Bullous myringitis, also known as hemorrhagic bullous myringitis, is an acute inflammation of the tympanic membrane and the adjacent skin of the external auditory canal. It commonly occurs during outbreaks of acute viral upper respiratory infections but can also present sporadically. It is more frequently seen in children and young adults, with no gender preference, and is typically unilateral.
Etiology
The condition is most caused by viral infections, such as influenza virus and poliovirus. In some cases, it may be associated with Mycoplasma pneumoniae infection, drug or physical irritation, or allergic reactions.
Clinical Manifestations
Sudden onset of severe, deep ear pain is described as a feeling of fullness or stabbing pain. The pain may subside after the rupture of the bullae.
A sensation of ear fullness and mild hearing impairment may also be present.
On examination, the tympanic membrane and adjacent skin of the external auditory canal appear congested. One or more pale yellow or purplish bullae are often observed, typically in the posterosuperior quadrant of the tympanic membrane.
The bullae may coalesce and are located within the epithelial layer of the tympanic membrane, containing blood or plasma. When ruptured, a small amount of blood-tinged exudate may drain, forming a thin scab that gradually heals.
No perforation of the tympanic membrane is observed.
Figure 1 Bullous myringitis
Diagnosis
A history of a recent cold or influenza, combined with the presence of vesicles on the tympanic membrane or adjacent skin of the external auditory canal, is sufficient for diagnosis. The condition should be differentiated from acute myringitis, early-stage acute suppurative otitis media, idiopathic hemotympanum, and blue tympanic membrane.
Treatment
The treatment principles include antiviral therapy, pain relief, and prevention of secondary infection.
Analgesics and sedatives can be used to alleviate ear pain.
Heat therapy can promote the resorption of fluid.
Under sterile conditions, the bullae can be punctured to release fluid.
Antibiotic ear drops should be applied locally.
Systemic antibiotics can be administered to prevent secondary bacterial infection.