Update : myringitis in a tympanic membrane graft

Kranti Bhavana
what do you do with myringitis in a tympanic membrane graft? Graft well taken up but surface keeps oozing and is always congested.....

· · · November 3 at 11:27pm

You and Ravi Sardesai like this.
- Pranabashish Banerjee will antibiotics, both topical and oral do any good?Isnt it an infection of the neotympanum
  November 3 at 11:38pm ·
- Suri Prabhu revision is indicated -
  November 3 at 11:51pm · · 3
- Harpreet Singh Kochar Has been happening since how long
  November 3 at 11:55pm via mobile ·
- Gautam Aggarwal Is it mucosalization of the graft ?
  November 3 at 11:57pm ·
- Vikas Malhotra steroid antibiotic drops...and oral antihistaminics
  November 4 at 2:18am ·
- Mohamed Mahaboob Shareef Try any steroid drops/ install betnovate cream. Acetyl salicalic acid preprations are worth a try OTEK AC drops ( if still available)
  November 4 at 2:20am ·
- Murthy S. Pusuluri Try chemical cauterization
  November 4 at 8:45am ·
- Rakesh Srivastava ACE ear drops+antibiotic steroid. First ACE later antibio+steroid. will respond in 3 days. Dr Kranti Bhavana.
  November 4 at 9:55am · · 1
- Suri Prabhu according to a colleague in Cochin - this is a good thing (monetarily) for the doctor - because the ear (and the attached patient) will have to visit the Ear specialist at least 5 or 6 times a year for the rest of his life - and each visit will be a standard protocol of -
  1. chemical cautery with phenol, or AgN03, TCA, or something like that-
  2. prescription of 2%acetic acid drops for 2 weeks
  3. when the patient asks - Doctor, why am i having this severe itching and fungus infection ? It was not so bad before the operation?" - the answer given by doctor is " Ear Drum is 100% intact - some red spots on the drum are causing the problem, but please do not use ear-buds"
  
  after about two years - the ear (and the attached person) get sick of the whole thing - and decide to visit that other "good" ENT doctor -
  and the original ENT doctor is happy and unhappy-
  
  happy because that damn ear is not interfering with his concept of 100% success in tympanoplasty-
  and probably unhappy because of the loss of a steady source of income-
  November 4 at 10:27am · · 4
- Vinod Felix Prabhu sir, is surgery necessary in all cases?..i have come across post op pts with myringitis which responded well with a short course antibiotic steroid drops && acetic acid drops...in my opinion surgery is necessary for only those pts who have a chronic problem..
  November 4 at 10:37am ·
- Suri Prabhu ‎^^yes -for the chronic post-operative ear - the problem in such post-operative ears is that the ear does well for two or three months and then the problem flares up again -
  the way i tend to look at this is-
  if the patient has to visit the ear specialist more than 6 times in the post-operative year - then the problem is chronic and will need revision-
  November 4 at 10:51am ·
- Neelam Vaid how does one try and prevent the same when doing revision
  November 4 at 11:38am · · 1
- Suri Prabhu ‎^^ Neelam Vaid -to cut a long story short - the entire drumhead (afflicted with myringitis) - has to go -
  and,before the new graft is placed, the surgeon has to make sure that all mucous membrane is medial to the graft- and that the lateral flap (which will be placed on the new graft) is free of mucous membrane-
  and yes, postoperative myringitis is (most likely) caused by allowing mucous membrane to reside lateral to the (underlaid) fascial graft -
  November 4 at 2:49pm · · 3
- Prahlada Nayaka Basavanthappa ‎Suri Prabhu: I presented this at Cholesteatoma and Mastoid surgery international congress at Hague, Netherlands in 2004. I told them entire TM should be excised and grafted. Initially people laughed at me. But I got support from unexpected corner. Prof. Mirko Tos, who is around here on facebook, got up and said, What I said is making sense. The mucosalisation of the lateral surface of the TM is troublesome. The mucin is highly irritant to the EAC skin.
  November 4 at 3:14pm · · 1
- Ajit Man Singh GV paint. apply GV paint on the graft 2-3 tmes a week for 2 weeks. This was tought to me by My Prof. and it works
  November 4 at 3:19pm · · 3
- Harpreet Singh Kochar It continued till our times too at institute and showed benefit. I practice this and chemical cautery. But am not facing this problem with graft now. The only thing is that GVP is sometimes messy as it tends to stain the skins and clothes and on occasion crusts form under which disease persists for which a saline irrigation and cleaning may need to be done weekly.
  November 4 at 3:32pm via mobile · · 1
- Gautam Aggarwal What is the mech of action of GV ?
  November 4 at 3:49pm ·
- Santosh Kumar Kacker eum under la and clean surface under microscope i.e denude, if not respondibng to local steroid like betnesol n ear drops.
  kacker s k
  November 4 at 4:34pm via · · 2
- Sudhir Halikar This is where the technique of surgery counts, interlay scores over others like underlay or hybrid ! In small perforations whenever I tempted to do hybrid [interlay posteriorly & underlay anteriorly] ,I always worried about this problem.
  November 4 at 5:15pm · · 2
- Suri Prabhu yes - Sudhir Halikar - the "RED DRUM CONUNDRUM" is a problem that is best avoided ab initio -
  November 4 at 5:46pm · · 1
- Neelam Vaid ‎Suri Prabhu..would you say that in the overlay technique chances of mucolisation happenning is less?
  November 4 at 8:54pm · · 1
- Suri Prabhu ‎^^ oh yes - Neelam Vaid - as long as any (potentially viable) mucous membrane is not allowed to remain lateral to the graft - and all of it (viable mucous membrane) remains medial to the graft -
  November 4 at 9:16pm ·
- Kranti Bhavana i am so excited to have recieved so many inputs from various corners...i shall try to tackle the problem with multi pronged approach and then see its effect....lets hope to have a positive effect!
  November 5 at 12:54am · · 1
- Prahlada Nayaka Basavanthappa The issue here is not myringitis actually. It is the mucosalization of the lateral surface of the tympanic membrane, which does not responds to various paints and burns easily.
  November 5 at 9:04am · · 4
- Kallakuri Suryanarayana At times we all face this, steroids antibiotics drops,no buds , mostly resolve
  November 6 at 11:07pm ·
- Ravi Meher i have found Gentian violet very useful in such condition. it promotes rapid epothelisation and drying of the ear. Useful in cases of non drying mastoid cavities also.
  November 7 at 6:24pm ·