{"id":63420,"date":"2026-06-23T15:08:35","date_gmt":"2026-06-23T08:08:35","guid":{"rendered":"https:\/\/www2.si.mahidol.ac.th\/en\/?p=63420"},"modified":"2026-06-23T15:09:24","modified_gmt":"2026-06-23T08:09:24","slug":"efficacy-of-diluted-vinegar-in-treating-granular-myringitis-a-randomized-controlled-trial","status":"publish","type":"post","link":"https:\/\/www2.si.mahidol.ac.th\/en\/highlights\/efficacy-of-diluted-vinegar-in-treating-granular-myringitis-a-randomized-controlled-trial\/","title":{"rendered":"Efficacy of Diluted Vinegar in Treating Granular Myringitis: A Randomized Controlled Trial"},"content":{"rendered":"<div id='av_section_1'  class='avia-section av-av_section-be5469b648f3c66bc848ea728be917cc main_color avia-section-small avia-no-border-styling  avia-builder-el-0  el_before_av_section  avia-builder-el-first  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-63420'><div class='entry-content-wrapper clearfix'>\n<div  class='avia-button-wrap av-av_button-8f046c302bf8e134ae065fff93ecd902-wrap avia-button-left  avia-builder-el-1  avia-builder-el-no-sibling '>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_button-8f046c302bf8e134ae065fff93ecd902\">\n#top #wrap_all .avia-button.av-av_button-8f046c302bf8e134ae065fff93ecd902{\nfont-size:21px;\nbackground-color:#ffffff;\nborder-color:#ffffff;\ncolor:#0b5ebd;\nborder-style:solid;\ntransition:all 0.4s ease-in-out;\n}\n#top #wrap_all .avia-button.av-av_button-8f046c302bf8e134ae065fff93ecd902:hover{\nbackground-color:#ffffff;\ncolor:#0b5ebd;\ntransition:all 0.4s ease-in-out;\n}\n#top #wrap_all .avia-button.av-av_button-8f046c302bf8e134ae065fff93ecd902 .avia-svg-icon svg:first-child{\nfill:#0b5ebd;\nstroke:#0b5ebd;\n}\n#top #wrap_all .avia-button.av-av_button-8f046c302bf8e134ae065fff93ecd902:hover .avia-svg-icon svg:first-child{\nfill:#0b5ebd;\nstroke:#0b5ebd;\n}\n<\/style>\n<a href='https:\/\/www2.si.mahidol.ac.th\/en\/highlights\/'  class='avia-button av-av_button-8f046c302bf8e134ae065fff93ecd902 av-link-btn avia-icon_select-yes-left-icon avia-size-large avia-position-left'   aria-label=\"Our Highlights\"><span class='avia_button_icon avia_button_icon_left avia-svg-icon avia-font-svg_entypo-fontello' data-av_svg_icon='left-thin' data-av_iconset='svg_entypo-fontello'><svg version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"31\" height=\"32\" viewBox=\"0 0 31 32\" preserveAspectRatio=\"xMidYMid meet\" aria-labelledby='av-svg-title-1' aria-describedby='av-svg-desc-1' role=\"graphics-symbol\">\n<title id='av-svg-title-1'>Left-thin<\/title>\n<desc id='av-svg-desc-1'>Left-thin<\/desc>\n<path d=\"M7.68 24l-7.68-8 7.68-8v5.12h23.68v5.696h-23.68v5.184z\"><\/path>\n<\/svg><\/span><span class='avia_iconbox_title' >Our Highlights<\/span><\/a><\/div>\n\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><div id='av_section_2'  class='avia-section av-av_section-f22f0f9dd672aac3df52cf5913f6ac08 main_color avia-section-default avia-no-border-styling  avia-builder-el-2  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap fullsize'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-full alpha units'><div class='post-entry post-entry-type-page post-entry-63420'><div class='entry-content-wrapper clearfix'>\n<div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-3  el_before_av_three_fifth  avia-builder-el-first  first flex_column_div  '     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-4  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mqqcyo6f-69345b341abfdd1308a9b9052ad2f594\">\n.avia-image-container.av-mqqcyo6f-69345b341abfdd1308a9b9052ad2f594 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-mqqcyo6f-69345b341abfdd1308a9b9052ad2f594 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-mqqcyo6f-69345b341abfdd1308a9b9052ad2f594 av-styling- avia-align-center  avia-builder-el-5  avia-builder-el-no-sibling '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-63421 avia-img-lazy-loading-not-63421 avia_image ' src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/floral-ear-design-on-teal-background-2026-03-24-03-23-16-utc.jpg\" alt='' title='Illustration of human ear with hearing aid made of natural flowers on green background. 