Efficacy of carbon dioxide laser and caustic agent cauterisation for the focal granular myringitis: A randomised trial

Objectives Granular myringitis (GM) is a troublesome disease with a high incidence of recurrence and relapse. CO2 laser vaporisation and trichloroacetic acid (TAA) have been applied in treating several otological diseases, both with favourable therapeutic efficacy. However, long-term therapeutic efficacy of both CO2 laser vaporisation and TAA cauterisation against GM has not yet been evaluated. We aimed to investigate the therapeutic potential of CO2 laser vaporisation and TAA cauterisation in GM management.Study Design Prospective and randomised study.Participants A total of 88 GM patients who failed therapy with boric acid, alcohol and glycerin ear drop otic solution between July 2009 and January 2018 were included. Participants were randomly assigned to receive CO2 laser vaporisation (n = 39) or TAA cauterisation (n = 49).Main Outcome Measures Main outcomes were treatment success, complications after 4 months of treatment, and recurrence within 4-12 months after treatment.Results The success rate was significantly higher in the CO2 group than in the TAA group (94.9% vs. 77.6%, p = .023). After 4 months of treatment, the GM recurrence rate was comparable between the two groups (13.5% vs. 18.4%, p = .562). The CO2 laser group had one case of perforation and one case of severe vertigo, whereas one participant in the TAA cauterisation group experienced hearing loss.Conclusion Both TAA cauterisation and CO2 laser vaporisation are safe and effective treatments for GM. The success rate of CO2 laser vaporisation for treating GM is higher than that of TAA cauterisation. Recurrence rates are comparable within 1 year.