Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
Department of Otorhinolaryngology, Universiti Malaya Faculty of Medicine, Kuala Lumpur, Malaysia.
J Int Adv Otol. 2024 Sep 26;20(5):458-461. doi: 10.5152/iao.2024.231292.
Granular myringitis is a chronic inflammatory condition of the tympanic membrane that does not involve the middle ear. Various treatment modalities have been proposed for the treatment of granular myringitis, but there is no standard treatment regime. A 60-year-old woman had left persistent ear discharge for 4 months. Examination revealed diffuse granulation tissue, forming a pseudomembrane at the medial aspect of the ear canal and obstructing the tympanic membrane. An audiogram revealed mild-to-moderate left-sided conductive hearing loss. She was treated with multiple courses of ear drop antibiotics but had no improvement. The decision for surgical intervention was driven by the presence of a grade IV medial meatal stenosis, the potential risks associated with prolonged medical management, the distressing impact on the patient's life, and a shared decision-making process. A combined transcanal and postauricular endoscopic approach whereby excision of the granulation tissue, canalplasty, and myringoplasty were performed. She exhibited complete symptom resolution and reported an improved quality of life. This approach yielded successful symptom resolution, highlighting its potential in managing refractory chronic granular myringitis. We aimed to carefully weigh the risks of surgery against its potential benefits in a refractory chronic case, acknowledging the inherent risks and disadvantages of surgical interventions. Further studies are warranted to evaluate the long-term outcomes and benefits of this approach.
鼓膜肉芽炎是一种不涉及中耳的慢性鼓膜炎症。已经提出了各种治疗方式来治疗鼓膜肉芽炎，但没有标准的治疗方案。一位 60 岁的女性左耳持续有耳漏已经 4 个月了。检查发现弥漫性肉芽组织，在耳道内侧形成假膜并阻塞鼓膜。听力图显示左侧中重度传导性听力损失。她曾接受多次耳部滴注抗生素治疗，但没有改善。由于存在 IV 级内耳道狭窄、长期药物治疗相关的潜在风险、对患者生活的困扰影响以及共同决策过程，决定进行手术干预。采用经耳道和耳后联合内镜方法，切除肉芽组织、耳道成形术和鼓膜成形术。她的症状完全缓解，生活质量得到改善。这种方法成功地缓解了症状，突出了其在治疗难治性慢性鼓膜肉芽炎方面的潜力。我们旨在仔细权衡手术的风险与其在难治性慢性病例中的潜在益处，同时认识到手术干预的固有风险和缺点。需要进一步的研究来评估这种方法的长期结果和益处。
