From the Research
Bullous myringitis is a rare and painful manifestation of acute otitis media that requires prompt medical attention, including pain management and possibly systemic corticotherapy, to prevent complications such as sensorineural hearing loss. The condition is characterized by the formation of fluid-filled blisters or bullae on the tympanic membrane, and its management may be a medical emergency requiring the opening of hemorrhagic bullae 1. The responsible germs are the same as those found in acute otitis media, including S. pneumoniae, H. influenzae, and M. catarrhalis, and its treatment is identical, adapted to each clinical situation 1.
Causes and Symptoms
The condition is often caused by viral or bacterial infections, and patients may present with severe ear pain, fever, and symptoms of upper respiratory tract infection, such as rhinitis and cough 2. Earache and fever are more common in bullous myringitis than in acute otitis media, and the symptoms can be relieved in 1-2 days with appropriate treatment 2.
Treatment
Treatment typically involves pain management with analgesics such as acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) for adults [@Example@]. Topical antibiotic ear drops containing fluoroquinolones like ciprofloxacin or ofloxacin may be administered, typically 3-4 drops in the affected ear twice daily for 7-10 days [@Example@]. If there's evidence of a middle ear infection, oral antibiotics such as amoxicillin (500mg three times daily for adults) or amoxicillin-clavulanate (875/125mg twice daily for adults) for 5-7 days may be necessary [@Example@].
Prevention of Complications
Patients should avoid getting water in the ear during treatment and follow up if symptoms worsen or don't improve within 48-72 hours [@Example@]. The bullae usually rupture spontaneously, releasing fluid and providing pain relief, but medical intervention speeds recovery and prevents complications like hearing loss or spread of infection 1.
Key Points
- Bullous myringitis is a rare and painful manifestation of acute otitis media
- Prompt medical attention is required to prevent complications
- Treatment includes pain management and possibly systemic corticotherapy
- Patients should avoid getting water in the ear during treatment and follow up if symptoms worsen or don't improve within 48-72 hours
- The condition is often caused by viral or bacterial infections, including S. pneumoniae, H. influenzae, and M. catarrhalis 1, 2.