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class='avia_textblock'  itemprop=\"text\" ><h2>Efficacy of Diluted Vinegar in Treating Granular Myringitis: A Randomized Controlled Trial<\/h2>\n<\/div><\/section><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-11  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  '     ><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-12  el_after_av_one_fifth  el_before_av_three_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-13  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><p><section  class='av_textblock_section av-mqqczxc8-b6a2bcb87beade7f0ce14b3982319be3 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-63422\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-200x300.jpg\" alt=\"\" width=\"200\" height=\"300\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-200x300.jpg 200w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-687x1030.jpg 687w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-768x1152.jpg 768w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-1024x1536.jpg 1024w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-1000x1500.jpg 1000w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752-470x705.jpg 470w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/06\/S__89800752.jpg 1045w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/p>\n<p><em>Assistant Professor Sarun Prakairungthong, MD<\/em><br \/>\n<em>Department of Otorhinolaryngology<\/em><br \/>\n<em>Faculty of Medicine Siriraj Hospital, Mahidol University<\/em><\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mqqd31kk-fc4b122e71d9c0c0d8843106dc0d1aa8\">\n#top .av_textblock_section.av-mqqd31kk-fc4b122e71d9c0c0d8843106dc0d1aa8 .avia_textblock{\ncolumn-count:2;\n}\n<\/style>\n<section  class='av_textblock_section av-mqqd31kk-fc4b122e71d9c0c0d8843106dc0d1aa8 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock av_multi_colums'  itemprop=\"text\" ><p>&#x1f539; <strong>The Pathology of Granular Myringitis<\/strong><br \/>\nA healthy tympanic membrane (TM) is covered by an intact epithelial layer that maintains a dry environment. The loss of this epithelium (de-epithelialization) triggers active inflammation characterized by otorrhea (weeping discharge) and chronic pruritus. If managed inadequately, this condition can progress to severe complications such as TM perforation or, paradoxically, marked fibrosis resulting in external auditory canal stenosis. Clinically, granular myringitis is strongly associated with mechanical trauma to the TM epithelium, often caused by ear picking or the abrasive use of cotton swabs.<\/p>\n<p>&#x1f539; <strong>Clinical Treatment Challenges<\/strong><br \/>\nThe cornerstone of managing this condition requires meticulous and adequate aural toilet, necessitating scheduled follow-up visits specifically for micro-suctioning\/cleaning, coupled with topical otic drops to promote epithelial healing. Currently, clinical practice varies widely, employing diverse topical agents\u2014ranging from antibiotics and anti-inflammatories to combination drops. However, the outcomes of these regimens remain inconsistent and carry inherent risks of adverse effects, prominently antibiotic resistance and secondary otomycosis (fungal superinfections).<\/p>\n<p>&#x1f539; <strong>The Rationale for Diluted Vinegar (Acetic Acid)<\/strong><br \/>\nAcetic acid possesses distinct bactericidal properties without inducing antimicrobial resistance. It is highly cost-effective, ubiquitous, and boasts a well-documented safety profile for historical wound care and hygiene. Repurposing diluted vinegar for the treatment of granular myringitis presents a highly safe and viable therapeutic alternative that effectively mitigates pharmacological risks for the patient.<\/p>\n<p>&#x1f539;<strong> Trial Methodology &amp; Results<\/strong><br \/>\nThis double-blind randomized controlled trial (RCT) evaluated the efficacy of 1% diluted vinegar (acetic acid) against chloramphenicol otic solution\u2014a standard topical antibiotic in general practice\u2014among 24 patients diagnosed with granular myringitis.<\/p>\n<p>Following aural toilet, patients were instructed to administer the intervention drops into the affected ear three times daily, retaining the fluid for 3 to 5 minutes before draining. Patients were scheduled for aural toilet and clinical evaluation every 1 to 2 weeks.