Myringitis (Middle Ear, Tympanic Membrane, Inflammation) 

Updated: Oct 19, 2018
Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA 

Overview

Practice Essentials

The extremely thin and delicate tympanic membrane (TM) is the first component of the middle ear conductive system. The TM is easily traumatized, and diseases of the TM deprive patients of their ability to work and to enjoy life.

Myringitis, or inflammation of the TM, may be accompanied by hearing impairment and a sensation of congestion and earache. After 3 weeks, acute myringitis becomes subacute and, within 3 months, chronic.

The TM lies across the end of the external auditory canal (EAC) and looks like a flattened cone with its apex pointed inward as seen in the image below. The diameter of the TM is about 8-10 millimeters. Its outer surface is slightly concave.

Tympanic membrane (TM) as continuation of the uppe Tympanic membrane (TM) as continuation of the upper wall of external auditory canal (EAC) with angle of incline up to 45 degrees on the border between middle ear and the EAC.

The edge of the membrane is thickened and attached to a groove in an incomplete ring of bone, the tympanic annulus, which almost encircles it and holds the membrane in place as seen in the image below.

Normal tympanic membrane. Pars tensa (PT), pars fl Normal tympanic membrane. Pars tensa (PT), pars flaccida (PF), light reflex (LR), fibrous ring (FR), umbo (Um), handle of malleus (HM), lateral process of malleus (Lpm), anterior plica (AP), posterior plica (PP).

In newborns, the angle of incline of the TM is more than 30° relative to the horizontal plane. In addition, the TM in newborns is thicker than in adults; consequently, in the newborn, examining the TM is sometimes difficult.

The uppermost small area of the membrane, where the ring is open, is under no tension; this part is known as the pars flaccida. The majority of the membrane is tightly stretched; this is called the pars tensa. The loose part of the TM, or the pars flaccida, borders on the pars tensa from above and is considerably smaller, about one-eighth the size of the pars tensa. See the image below.

Mirror display of a tympanic membrane surface on t Mirror display of a tympanic membrane surface on the polymeric masc from external acoustical canal of healthy man. Masc of tympanic membrane surface (MtmS).

The physiologic function of the TM involves conduction of sound to the middle ear through a system of small bones, the ossicles. The surface of the TM is approximately 25 times larger than that of the stapes footplate, with the resulting amplification of sound to 45 decibels, or 27 times ambient volume levels. At the same time, the TM forms a safe shield with the round window of the labyrinth against direct sound waves. This window is necessary for movement of the liquid in the cochlea, providing for transmission of the sound to the acoustic receptors in the organ of Corti. In addition, the TM protects the gentle mucosa of the middle ear from the external environment.

Workup

Cultures may be obtained from middle ear fluid. Imaging studies that can be performed include the following:

  • Otomicroscopy with microscope or otoendoscopy with imaging display

  • Pneumatic otoscopy - Provides information on the appearance and mobility of the TM and is the preferred method for diagnosis

  • High-resolution computed tomography (CT) scanning of the temporal bones

  • Magnetic resonance imaging (MRI) - Useful for the evaluation of intracranial complications from otitis, but otherwise this modality tends to overestimate middle ear inflammatory processes

  • Acoustic otoscopy - A method to examine the TM using concurrent otoscopy and tympanometry; it is especially useful for children

Additional tests include the following:

  • Pure tone and speech audiometry - The shape of the audiogram for an individual with hearing loss can provide the otologist or audiologist with important information for determining the nature and cause of the hearing defect; the audiogram configuration of air conduction hearing loss can be used as an additional test for diagnosis of myringitis

  • Tympanometry - Tympanometry can provide evidence of fluid behind the eardrum, while multifrequency tympanometry has become an accepted objective method for determining the status of the middle ear, especially in regard to diagnosis of effusion

  • Infrared emission detection tympanic thermometry

Management

Seek emergency department or primary care when a patient presents with acute myringitis, suspected otitis media, external otitis, or foreign bodies in the ear. Analgesics, anti-inflammatory medications, antipruritics, and antihistamines may be prescribed.

In case of suppurative complications, perforated TM, or suspicion of mastoiditis, consultation with an otolaryngology (ENT) specialist is imperative.

A useful method of myringoplasty (surgical closure of a TM perforation), described by Heermann, uses a cartilaginous framework. The TM is supported by the cartilaginous palisade without affecting mobility.

Pathophysiology

Regarding diseases of the TM, discussion of pathophysiology includes the concrete causes, mechanisms, and common regularities of source, development, and termination of myringitis.

