Myringitis (Middle Ear, Tympanic Membrane, Inflammation) Treatment & Management

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

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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]

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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.

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