Objective <p>Chronic myringitis is a prevalent inflammatory disease of the external auditory canal, characterized by its tendency to persist and resist healing. Currently, there is no universally accepted and effective treatment protocol in clinical practice. This study aims to investigate a stepwise treatment approach for chronic myringitis under otoendoscopy.</p> Methods <p>A retrospective analysis was performed on the clinical data of 118 patients with chronic myringitis who were treated at the Otology Medical Center of the First People’s Hospital of Foshan between March 2021 and September 2024. Based on the severity and extent of the disease, patients were categorized into four grades (I-IV), and personalized tiered treatments were administered accordingly.</p> Results <p>Among the patients, 21 cases were classified as Grade I, using a crochet hook to physical scraping and powder spraying; 56 Grade II cases were treated with argenti nitrate or clotrimazole solution for chemical cauterization; 14 Grade III cases underwent Jesse bipolar cauterization; and 27 Grade IV cases received ear endoscopic tympanoplasty. Notably, two Grade I and eleven Grade II patients who did not demonstrate significant improvement after physical scraping, powder spraying, or chemical cauterization subsequently recovered following treatment with the Jesse bipolar technique.</p> Conclusion <p>This study proposes a novel stepwise treatment strategy based on clinical grading of chronic myringitis under otoendoscopy. The Jesse micro bipolar offers a safe and effective alternative for treating severe, complex, and refractory cases of chronic myringitis in clinical practice.</p>