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CC BY-NC-ND 4.0 · Annals of Otology and Neurotology 2018; 01(02): 077-082
DOI: 10.1055/s-0038-1676914
Original Article
Indian Society of Otology

A Novel Classification and Staging System to Address Prognosis and Treatment Decisions for Patients with Granular Myringitis

Mohan Bansal
1   C. U. Shah Medical College, Surendranagar, Gujarat, India
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Publication History

Publication Date:
04 January 2019 (online)

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Abstract

Objective Does the severity of disease influence outcomes in patients with granular myringitis (GM)? There is no classification and staging system on the severity of GM although it is not a very rare disorder. The aim of this study was to propose a novel classification and staging system for the patients with GM according to the type, extent, and sequelae of the lesions so that indications of various modalities of treatments for the different classes of the disease and their outcomes could be studied.

Methods Data were retrieved from PubMed, Embase, and Cochrane Library. Relevant articles were also sought by a hand search review of references, books, and journals. The databases were searched using the keywords “granular myringitis,” “granular otitis externa,” “myringitis granulosa,” and “myringitis.” Data from the relevant articles were extracted using a pre-defined data-extraction form.

Results After reviewing the various otoscopic findings, the study proposes a clinical and surgical GAS classification and staging of granular myringitis, which is based on the type of G ranulating lesion, A rea of involvement, and S equelae of the disease. On the basis of GAS classification, patients with GM are grouped into four stages that indicate the overall severity and prognosis of the disease and can be used for selecting various modalities of treatment and their outcomes.

Conclusion The GAS classification is simple, descriptive, and comprehensive and would provide practical basis for the indications of different modalities of management and outcomes research in patients with GM. This would facilitate in knowing the prognostic impact of extent of granulations.

This study has a 1a type level of evidence.

Keywords

granular myringitis - tympanic membrane - external auditory canal - myringitis - otitis - classification - staging - review
 

  • References

  • 1 Bansal M. Essentials of Ear, Nose and Throat. 1st ed. New Delhi, Jaypee Brothers Medical Publishers, 2016:85–94
  • 2 Bansal M. Diseases of Ear, Nose and Throat. 2nd ed. New Delhi, Jaypee Brothers Medical Publishers, 2018:198–209
  • 3 Bansal M. Granular myringitis: Current status of management. Int J Otorhinolaryngol Head Neck Surg 2015; 1: 55-57
    CrossrefGoogle Scholar
  • 4 Wolf M, Primov-Fever A, Barshack I, Polack-Charcon S, Kronenberg J. Granular myringitis: Incidence and clinical characteristics. Otol Neurotol 2006; 27 (08) 1094-1097
    CrossrefPubMedGoogle Scholar
  • 5 Kim YH. Clinical characteristics of granular myringitis treated with castellani solution. Eur Arch Otorhinolaryngol 2011; 268 (08) 1139-1146
    CrossrefPubMedGoogle Scholar
  • 6 Atef AM, Hamouda MM, Mohamed AH, Fattah AF. Topical 5-fluorouracil for granular myringitis: a double-blinded study. J Laryngol Otol 2010; 124 (03) 279-284
    CrossrefPubMedGoogle Scholar
  • 7 Blevins NH, Karmody CS. Chronic myringitis: prevalence, presentation, and natural history. Otol Neurotol 2001; 22 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 8 El-Seifi A, Fouad B. Granular myringitis: is it a surgical problem?. Am J Otol 2000; 21 (04) 462-467
    Google Scholar
  • 9 Levi JR, Ames JA, Gitman L, Morlet T, O’Reilly RC. Clinical characteristics of pediatric granular myringitis. Otolaryngol Head Neck Surg 2013; 148 (02) 291-296
    CrossrefPubMedGoogle Scholar
  • 10 Bansal M. Why Cannot We have an Etiological Classification for the Patients with Granular Myringitis?. Indian J Otolaryngol Head Neck Surg 2017; 69 (03) 397-400
    CrossrefPubMedGoogle Scholar
  • 11 Cheng YF, Shiao AS. Intractable chronic myringitis treated with carbon dioxide laser microsurgery. Arch Otolaryngol Head Neck Surg 2008; 134 (02) 152-156
    CrossrefPubMedGoogle Scholar
  • 12 Jang CH, Kim YH, Cho YB, Wang PC. Endoscopy-aided laser therapy for intractable granular myringitis. J Laryngol Otol 2006; 120 (07) 553-555
    CrossrefPubMedGoogle Scholar
  • 13 Wolf M, Primov-Fever A, Barshack I, Kronenberg J. Granular myringitis in children. Int J Pediatr Otorhinolaryngol 2001; 57 (01) 17-20
    CrossrefPubMedGoogle Scholar
  • 14 Zhang Z, Liu X, Chen S, Zheng Y. Combined tympanic epithelial layer avulsion and overlay myringoplasty for diffuse granular myringitis. J Laryngol Otol 2010; 124 (08) 842-845
    CrossrefPubMedGoogle Scholar
  • 15 Hoshino T, Ueda Y, Mukohdaka H, Mizuta K. Acute granulomatous myringitis. J Laryngol Otol 1998; 112 (02) 150-153
    CrossrefPubMedGoogle Scholar
  • 16 Boedts D. Myringitis granulosa. Acta Otorhinolaryngol Belg 1995; 49 (02) 187-189
    PubMedGoogle Scholar
  • 17 Fechner FP, Cunningham MJ, Eavey RD. Laser therapy for refractory myringitis in children. Otolaryngol Head Neck Surg 2002; 127 (03) 163-168
    CrossrefPubMedGoogle Scholar
  • 18 Jung HH, Cho SD, Yoo CK, Lim HH, Chae SW. Vinegar treatment in the management of granular myringitis. J Laryngol Otol 2002; 116 (03) 176-180
    CrossrefPubMedGoogle Scholar
  • 19 Yinglin Z. Three cases of chronic granular myringitis cured by formalin. J Otolaryngol 1985; 14 (06) 379-380
    PubMedGoogle Scholar
  • 20 Stoney P, Kwok P, Hawke M. Granular myringitis: a review. J Otolaryngol 1992; 21 (02) 129-135
    PubMedGoogle Scholar
  • 21 Makino K, Amatsu M, Kinishi M, Mohri M. The clinical features and pathogenesis of myringitis granulosa. Arch Otorhinolaryngol 1988; 245 (04) 224-229
    CrossrefPubMedGoogle Scholar