Myringitises can develop as self-maintained primary disease of the TM (primary myringitis) or as an effect of an inflammatory process of adjacent tissues of the external or middle ear (secondary myringitis). The etiology and pathogenesis of primary myringitis and secondary myringitis are significantly different, and they require different treatments. Therefore, they should be considered separately.

Etiology of primary myringitis

See the list below:

  • Acute myringitis can occur because of direct trauma to the TM through penetration by a foreign body.

  • Primary myringitis may also be caused by unsuccessful removal of a foreign body, such as a live insect, or it may occur during self-cleaning of the ear.

  • An explosion, a change in the pressure in an airplane cabin, a blow to the ear with the palm, or even a kiss in the ear can cause trauma to the TM.

  • Acute bullous myringitis can be the consequence of a bacterial infection such as Streptococcus pneumoniae or a viral infection such as influenza, herpes zoster, and others.

  • Acute hemorrhagic myringitis can also be the consequence of a bacterial or a viral infection.[1]

  • Fungal myringitis can be the consequence of a fungal infection of the TM's epidermis.

  • Eczematous myringitis can occur in cases of dermal eczema of the TM's epidermis.

  • Myringitis granulosa occurs when the TM is covered with granulation tissue. The causes of this destruction of the TM's epidermis are rarely clear, except when a similar case is demonstrated during a myringoplasty, when the epidermis perishes, or when the mucosa, expanding from a tympanic membrane perforation, erases an epidermis.

Etiology of secondary myringitis

See the list below:

  • Acute myringitis with acute otitis media

    • The TM is involved in the initial stage of acute otitis media (AOM), the stage when negative pressure is formed in the middle ear space.

    • During this time, the handle of the malleus, the lateral process of the malleus, and the TM bulge outward. The pars flaccida is also noticeably affected.

    • With the appearance of fluid in the middle ear, these phenomena disappear from the surface of the TM, so observing the fluid is possible.

    • The inflammatory process of an upper respiratory tract infection affects the TM in the form of myringitis. The TM becomes red and thickened, and the light reflex disappears.

    • Increased inflammation in the middle ear results in bulging of the TM with possible perforation. This is accompanied by intense earache and by typical clinical manifestations of AOM.

  • Acute myringitis with acute otitis externa

    • Acute myringitis can occur in cases of posttraumatic acute otitis externa.

    • Myringitis can be the consequence of bacterial acute otitis externa.

    • Myringitis can also be the consequence of viral acute otitis externa.

    • Fungal myringitis can occur in cases of fungal otitis externa.

    • Eczematous myringitis can occur in cases of dermal eczema of the external acoustic canal.

    • Acute myringitis can occur in cases of an exacerbation of chronic inflammation of the EAC.

    • See also Middle Ear, Acute Otitis Media, Surgical Treatment and Middle Ear, Acute Otitis Media, Medical Treatment.

  • Perforation of the tympanic membrane

    • In untreated patients, as middle ear pressure increases, the TM eventually perforates, pain decreases, and mucopurulent discharge with blood appears in the EAC.

    • In cases of favorable cessation of AOM, the inflammatory process and all the inflammatory phenomena gradually regress with restoration of the TM and normal hearing.

    • Similar phenomena occur in cases of viral myringitis (influenza). With viral myringitis, as with acute bullous myringitis, bubbles filled with blood form on the surface of the TM and burst with effusing blood; however, the TM is not perforated.

  • Chronic myringitis with chronic otitis media

    • In cases of adverse courses of the inflammatory process, perforation of the TM persists. Persisting perforation is one characteristic sign of chronic otitis media (COM).

    • Chronic inflammation of the TM accompanies inflammation of the middle ear. On the surface of the TM, the epidermis is actively displaced into the ear canal, and, in 15% of cases, it may penetrate through small perforations of the TM. As a result, the middle ear is isolated, with resulting long-term hearing impairment.

    • This takes place in cases in which the speed of mucosal displacement and that of epidermal displacement coincide. If perforation of the TM is considerable, the epidermis and the mucous membrane meet on the edge of the perforation.

    • Some evidence exists that chronic otitis media may be related to extra-esophageal reflux.[2]

  • Mucoepidermal conflict

    • If the speed of the epidermis displacement and that of the mucosal displacement are different, conflict, which is typical for chronic myringitis, develops.

    • When the redundant mucous membrane penetrates the perforation and extends over the edges of the dermis, growth of the epithelium ceases.

