What is the treatment for myringitis?

Treatment of Myringitis

For myringitis, surgical excision of granulation tissue combined with cauterization is the most effective treatment, with dilute vinegar solution (acetic acid) serving as a highly effective, non-invasive alternative that reduces recurrence by 96% compared to conventional antibiotic therapy. 1

Initial Management Approach

Acute Granulomatous Myringitis

• Remove granulation tissue mechanically using small cup forceps, followed by cauterization with 20% trichloroacetic acid 2
• Two to three treatment sessions typically achieve complete healing within approximately 30 days 2
• This approach prevents progression to chronic disease and has minimal recurrence rates 2

Chronic Granular Myringitis

The treatment strategy depends on disease severity and patient tolerance:

First-Line Treatment:

• Dilute vinegar solution (acetic acid) applied topically demonstrates 96% reduction in recurrence compared to conventional therapy 1
• This represents a logical, safe alternative to antibiotic drops with superior outcomes 1

Second-Line Treatment:

• Surgical excision of granulation tissue results in 80% reduction in recurrence compared to conventional antibiotic therapy 1
• Indicated when topical therapy fails or disease progresses 1

Novel Therapy for Refractory Cases:

• Topical 5-fluorouracil 5% cream applied three times at two-week intervals shows highly significant improvement in both symptoms and granulation tissue reduction 3
• This treatment proved safe with no serious local reactions or complications 3
• Follow-up at two years demonstrated sustained disease control 3

Why Conventional Antibiotics Fail

Topical antibiotic and steroid drops are less efficacious and more likely to lead to symptom recurrence compared to the interventions described above 1. The disease involves chronic inflammation of the lateral tympanic membrane surface with persistent granulation tissue, which responds poorly to antimicrobial therapy alone 4, 5.

Critical Pitfalls to Avoid

• Do not rely on conventional antibiotic-steroid drops as primary therapy - they have inferior outcomes and higher recurrence rates 1
• Do not delay mechanical removal in acute cases - untreated granular myringitis can progress to post-inflammatory medial external auditory canal fibrosis, acquired canal atresia, and inflammatory infiltration of the deep canal 1
• Do not confuse with acute otitis media - myringitis involves the tympanic membrane itself without middle ear involvement and requires different management 4, 5

Treatment Algorithm

1. Acute presentation with granulomatous bulge: Mechanical removal with cup forceps + 20% trichloroacetic acid cauterization 2

2. Chronic granular myringitis (first episode): Trial of dilute vinegar solution topically 1

3. Persistent or recurrent disease after vinegar therapy: Surgical excision of granulation tissue 1

4. Refractory cases despite surgical excision: Topical 5-fluorouracil 5% cream (three applications at two-week intervals) 3

5. Follow-up: Monitor every two weeks initially, then long-term surveillance to detect recurrence 3, 2