Bullous Myringitis

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DEFINITION Bullous myringitis is a painful condition of the ear characterized by bulla formation on the TM and deep EAC. Its epidemiology, etiology, and pathology are poorly understood. It may occur at any age, frequently after an upper respiratory tract infection.

PATHOPHYSIOLOGY The blisters are believed to occur between the highly innervated outer epithelium and the inner fibrous layer of the TM, explaining the severe otalgia. The blisters may be blood-filled, serous, or serosanguinous. Middle ear effusions may be present, either sympathetic in origin or as a result of medial rupture of bullae. Otorrhea as a result of ruptured bullae is short-lived. A reversible hearing loss is commonly associated with the condition and may be conductive, sensorineural, or mixed.

MICROBIOLOGY Although bullous myringitis was originally associated with influenza epidemics, since then numerous pathogens have been implicated in its etiology, including Mycoplasma pneumoniae, Chlamydia psittaci, and numerous viral pathogens. Herpes simplex has not been implicated as a causative agent.21

DIAGNOSIS Patients with bullous myringitis typically present with severe, throbbing otalgia, often with hearing loss. Otoscopy reveals multiple fluid-filled blisters, which may be yellow to red in color. There may be bloody otorrhea or hemotympanum.

TREATMENT As the etiologic agent of bullous myringitis remains elusive, treatment of the condition consists of warm compresses and systemic analgesia with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Oral antibiotics may be added in cases with an associated middle ear effusion, since some of these may represent a concomitant otitis media.

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