<\/p>\n<p><strong>Primary Endpoint at 8 Weeks<\/strong>:<br \/>\nThe trial yielded excellent clinical outcomes with no significant difference in mucosal irritation between the two cohorts. Remarkably, the 1% diluted vinegar arm achieved a robust **91% clinical cure rate** at the 8-week mark. Furthermore, the data trend suggests that patients treated with diluted vinegar experienced expedited clinical improvement compared to those utilizing traditional topical antibiotics.<\/p>\n<p>&#x1f539; <strong>Clinical Conclusion<\/strong><br \/>\nTreating granular myringitis with diluted vinegar yields excellent therapeutic outcomes. It is highly safe, presents no statistically significant risk of irritation to the patient, and serves as a formidable substitute for topical antibiotics.<\/p>\n<p>As a direct translation of this clinical research, Siriraj Hospital currently compounds a 1% acetic acid solution, officially integrating it into the hospital&#8217;s drug formulary for active prescription and patient care.<\/p>\n<\/div><\/section><\/p><\/div><div  class='flex_column av-av_one_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_one_fifth  avia-builder-el-16  el_after_av_three_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-17  el_after_av_one_fifth  el_before_av_three_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-18  el_after_av_one_fifth  el_before_av_one_fifth  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.avia_textblock{\ntext-align:center;\n}\n<\/style>\n<section  class='av_textblock_section av-av_textblock-191303a5a297a2be5faedcc0c0e16f41 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><h1>Related Highlights<\/h1>\n<\/div><\/section><\/div><div  class='flex_column av-av_one_fifth-2d22dc0500e159f2b39fe7a147caf14c av_one_fifth  avia-builder-el-24  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div  column-top-margin'     ><\/div><div  class='flex_column av-av_three_fifth-3b0d446bf9e6f7db91541aa567be4cdf av_three_fifth  avia-builder-el-25  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div  column-top-margin'     ><div  id=\"avia-magazine-1\"  class='av-magazine av-av_magazine-e97233d63e2da7564ef1f32355184952  avia-builder-el-26  avia-builder-el-no-sibling   avia-builder-el-26  avia-builder-el-no-sibling ' ><div class='av-magazine-group sort_all'><article class='av-magazine-entry av-magazine-entry-id-62742 av-magazine-format-standard av-magazine-type-post av-magazine-entry-1 av-magazine-entry-small '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class=\"av-magazine-thumbnail\"><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-36th-american-glaucoma-society-aunnual-meeting-in-usa\/' title='Link to: Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA' class='av-magazine-thumbnail-link'><img decoding=\"async\" fetchpriority=\"high\" width=\"80\" height=\"80\" src=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/03\/Feature-80x80.jpg\" class=\"wp-image-62743 avia-img-lazy-loading-not-62743 attachment-thumbnail size-thumbnail wp-post-image\" alt=\"\" srcset=\"https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/03\/Feature-80x80.jpg 80w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/03\/Feature-36x36.jpg 36w, https:\/\/www2.si.mahidol.ac.th\/en\/wp-content\/uploads\/2026\/03\/Feature-180x180.jpg 180w\" sizes=\"(max-width: 80px) 100vw, 80px\" \/><\/a><\/div><div class=\"av-magazine-content-wrap\"><header class=\"entry-content-header\" aria-label=\"Post: Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA\"><time class='av-magazine-time updated'  itemprop=\"datePublished\" datetime=\"2026-03-05T16:27:46+07:00\" >March 5, 2026<\/time><h3 class='av-magazine-title entry-title '  itemprop=\"headline\" ><a href='https:\/\/www2.si.mahidol.ac.th\/en\/news-events\/siriraj-faculty-abroad-at-the-36th-american-glaucoma-society-aunnual-meeting-in-usa\/' title='Link to: Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA'>Siriraj Faculty Abroad at the 36th American Glaucoma Society Aunnual Meeting  in USA<\/a><\/h3><\/header><\/div><footer 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