Introduction
Granular myringitis (GM) is first described by Politzer and Gruber in
1800s as “chronic inflammation of the membrane tympani. It occurs as
the result of primary acute myringitis, a sequel of a previous otitis
externa or of a perforating inflammation of the middle ear”. It is not
an uncommon clinical condition characterized by desquamation of the
tympanic membrane and the formation of granulations on the ear drum
which may extend to the external auditory canal (EAC). It is thought as
an idiopathic inflammatory disease of tympanic membrane and the etiology
is still poorly understood. Mohan Bansal had summarized the etiological
classification of GM: idiopathic, traumatic, especially after
ontological surgery, infection and chronic inflammation, and neoplasm
[1]. The presenting symptoms and physical finding can vary over a
broad range and sometimes confused with chronic otitis externa or
chronic otitis media. Because most symptoms of chronic myringitis are
relatively mild and nonspecific, it is often overlooked by clinical
practician. However, if left untreated, patients often experience
troublesome symptoms and affect quality of life. The treatment of
myringitis is diverse, including topical and systemic antimicrobial
agents, antiseptic solutions, cauterizing agents, curettage or more
aggressive surgical procedures [2]. The ideal treatment is still
elusive. Among these, CO2 laser is a novel option to
chronic focal GM. It has the advantages of less invasiveness and more
accurate procedures. Though the previous studies had demonstrated the
effectiveness of CO2 laser, there are lack of sample
size [3]. We would like to offer a study of 130 patients at a single
medical center to investigate two different strategies about managing
focal refractory granular myringitis, including carbon dioxide laser and
caustic agent solution. Our primary goal is to demonstrate
CO2 laser had a higher successful rate and less
complications. We also recorded the clinical course and character of GM
in our study.