bullous myringitis

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Bullous myringitis Definition ; Bullous myringitis (myringitis bullosa haemorrhagica) is the vesicles in the superficial layer of the TM. Pathology The vesicles appear between the outer epithelium & the lamina propria of the TM. Aetiology Aspirates from vesicles of the TM contains influenza virus or mycoplasma pneumonia. Bullous myringitis occurs in all age groups but children , adolescents & young adults are more frequently affected. Symptoms/signs Sudden onset of severe usually unilateral , often throbbing pain in the ear is the most common presentation. Usually set in during or following an upper respiratory tract infection. A blood staining discharge can be present for a couple of hours. A hearing impairment is common( conductive and /or sensorineural). The site of the sensorineural haering loss is the cochlea, however pathogenic base is not understood. Otoscopy reveals blood –filled, serous or serosanginous blisters involving the TM & sometimes the medial aspect of the ear canal. Diagnosis Based on physical examination, D/D acute otitis media, herpes zoster oticus, Ramsay hunt syndrome. Investigations Inspection of the ear using microscope is essential for diagnosis. Tympanometry to determine middle ear fluid. PTA to see the hearing impairment. Outcomes Vast majority of cases a complete recovery is seen within days. A sensorineural hearing loss of more than 15 db in two frequencies was reported in 65% cases. In other reports sensorineural hearing loss between 15% & 67%.

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Page 1: Bullous myringitis

Bullous myringitisDefinition ; Bullous myringitis (myringitis bullosa haemorrhagica) is the vesicles in the superficial layer of the TM.

PathologyThe vesicles appear between the outer epithelium & the lamina propria of the TM.

AetiologyAspirates from vesicles of the TM contains influenza virus or mycoplasma pneumonia.

Bullous myringitis occurs in all age groups but children , adolescents & young adults are more frequently affected.

Symptoms/signsSudden onset of severe usually unilateral , often throbbing pain in the ear is the most common presentation. Usually set in during or following an upper respiratory tract infection.

A blood staining discharge can be present for a couple of hours.

A hearing impairment is common( conductive and /or sensorineural). The site of the sensorineural haering loss is the cochlea, however pathogenic base is not understood.

Otoscopy reveals blood –filled, serous or serosanginous blisters involving the TM & sometimes the medial aspect of the ear canal.

DiagnosisBased on physical examination, D/D acute otitis media, herpes zoster oticus, Ramsay hunt syndrome.

InvestigationsInspection of the ear using microscope is essential for diagnosis.

Tympanometry to determine middle ear fluid.

PTA to see the hearing impairment.

OutcomesVast majority of cases a complete recovery is seen within days.

A sensorineural hearing loss of more than 15 db in two frequencies was reported in 65% cases. In other reports sensorineural hearing loss between 15% & 67%.

Page 2: Bullous myringitis

Management optionsAnalgesic & antibiotic can be used in the treatment of bullous myringitis.Complete recovery of the sensorineural impairment within three months occoured in between 60 to 100% treated with amoxycilin.