What is tympanogenic myringitis?
Myringitis is the isolated inflammation of the tympanic membrane — the thin membrane that separates the ear canal from the middle ear. The term "tympanogenic" emphasizes that the condition originates in the tympanic membrane, without involvement of the middle ear. It is a clinical entity distinct from otitis media and otitis externa.
Clinical forms
Bullous (vesicular) myringitis
The best-known form, frequently associated with respiratory viral infections. Hemorrhagic or serous blisters appear on the eardrum. The pain is extremely intense. It can be caused by:
- Respiratory viruses (influenza, adenoviruses)
- Mycoplasma pneumoniae
- Herpes simplex or varicella-zoster (rare)
Chronic granular myringitis
A chronic, rarer form, with granulation tissue on the eardrum. It presents with persistent otorrhea and mild hearing loss.
Symptoms
- Severe otalgia — pulsatile, intense pain with sudden onset, often nocturnal
- Tenderness to touch — pain increases when pulling the auricle
- Otorrhagia — mild bleeding from the ear canal (when hemorrhagic blisters rupture)
- Mild transient hearing loss
- Absence of fever — unlike acute otitis media
- Frequent viral context — cold symptoms in the preceding days
Diagnosis
The diagnosis is otoscopic — direct visualization of the eardrum with an otoscope or video otoendoscopy:
- Bullous myringitis — transparent or hemorrhagic blisters on the eardrum, without the bulging seen in otitis media
- Tympanometry — type A (normal), confirming that the middle ear does not contain fluid
Treatment
Analgesics
Priority: pain control. Ibuprofen or paracetamol. Ear drops with local anesthetic in severe cases.
Blister myringotomy
If the blisters are tense and the pain unbearable, incision under endoscopic guidance provides immediate relief.
Anti-infective treatment
Antibiotics only if bacterial superinfection is suspected. Macrolides (azithromycin) if Mycoplasma is suspected.
Prognosis
Complete healing in 7-14 days, without auditory sequelae. Recurrences are rare.
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