Acute infectious myringitis is characterized by inflammation, hemorrhage, and effusion of fluid into the tissue at the end of the external ear canal and the tympanic membrane. This self-limiting disorder (resolving spontaneously within 3 days to 2 weeks) commonly follows acute otitis media or upper respiratory tract infection and commonly occurs epidemically in children.
Chronic granular myringitis, a rare inflammation of the squamous layer of the tympanic membrane, causes gradual hearing loss. Without specific treatment, this condition can lead to stenosis of the ear canal, as granulation extends from the tympanic membrane to the external ear.
Acute infectious myringitis usually follows viral infection but may also result from infection with bacteria (pneumococci, Haemophilus influenzae, betahemolytic streptococci, staphylococci) or any other organism that may cause acute otitis media. Myringitis is a rare sequela of atypical pneumonia caused by Mycoplasma pneumoniae. The cause of chronic granular myringitis is unknown.
Acute infectious myringitis begins with severe ear pain, commonly accompanied by tenderness over the mastoid process. Small, reddened, inflamed blebs form in the canal, on the tympanic membrane and, with bacterial invasion, in the middle ear.
Fever and hearing loss are rare unless fluid accumulates in the middle ear or a large bleb totally obstructs the external auditory meatus. Spontaneous rupture of these blebs may cause bloody discharge. Chronic granular myringitis produces pruritus, purulent discharge, and gradual hearing loss.
With acute infectious myringitis, the diagnosis is based on a physical examination showing characteristic blebs and on a typical patient history. Culture and sensitivity testing of exudate identifies secondary infection. With chronic granular myringitis, physical examination may reveal granulation extending from the tympanic membrane to the external ear.
Hospitalization isn’t usually required for acute infectious myringitis. Treatment consists of measures to relieve pain. Administration of an analgesic, such as aspirin or acetaminophen, and application of heat to the external ear are usually sufficient, but severe pain may necessitate the use of codeine.
A systemic or topical antibiotic can prevent or treat secondary infection. Incision of the blebs and evacuation of serum and blood may relieve pressure and help drain exudate, but these measures don’t speed recovery.
Treatment of chronic granular myringitis consists of a systemic antibiotic or local anti-inflammatory antibiotic combination eardrops, and surgical excision and cautery. If stenosis is present, surgical reconstruction is necessary.
❑ Stress the importance of completing prescribed antibiotic therapy.
❑ Teach the patient how to instill the topical antibiotic (eardrops). When necessary, explain incision of the blebs.
CLINICAL TIP: To help prevent acute infectious myringitis, advise early treatment of acute otitis media.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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