am J Otol 1993;14:141–6Google ScholarPubMed
19Albers, FWJ. Complications of otitis media – the importance of early recognition. Am J Otol 1999;20:9–12Google ScholarPubMed
20Jang, CH, Park, SY. Emergence of ciprofloxacin resistant pseudomonas in CSOM. Clin Otolaryngol 2004;29:321–3CrossRefGoogle Scholar
21MacFadyen, C, Gamble, C, Garner, P, Macharia, I, MacKenzie, I, Mugwe, P et al. Topical quinolone versus antiseptic for treating chronic suppurative otitis media: a randomised controlled trial. Trop Med Int Health 2005;10:190–7CrossRefGoogle Scholar
22Wai, TKH, Tong, MCF. A benefit risk assessment of ofloxacin otic solution in ear infection. Drug Safety 2003;26:405–20CrossRefGoogle ScholarPubMed
23Indorewala, S. Dimensional stability of free fascia grafts: clinical application. Laryngoscope 2005;115:278–82CrossRefGoogle ScholarPubMed
24Dohar, JE. Evolution of management approaches for otitis externa. Pediatr Infect Dis J 2003;22:299–308CrossRefGoogle ScholarPubMed
25Roland, PS. The formation and management of middle ear granulation tissue in chronic ear disease. Ear Nose Throat J 2004;83:5–8CrossRefGoogle ScholarPubMed
26Aminifarshidmehr, N. The management of chronic suppurative otitis media with acid media solution. Am J Otol 1996;17:24–5Google ScholarPubMed
27Schapowal, A. Otitis externa: a clinical overview. Ear Nose Throat J 2002;81:21–2Google ScholarPubMed
28Tos, M, Balle, V. Post-inflammatory acquired atresia of the external auditory canal: late results of surgery. Am J Otol 1986;7:365–70Google Scholar
29Ong, YK, Chee, G. Infections of the external ear: a review. Ann Acad Med Singapore 2005;34:330–4CrossRefGoogle Scholar
30Coates, H, Hawke, M, Manning, SC, Vesterhauge, S. Strategies for managing granulation tissue. Ear Nose Throat J 2003;82:21–4Google ScholarPubMed
31Zapalac, JS, Billings, KK, Schwade, ND, Roland, PS. Suppurative complications of acute otitis media in the era of antibiotic resistance. Arch Otolaryngol Head Neck Surg 2002;128:660–3CrossRefGoogle ScholarPubMed
32Hoshino, T, Ueda, Y, Mukohdaka, H, Mizuta, K. Acute granulomatous myringitis. J Laryngol Otol 1998;112:150–3CrossRefGoogle ScholarPubMed
33Giridharan, W, Papanikolou, V, Knight, L. ‘Buzz’ in the ear. Ear Nose Throat J 2004;82:83CrossRefGoogle Scholar
34Morais, D, Dalmau, J, Bernat, A, Ayerbe, V. Granular myringitis [in Spanish]. Acta Otorrinolaringol Esp 1989;40:43–5Google ScholarPubMed
35Kashiwamura, M, Chida, E, Matsumura, M, Nakamaru, Y, Suda, N, Terayama, Y et al. The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections. Otol Neurotol 2004;25:9–13CrossRefGoogle ScholarPubMed
36Makino, K, Amatsu, M, Kinishi, M, Mohri, M. The clinical features and pathogenesis of myringitis granulosa. Arch Otorhinolaryngol 1988;245:224–9CrossRefGoogle ScholarPubMed
37Wolf, M, Primov-Fever, A, Barshack, I, Kronenberg, J. Granular myringitis in children. Int J Pediatr Otorhinolaryngol 2001;57:17–20CrossRefGoogle ScholarPubMed
38Jang, CH, Kim, YH, Cho, YB, Wang, PC. Endoscopy-aided laser therapy for intractable granular myringitis. J Laryngol Otol 2006;10:1–3Google Scholar
39Puls, T. Tympanoplasty using conchal cartilage graft. Acta Otorhinolaryngol Belg 1996;57:187–91Google Scholar
40Stoney, P, Kwok, P, Hawke, M. Granular myringitis: a review. J Otolaryngol 1992;21:297–8Google ScholarPubMed
41Yinglin, Z. Three cases of granular myringitis cured by Formalin. J Otolaryngol 1985;14:379–80Google ScholarPubMed
42Zhu, F, Zhang, Q, Yu, H, Zhang, X, Yu, A. Evaluation of healing effect for simultaneous tympanoplasty in treating chronic suppurative otitis media with cholesteatoma and/or granulation tissue [in Chinese]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2004;18:547–8Google ScholarPubMed
43Schroeder, A, Darrow, DH. Management of the draining ear in children. Pediatr Ann 2004;33:843–53CrossRefGoogle ScholarPubMed
44Jung, HH, Cho, SD, Yoo, CK, Lim, HH, Chae, SW. Is vinegar solution useful in the treatment of granular myringitis? Focus on Alternative and Complementary Therapies 2002;7:261Google Scholar
45Eliashar, R, Gross, M, Saah, D, Elidan, J. Vestibular involvement in myringitis bullosa. Acta Otolaryngol 2004;124:249–52CrossRefGoogle ScholarPubMed
46Terayama, Y, Takizawa, M, Gotouda, H, Sutou, S, Kashiwamura, M. Effects of Burrow's solution as an ear drop on intractable chronic suppurative diseases of the external ear canal and middle ear [in Japanese]. Nippon Jibiinkoka Gakkai Kaiho 2003;106:28–33CrossRefGoogle Scholar
47Sade, J. Granular external otitis. Ann Otol Rhinol Laryngol 1962;71:391–6CrossRefGoogle ScholarPubMed
48Ramsey, AM. Diagnosis and treatment of the child with a draining ear. J Pediatr Health Care 2002;16:161–9CrossRefGoogle ScholarPubMed
49Boedts, D. Myringitis granulosa. Acta Otorhinolaryngol Belg 1995;49:187–9Google ScholarPubMed
50Fitzgerald, DC. Chronic myringitis: prevalence, presentation, and natural history. Otol Neurotol 2001;22:709CrossRefGoogle ScholarPubMed
51Lien, CF, Chang, CP. Clinical experience of surgical management in granular myringitis. Journal of Taiwan Otolaryngology Head and Neck Surgery 1996;31:47–51Google Scholar
52Lien, CF, Chang, CP. Otozambon ear drops in the treatment of granular myringitis. Journal of Taiwan Otolaryngology Head and Neck Surgery 1995;30:12–17Google Scholar
53Mehta, DK, ed. British National Formulary 50, 2005. London: BMJ Publishing Group and Royal Pharmaceutical Society of Great Britain, 2005Google Scholar