Myringitis granulosa
Definition:
Granular myringitis (Myringitis granulosa) is a specific form of otitis externa. It is characterized by the presence of granulation tissue on the lateral aspect of the ear drum sometimes with involvement of external auditory canal.
Synonyms:
1. Granular myringitis
2. Granulating myringitis
3. Granulomatous otitis externa
4. Chronic myringitis
5. Acute granulomatous myringitis
Histopathology:
Specimen for HPE is easy to obtain.
Features:
1. Oedematous granulation tissue with capillaries and diffuse infiltration of chronic inflammatory cells.
2. There is no lining epithelium over these granulation tissue
Etiology:
1. High ambient temperature
2. Swimming
3. Lack of personal hygiene
4. Exposure to local irritants
5. Foreign bodies
6. Bacterial and fungal infections
7. Occasionally may complicate grafted ear drum
Symptoms:
1. Foul smelling discharge from the involved ear
2. There is very little or negligible pain
3. There may be fullness / irritation in the affected ear
4. Hearing is nearly normal
5. Some patients may be totally asymptomatic
Signs:
The ear drum is covered with purulent secretions, which on removal reveals the underlying granulation tissue. Granulations may be localized or diffuse. The localized form of granulations are the most common, here small areas of the drum are affected, with formation of one or more polyps. These granulations are common over the postero superior margin of the ear drum. These granulations may also affect the adjacent wall. Despite all these signs the ear drum is intact.
All these patients must under go pure tone audiometric evaluation to rule out middle ear pathology.
Management:
Localized form:Meticulous microscopic debridement will help. Topical administration of steroid / antibiotic ear drops will help These patients should be treated over a prolonged period to time. Application of caustic agents like formalin / trichloroacetic acid can be tried. In refractory cases surgical removal of granulations can be attempted.
