Myringosclerosis

Myringosclerosis refers to the calcification and thickening of the tympanic membrane.

Terminology

It is similar but not entirely synonymous with the term tympanosclerosis where myringosclerosis, the calcium deposition is primarily on the eardrum where as is tympanosclerosis, calcium deposition appear on the eardrum and the middle ear structures.

Epidemiology

Myringoscleorsis is usually seen in children, with a reported incidence of 28%-61% of all patients treated with tympanostomy tubes ².

A case of myringosclerosis has been reported in a two-year-old infant ¹.

Clinical presentation

It is usually an asymptomatic condition ¹.

If sclerosis affects large areas of the tympanic membrane with extension to the handle of malleus or bony annulus, the function of the drum will be reduced, leading to conductive hearing loss ¹.

In otoscopy, it's seen as white, 'chalky' plaques in the tympanic membrane.

Pathology

Myringosclerosis is secondary to calcification and hyalinization of the connective tissue of the tympanic membrane ¹.

These changes are thought to be caused by long-term inflammation, in which collagen fibers are destroyed, and replaced by exudate with granulation tissue ¹.

Intraepithelial hemorrhages in a post-traumatic setting e.g. myringotomy can heal by fibrosis, leading to myringosclerosis ^1_.

Etiology

Myringosclerosis is usually sequelae of: 

• inflammation

  • chronic otitis media

  • otitis media with effusion

• trauma

  • myringotomy

  • tympanostomy tube placement

• other

  • atherosclerosis: some studies suggested a relation between calcium deposit in the tympanic membrane and carotid arteries  ²

Radiographic features

CT

HR-CT of the temporal bone demonstrates thickened, and calcified tympanic membrane.

Treatment and prognosis

Myringosclerosis is not treated if asymptomatic.

If the sclerotic plaques are adherent to the head of the malleus and the bony annulus, with substantial fixation of the drum, surgical removal of the scar tissue may be performed in association with a tympanoplasty ¹.

Differential diagnosis

The main differential to consider is tympanosclerosis, in which the sclerotic plaques extend beyond the tympanic membrane reaching the ossicular chain and the tympanic cavity.  

See also

• chronic otomastoiditis with tympanosclerosis