    • The maceration of the dermis and its tendency to grow into the injured tissue become the main sources of inflammation. Lacking the necessary support, the mucous membrane forms granulation tissue and polyps.

    • When redundant tissue has formed within the middle ear mucosa, the epidermis penetrates into the middle ear space through the edge of the perforated TM and expands there; it is exposed to desquamation, and cholesteatoma is formed.

    • All types of dermatitis of the external ear affect the TM, involving it in similar inflammation.

  • Chronic myringitis with chronic otitis externa

    • Chronic myringitis is often accompanied by chronic bacterial inflammation of the EAC.

    • Chronic myringitis can also be the consequence of viral chronic otitis externa.

    • Chronic fungal myringitis can occur in cases of chronic fungal otitis externa.

    • Chronic eczematous myringitis can occur in cases of chronic dermal eczema of the external acoustic canal.

    • See also Middle Ear, Acute Otitis Media, Surgical Treatment and Middle Ear, Acute Otitis Media, Medical Treatment.

Epidemiology

Frequency

United States

Approximately 8% of children age 6 months to 12 years with AOM have acute bullous myringitis.

Mortality/Morbidity

Morbidity from myringitis is correlated with morbidity in cases of otitis media, external otitis, and foreign bodies in the ear.

Race

Data on racial distributions of TM diseases have not been collected. See also Middle Ear, Otitis Media with Effusion.

Sex

Males and females are affected by diseases of the TM with equal frequency.

Age

People of all ages are affected.

 

Presentation

History

Generally, the patient presents with a 2- to 3-day history of ear congestion and mild hearing loss. Patients often have a history of self-cleaning of the EAC, trauma, or penetration of water into the EAC. Sensations of heaviness and slight pain in the ear are common. Sometimes an itch is present in the EAC, or discharge from it is noted.

Physical

The TM has long been recognized as the true mirror of the middle ear, with all its changes reflected on the surface of the TM. In the case of AOM, examining the changes related to all stages of inflammation on the surface of the TM is possible. Otoscopy allows examination of the tensed grey-blue membrane with reflected light directed into the lower front section. The TM has identifiable items, such as the light reflect, the umbo, the handle of the malleus, the lateral process of the malleus, the lenticular process of the incus, and the anterior and posterior plicae of the TM.

Typical otoscopic examination results are as follows:

  • In cases of acute myringitis, the TM is evidently altered by the inflammatory process; it is red and deformed, and the light reflex is shortened or disappears completely.

  • Acute hemorrhagic myringitis can be the consequence of a bacterial infection such as S pneumoniae or a viral infection. Differential diagnoses for a red tympanic membrane are widely varied and include malformations, traumas, infections, and even tumors and other degenerative pathologies.

  • Acute bullous myringitis can also be the consequence of a bacterial or viral infection.

  • Myringitis granulosa, when the TM is covered with granulation tissue, may be observed.

  • When acute otitis has resolved, recognizing perforations of the TM is possible. These perforations are characterized by scarring (myringosclerosis) and areas of calcification.

  • In cases of chronic myringitis, the TM is perforated, with inflamed edges and granulation tissue.

  • Hearing loss may be noted.

  • Discharge from the EAC is present in some cases.

  • Some children experience pain upon traction of the pinna.

Causes

Determining the cause of the TM inflammation is important to treat both it and the accompanying and subsequent processes of otitis media and external otitis.

Bacterial causes of TM inflammation include the following:

  • Staphylococcus pyogenes and Staphylococcus aureus

  • Escherichia coli and Klebsiella species

  • S aureus and Streptococcus epidermidis

  • Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis (causes of about 70% of cases) - In a pooled analysis of 10 observational studies of children aged 3 months to 5 years with AOM, Van Dyke et al found that severe TM inflammation was more likely to be a presenting symptom in cases that were positive for H influenzae than in those that were positive for S pneumoniae[3]

  • Bacillus fragilis and Peptostreptococcus species

  • Pseudomonas aeruginosa, Proteus mirabilis, and S aureus

  • Mycoplasma pneumoniae (bullous myringitis)

  • Trichophyton rubrum in the external auditory meatus

  • Mycobacterium tuberculosis

  • Corynebacterium species - A retrospective study of cultures from adult and pediatric patients who presented with purulent and mucopurulent otologic infections found corynebacteria in 24 patients (33.3%), with a significant relationship indicated between Corynebacterium-positive infections and the presence of chronic granular myringitis[4]

Other causes include the following:

  • Fungal infection

  • Viral infection (eg, herpes zoster, influenza)

  • Eczematous otitis externa, which can cause eczematous myringitis

  • Granulation tissue covering the TM

  • Extra-esophageal reflux[2]

  • Chronic myringitis, which is often accompanied by chronic inflammation of the middle ear or the EAC (Chronic myringitis is often mistaken for chronic otitis media. Such confusion prolongs the initiation of appropriate management and sometimes leads to needless tympanomastoid surgery. The ENT specialist should be aware of this clinical entity and its varied presentation.)

