Tutorial - Granular and Bullous Myringitis

Granular Myringitis

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

Symptoms and Signs

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

The images show two cases of granular myringitis.


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

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

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.

Symptoms and Signs

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.

Two cases of bullous myringitis


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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