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.