Myringitis (Middle Ear, Tympanic Membrane, Inflammation) Workup

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• No laboratory tests are needed to make the diagnosis of myringitis. Cultures may be obtained from middle ear fluid. In addition, some evidence suggests that examination of middle ear fluid for the ratio of albumin to immunoglobulin G may determine whether the fluid is a transudate or exudate. ^[6]

• Also see the following articles:

  • Middle Ear, Otitis Media with Effusion

  • External Ear, Inflammatory Diseases

  • External Otitis

  • Complications of Otitis Media

See the list below:

• Otomicroscopy with microscope or otoendoscopy with imaging display

• Pneumatic otoscopy - Provides information on the appearance and mobility of the TM and is the preferred method for diagnosis

• High-resolution computed tomography (CT) scanning of the temporal bones

• Magnetic resonance imaging (MRI) - Useful for the evaluation of intracranial complications from otitis, but otherwise this modality tends to overestimate middle ear inflammatory processes

• Acoustic otoscopy - A method to examine the TM using concurrent otoscopy and tympanometry; it is especially useful for children

See the list below:

• Pure tone and speech audiometry: This consists of an oscillator, or signal generator; an amplifier; and an attenuator, which controls and specifies the intensity of tones produced. The shape of the audiogram for an individual with hearing loss can provide the otologist or audiologist with important information for determining the nature and cause of the hearing defect. The audiogram configuration of air conduction hearing loss can be used as an additional test for diagnosis of myringitis.

• Tympanometry: Tympanometry can provide evidence of fluid behind the eardrum, while multifrequency tympanometry has become an accepted objective method for determining the status of the middle ear, especially in regard to diagnosis of effusion.

• Infrared emission detection tympanic thermometry

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• Gentle cleaning of the EAC

• Irrigation of the EAC for removal of the debris (may be contraindicated if the status of the TM is unknown)

• Tympanocentesis: A small puncture is made in the TM with a needle to permit entry into the middle ear. This procedure permits culture and identification of the offending agent in situations in which this information is vital.

• Myringotomy: In cases of AOM, myringotomy and removal of fluid prevents bursting of the TM when it bulges. It contributes to faster relief of systems, and the resulting incision usually heals quickly.

• Tympanostomy with insertion of a tube into the middle ear to allow drainage: This is the most frequently performed otolaryngologic procedure in the United States; however, permanent perforation is possible.

In a study of 248 pediatric patients who received tympanostomy tubes and postoperative otic drop therapy, Conrad et al found that occlusion of the tubes was most prevalent in patients with middle ear fluid and in those with longer time to postsurgical follow-up. The investigators, who conducted a retrospective medical record review, found that at first follow-up, one or both tubes were occluded in 10.6% of patients. Children with no serous fluid were found to be 3 times more likely to be free of tube obstructions than were children with fluid. It was also found that the chance of occlusion increased in relation to the amount of time that existed between surgery and follow-up. ^{[7, 8]}