Chronic myringitis: Prevalence, presentation, and natural history

Objective: The aim of this study was to examine the clinical presentation a nd natural history of chronic myringitis (CM). Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Chronic myringitis is defined as a loss of tympanic membrane epit helium for >1 month without disease within the tympanic cavity. Seven hundr ed fifty patient records were reviewed to determine the prevalence of CM in an academic otology practice. The records of 40 patients (45 ears) with CM seen between 1995 and 1999 inclusive were reviewed. Main Outcome Measures: The series was reviewed with attention to previous m edical and otologic history, the nature and duration of symptoms. the physi cal findings, and management. Results: The prevalence of CM was found to be similar to1% (approximately one fourth as common as cholesteatoma). Sympto ms were often present for many years before the diagnosis of CM, with CM of ten mistaken for chronic otitis media. Sixty percent of patients had underg one previous otologic procedures. There did not appear to be an association between CM and systemic disease. Physical findings were varied, with granu lation tissue and tympanic membrane perforations often occurring transientl y. The clinical course of CM is typified by recurrent episodes of symptoms, often interspersed with long asymptomatic periods. A subset of CM can resu lt in an acquired atresia. The most effective treatment appeared to be prol onged topical medications, surgery being reserved for only the most refract ory cases. Conclusions: Chronic myringitis is often mistaken for chronic otitis media. Such confusion prolongs the initiation of appropriate management and somet imes leads to needless tympanomastoid surgery. The otologist should be awar e of this clinical entity and its varied presentation.