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.
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 (pneumococcus, Haemophilus influenzae, beta-hemolytic streptococci, staphylococci) or any other organism that can 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 frequently occurs epidemically in children.
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.
Hospitalization usually isn’t required for acute infectious myringitis. Treatment consists of measures to relieve pain: analgesics, such as aspirin or acetaminophen, and application of heat to the external ear are usually sufficient, but severe pain may necessitate use of codeine.
Systemic or topical antibiotics prevent or treat secondary infection. Incision of blebs and evacuation of serum and blood may relieve pressure and help drain exudate but don’t speed recovery.
Treatment for chronic granular myringitis consists of systemic antibiotics 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 the prescribed antibiotic therapy.
❑ Teach the patient how to instill topical antibiotics (eardrops). When necessary, explain incision of blebs.
❑ To help prevent acute infectious myringitis, advise early treatment for acute otitis media.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Myringitis, acute infectious (Handbook of Diseases)
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