ព្រះរាជាណាចក្រកម្ពុជា

Tutorial - Granular and Bullous Myringitis

Granular Myringitis

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This is a chronic disorder where the outer layer of the eardrum loses its epithelium and is replaced by granulations.

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Symptoms and Signs

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There may be mild discomfort and a discharge from the ear. Sometimes this is smelly.

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The images show two cases of granular myringitis.

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Treatment

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This can be very difficult to treat. Try the following:

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1.  1:1 solution of white vinegar and boiled water. Apply drops of this twice daily for three weeks.

2. Topical antibiotic drops as for otitis externa

3. Surgical removal of granulations

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If you patient does not respond to simple applications and cleaning you should refer to the ENT Department for consideration of surgery.

Bullous Myringitis​

This may be bacterial (strep pneumoniae, Staphylococci), viral (influenza or herpes zoster virus) or fungal.

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Symptoms and Signs

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These are often painful and there may be a conductive hearing loss. The ear will show blisters on the drum or in the ear canal and these may be filled with clear of bloody fluid.

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Two cases of bullous myringitis

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Treatment

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Treat these as you would acute otitis media. Pain relief and antibiotics are needed. Bursting the blisters does not really help so you should leave them alone.

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