  • Chronic inflammation of the TM with perforation, which may also occur as a result of a condition developing at the junction between the skin and the mucous membrane (Retraction of the TM is clinically important because failure to do so is a possible cause of atelectasis, ossicular erosion, and cholesteatoma.)

For more information, see Otitis Media, External Ear, Infections, External Ear, Malignant External Otitis, and External Ear, Inflammatory Diseases.

 

DDx

Diagnostic Considerations

These include the following:

  • Sensorineural hearing loss

  • Chronic myringitis

  • Cholesteatoma

Differential Diagnoses

 

Workup

Laboratory Studies

See the list below:

  • No laboratory tests are needed to make the diagnosis of myringitis. Cultures may be obtained from middle ear fluid. In addition, some evidence suggests that examination of middle ear fluid for the ratio of albumin to immunoglobulin G may determine whether the fluid is a transudate or exudate.[5]

  • Also see the following articles:

    • Middle Ear, Otitis Media with Effusion

    • External Ear, Inflammatory Diseases

    • External Otitis

    • Complications of Otitis Media

Imaging Studies

See the list below:

  • Otomicroscopy with microscope or otoendoscopy with imaging display

  • Pneumatic otoscopy - Provides information on the appearance and mobility of the TM and is the preferred method for diagnosis

  • High-resolution computed tomography (CT) scanning of the temporal bones

  • Magnetic resonance imaging (MRI) - Useful for the evaluation of intracranial complications from otitis, but otherwise this modality tends to overestimate middle ear inflammatory processes

  • Acoustic otoscopy - A method to examine the TM using concurrent otoscopy and tympanometry; it is especially useful for children

Other Tests

See the list below:

  • Pure tone and speech audiometry: This consists of an oscillator, or signal generator; an amplifier; and an attenuator, which controls and specifies the intensity of tones produced. The shape of the audiogram for an individual with hearing loss can provide the otologist or audiologist with important information for determining the nature and cause of the hearing defect. The audiogram configuration of air conduction hearing loss can be used as an additional test for diagnosis of myringitis.

  • Tympanometry: Tympanometry can provide evidence of fluid behind the eardrum, while multifrequency tympanometry has become an accepted objective method for determining the status of the middle ear, especially in regard to diagnosis of effusion.

  • Infrared emission detection tympanic thermometry

Procedures

See the list below:

  • Gentle cleaning of the EAC

  • Irrigation of the EAC for removal of the debris (may be contraindicated if the status of the TM is unknown)

  • Tympanocentesis: A small puncture is made in the TM with a needle to permit entry into the middle ear. This procedure permits culture and identification of the offending agent in situations in which this information is vital.

  • Myringotomy: In cases of AOM, myringotomy and removal of fluid prevents bursting of the TM when it bulges. It contributes to faster relief of systems, and the resulting incision usually heals quickly.

  • Tympanostomy with insertion of a tube into the middle ear to allow drainage: This is the most frequently performed otolaryngologic procedure in the United States; however, permanent perforation is possible.

In a study of 248 pediatric patients who received tympanostomy tubes and postoperative otic drop therapy, Conrad et al found that occlusion of the tubes was most prevalent in patients with middle ear fluid and in those with longer time to postsurgical follow-up. The investigators, who conducted a retrospective medical record review, found that at first follow-up, one or both tubes were occluded in 10.6% of patients. Children with no serous fluid were found to be 3 times more likely to be free of tube obstructions than were children with fluid. It was also found that the chance of occlusion increased in relation to the amount of time that existed between surgery and follow-up.[6, 7]

 

Treatment

Medical Care

 

Seek emergency department or primary care when a patient presents with acute myringitis, suspected otitis media, external otitis, or foreign bodies in the ear.

Analgesics, anti-inflammatory medications, antipruritics, and antihistamines may be prescribed.

In case of suppurative complications, perforated TM, or suspicion of mastoiditis, consultation with an otolaryngology (ENT) specialist is imperative.

