Infectious Myringitis

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 is a self-limiting disorder that resolves spontaneously within 3 days to 2 weeks.

Acute infectious myringitis commonly follows acute otitis media or upper respiratory tract infection and frequently occurs epidemically in children. Chronic granular myringitis is a rare inflammation of the squamous layer of the tympanic membrane. Bullous myringitis causes retraction of the tympanic membrane due to negative pressure in the ear.

Causes

Myringitis is generally caused by an infection with a bacteria or virus. Sometimes, the infection starts in the eardrum. Most of the time, however, myringitis follows an infection in another part of the ear. Acute otitis media and swimmer''s ear can both lead to secondary myringitis. Upper respiratory infections, such as the flu or pneumonia , can predispose someone to ear infections.

Signs and Symptoms

The patient with acute infectious myringitis may complain of severe ear pain, commonly accompanied by tenderness over the mastoid process. In chronic granular myringitis, the patient's history may reveal pruritus, purulent discharge, and gradual hearing loss.

Otoscopic examination reveals small, reddened, inflamed blebs in the ear canal, on the tympanic membrane and, with bacterial invasion, in the middle ear Spontaneous rupture of these blebs may cause a blood, discharge. In chronic granular myringitis, examination may reveal granulation extending from the tympanic membrane to the external ear.

Fever and hearing loss are rare unless fluid accumulates in the middle ear or a large bleb completely obstructs the external auditory meatus.

Diagnostic tests

Culture and sensitivity testing of exudate identifies secondary infection.

Treatment

Hospitalization usually isn't required for patients with acute infectious myringitis. Treatment consists of:

• analgesics, such as aspirin or acetaminophen, to relieve pain
• application of heat to the external ear
• codeine for severe pain
• systemic or topical antibiotics to prevent or treat secondary infection
• incision of blebs and evacuation of serum and blood to relieve pressure and help drain exudate. (Note: 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.

Prevention

Some helpful measures to reduce the risk of myringitis include:

• avoiding prolonged immersion of the ear in water, such as a pool or hot tub
•  obtaining pneumonia and flu vaccines for children
• staying away from individuals with an upper respiratory infection
•  washing hands often