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. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center and private otology practice. PATIENTS: 94 patients presenting with GM over 28 years. INTERVENTION: Diagnosis by otoscopy, audiometry, radiology, and bacteriology; long-term follow-up (6 months to 12 years); assessment of treatment results. MAIN OUTCOME MEASURES: 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.