The advice of the skilled ENT specialist is required to choose appropriate medication and to ensure successful treatment of chronic myringitis accompanied by perforation of the TM.

Specific treatment of TM perforation includes the following:

  • Solutions of alcohol containing salicylic acid stimulate growth of the epithelium, which is very useful if the growth rate of the epithelium is diminished; however, when in contact with the mucosae of the middle ear, alcohol can cause earache and excessive irritation of the mucosae with subsequent increased secretion of mucus
  • Aqueous solutions may help to eliminate inflammation of the mucosae in the middle ear, but they cause maceration of the epidermis in the auditory canal; in addition, granulation tissue or polyps must be removed

A literature review by Chung et al found that the reported resolution rates for myringitis treated with topical agents or laser-assisted therapy were highly variable, ranging from 63.6-100% and from 20-85.7%, respectively. According to the investigators, such variability indicates a need for appropriate patient selection. However, the investigators also stated that well-designed randomized studies evaluating optimal myringitis treatment are lacking.[8]

Surgical Care

Untreated chronic perforation may result in exacerbation of COM and myringitis. Closure of perforations is also indicated in patients who enjoy water activities. Surgical closure of the TM perforation is called myringoplasty. Today, myringoplasty has made such viable progress that, in 70-90% of cases, a new TM is actually formed. A study from the United Kingdom of 495 myringoplasties (by 33 ENT surgeons) found an overall closure rate of 89.5%; successful primary myringoplasties were associated with an average hearing gain of 9.14 dB.[9]

Methods of partial surgical closure of TM perforations have been proposed. They consist of removing the epithelium from the edges of the perforation, covering it with film or paper on which the epidermis and the mucosa continue to grow, and, occasionally, blocking the perforation. However, such film is very thin and can be destroyed merely by sneezing. This procedure is typically reserved for perforations of less than 10%.

A useful method of myringoplasty, described by Heermann, uses a cartilaginous framework. The TM is supported by the cartilaginous palisade without affecting mobility. Other techniques have used temporalis fascia and loose areolar tissue as graft material.

  • Preoperative details: The basic condition for preparation of the TM for myringoplasty is absence of moisture and infection.

  • Intraoperative details: Intraoperative details are related to the anatomic features of the ear canal, the range of abnormalities to the middle ear, and the method of myringoplasty chosen by the surgeon.

  • Postoperative details: The ear should be kept dry. The patient should avoid positions and activities that place undue pressure on the graft. An antibiotic-soaked packing is left in the external canal through days 7-14. Remove at follow-up visitation and begin administration of eardrops for 7-10 days.

The aforementioned literature review by Chung et al found that surgery studies reported better myringitis resolution rates (95.8-100%) than did those assessing treatment with topical agents or laser-assisted therapy.[8]

Activity

Many surgeons postpone swimming until the ear is completely healed, or up to 6 months. In addition, some surgeons recommend water precautions during bathing for several weeks.

 

Medication

Medication Summary

Controlled studies of effective antibiotics in various countries demonstrate 80-90% efficacy. See also Otitis Media.

Myringitis is quite painful, and patients frequently request analgesics. Ortophenum, or acetaminophen with codeine (Tylenol #3), is commonly prescribed. See also Otitis Media; External Ear Infections; External Ear, Malignant External Otitis; and External Ear, Inflammatory Diseases.

Good results occur with use of acidifying agents such as acetic acid solution. See External Ear Infections; External Ear, Malignant External Otitis; and External Ear, Inflammatory Diseases.

Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who experience pain.

Diclofenac (Cataflam, Voltaren)

Has anti-inflammatory, antipyretic, and analgesic effects. In terms of anti-inflammatory and antipyretic activity, this is much stronger than salicylic acid derivatives, ibuprofen, and butadionum.

Acetaminophen with codeine (Tylenol #3, Ortophenum)

Indicated for the treatment of mild-to-moderate pain.

Keratolytic agents

Class Summary

These agents cause cornified epithelium to swell, soften, macerate, and then desquamate. CAUTION: Any use of ototopical medications should be used with the knowledge of whether a tympanic membrane perforation exists and whether the medication has any ototoxic potential.

Salicylic acid topical

May be used as local antiseptic and keratolytic with some benefit. By dissolving the intercellular cement substance, salicylic acid produces desquamation of the horny layer of skin, while not affecting the structure of the viable epidermis.

Acidifying agents

Class Summary

These agents lower pH levels, which makes the environment unfavorable to microbial growth. CAUTION: Any use of ototopical medications should be used with the knowledge of whether a tympanic membrane perforation exists and whether the medication has any ototoxic potential.

