Results
Total 130 patients with granular myringitis receiving treatment from July 2009 to January 2018 were enrolled. Patients’ age ranged from 11 to 93 year-old (mean age, 58.6). There were 72 male and 58 female, yielding a male to female ratio of 1.24:1. The granular myringitis were unilateral in 128 patients (98.4%) and bilateral in 2 patients (1.6%).
The presenting symptoms of granular myringitis in our 130 cases were shown in table 1. The most common symptom was otorrhea, presented in 86 patients (66.1%). In fact, most patients have two or more non-specific complaints which can be confused with the symptoms of otitis media or otitis externa. Although most symptoms are not life-threatening, but they really bothered the patients’ life quality.
Of all the enrollment, 47 patients(36.1%) had received previous otologic surgery on the affected ear, and the category of the surgery was shown in Table 2. The most common physical finding of ear drum on otoscope are a moist area where epithelium layer is absent, often covered with granulation. The most common site of involvement is posterior-inferior quadrant (76/130, 58.5%) (Figure 3). We excluded the extensive disease such as diffused granulation or disease involved to external auditory canal.
The microbiology was analyzed in otorrhea patients, especially purulent discharge. The most common bacteria cultured in our patients is Staphylococcus aureus, followed by Pseudomonas aeruginosa. [4]
All 130 patients were randomly divided into two groups, CO2 laser group, and caustic agent with TAA group. They had received eardrops treatment as first for at least 1 month. Only 29 cases (22.3%) had total remission after 1-month treatment, the other failed the treatment due to symptom persist, still granulation found or only partial remission. These patients who failed to ear drop treatment transferred to surgery group and received CO2 laser vaporization or caustic agents (TAA) cauterization randomly. Excluded those who refused surgery or loss followed up, a total 91 cases received the surgery. 39 cases in CO2 laser group and 49 cases in TAA caustic agent group. The other 3 cases received other surgical treatment such as conventional cold knife excision or myringoplasty. After four months followed up, 37 cases(94.9%) of CO2laser group had successful treatment with no pathologic finding on ear drum and improvement of clinical symptoms. In caustic agent group, only 38 cases (79.2%) had the successful treatment. The CO2laser group had significantly higher successful rate than the TAA group (χ2=5.175 p=0.023). In recurrence, CO2laser group and TAA group had similar results (13.5% vs 18.4%, χ2 = 0.336, p = 0.562). (Table. 3)
The post-operation complication is rare and self-limited. Only one eardrum perforation and one severe vertigo was noted in CO2 laser group, one hearing impairment in TAA group, but all of them recovered after supportive care. (Table. 3) The pre-operative and post-operative pure tone audiogram (PTA) result showed no obvious influence of hearing function in focal granular myringitis. The most common finding of HRCT showed thickening eardrum and some case showed adhesive drum.