Myringitis - Causes, Symptoms and Treatment

Definition:

Acute infectious myringitis is characterized by inflammation, hemorrhage, and effusion of fluid into the tissue at the end of the external car canal and the tympanic membrane. This self-limiting disorder (resolving spontaneously within 3 days to 2 weeks) often follows acute otitis media or upper respiratory tract infection and frequently occurs epidemically in children. Chronic granular myringitis, a rare inflammation of the squamous layer of the tympanic membrane, causes gradual hearing loss.

Causes of Myringitis

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.

Signs and Symptoms of Myringitis

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.

Diagnosis for Myringitis

In 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. In chronic granular myringitis, physical examination may reveal granulation extending from the tympanic membrane to the external ear. Differential diagnosis to consider include teething, tonsillitis, pharyngitis, and temporomandibular joint syndrome .

Treatment for Myringitis

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 the use of codeine. Since it is difficult to determine viral from bacterial or mycoplasmal otitis, antibiotic therapy as for acute otitis media is also indicated. Systemic or topical antibiotics 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 systemic antibiotics or local anti-inflammatory antibiotic combination eardrops, and surgical excision and cautery. If stenosis is present, surgical reconstruction is necessary.

Special Considerations and Prevention Tips for Myringitis

1. Stress the importance of completing the prescribed antibiotic therapy.

2. To help prevent acute infectious myringitis, advise early treatment of acute otitis media.

3. Teach the patient how to instill topical antibiotics (eardrops).

4. When necessary, explain the incision of the blebs to the patient.