Acetic acid (VoSol)

Works well in superficial bacterial infections of otitis externa.

 

Follow-up

Further Outpatient Care

See the list below:

  • Carry out general antibacterial and anti-inflammatory therapy on outpatient basis.

  • Remove the packing from the canal after 7-14 days. Clean out the canal and recommend eardrops 3 times per day until healing is complete.

Inpatient & Outpatient Medications

See the list below:

  • See External Ear, Inflammatory Diseases and External Otitis, Complications of Otitis Media.

Deterrence/Prevention

See the list below:

  • Advise patients to protect ears from water in pools or in the shower and to avoid trauma to the EAC and the TM from removal of earwax. Patients who have recurrent episodes of myringitis should be taught to use 70% propyl alcohol or acidifying drops after every exposure to water.

Complications

See the list below:

  • See Middle Ear, Chronic Suppurative Otitis, Surgical Treatment

  • See Complications of Otitis Media

  • Hearing loss (both sensorineural and conductive)

  • Tympanic membrane perforation

  • Facial Paralysis

  • Vertigo/dizziness

  • Extension of suppurative process to surrounding structures (coalescent mastoiditis, meningitis, abscess, sigmoid sinus thrombosis)

Prognosis

See the list below:

  • In most cases, patients with myringitis have a favorable prognosis.

  • As a rule, the prognosis is favorable. In case of destruction of the new TM, the surgeon may assess the reasons for the failure and repeat myringoplasty with necessary corrections.

Patient Education

See the list below:

  • Instruct patients to protect the EAC from penetration of water while washing hair or taking a shower.

  • For excellent patient education resources, visit eMedicineHealth's Ear, Nose, and Throat Center. Also, see eMedicineHealth's patient education articles Earache and Earwax.

 

Questions & Answers

Overview

What is myringitis?

How is myringitis diagnosed?

What is the role of audiometric testing in the diagnosis of myringitis?

What is the role of tympanic testing in the diagnosis of myringitis?

How is myringitis treated?

What is the pathophysiology of myringitis?

What causes primary myringitis?

What causes acute myringitis with acute otitis media?

What causes acute myringitis with acute otitis externa?

What causes perforation of tympanic membrane in myringitis?

What causes chronic myringitis with chronic otitis media?

What causes mucoepidermal conflict relative to myringitis?

What causes chronic myringitis with chronic otitis externa?

What is the prevalence of myringitis in the US?

What is the morbidity associated with myringitis?

What are the racial predilections of myringitis?

What are the sexual predilections of myringitis?

Which age groups have the highest prevalence of myringitis?

Presentation

Which clinical history findings are characteristic of myringitis?

What is the focus of the physical exam to evaluate myringitis?

Which findings on otoscopic exam are characteristic of myringitis?

What are the bacterial causes of myringitis?

Other than bacteria, what causes TM inflammation in myringitis?

DDX

Which conditions should be considered in the differential diagnosis of myringitis?

What are the differential diagnoses for Myringitis (Middle Ear, Tympanic Membrane, Inflammation)?

Workup

What is the role of lab testing in the diagnosis of myringitis?

What is the role of imaging studies in the workup of myringitis?

What is the role of pure tone and speech audiometry in the workup of myringitis?

What is the role of tympanometry in the workup of myringitis?

Which invasive procedures may be performed in the diagnosis of myringitis?

What is the role of tympanostomy in the treatment of myringitis?

Treatment

What is included in the medical treatment of myringitis?

When is consultation with an otolaryngology (ENT) specialist indicated for the treatment of myringitis?

How is tympanic membrane (TM) perforation treated in myringitis?

What is the efficacy of myringitis treatments?

What is the role of myringoplasty in the treatment of myringitis?

Which activity modifications are used in the treatment of myringitis?

Medications

Which medications are used in the treatment of myringitis?

Which medications in the drug class Acidifying agents are used in the treatment of Myringitis (Middle Ear, Tympanic Membrane, Inflammation)?

Which medications in the drug class Keratolytic agents are used in the treatment of Myringitis (Middle Ear, Tympanic Membrane, Inflammation)?

Which medications in the drug class Analgesics are used in the treatment of Myringitis (Middle Ear, Tympanic Membrane, Inflammation)?

Follow-up

What is included in postoperative care following myringoplasty to treat myringitis?

How is myringitis prevented?

What are the possible complications of myringitis?

What is the prognosis of myringitis?

What is included in patient education about myringitis?