Bullous Myringitis: causes, Clinical photo Presentations


What is Bullous Myringitis?

Bullous Myringitis is a type of ear infection in which small, fluid-filled blisters form on the eardrum. These blisters usually cause severe pain. Bullous myringitis is caused by the same viruses or bacteria that lead to other ear infections.

Bullous myringitis is painful inflammation blisters of the tympanic membrane and surrounding deep canal skin with the formation of serum or blood filled bullae. Petechial subcutaneous hemorrhages around the base of the bulla are characteristic.

Bullous Myringitis was thought that Mycoplasma pnumoniae was the most common pathogen but, recent studies have demonstrated that the pathogens are similar to otitis media.
Bacteria are responsible for most cases of bullous myringitis. Streptococcus pneumoniae is the most common, followed by Haemophilus influenzae and Moraxella catarrhalis.
Examination shows a vesicular or bullous eruption over the tympanic membrane and adjacent bony canal wall. In the early stages, the vesicles are erythematous and surrounded by injected epithelium. In the later stages, they are larger and filled with fluid which may be clear and serous or blood filled.

In this photograph, the Bullous Myringitis has now been incised with a myringotomy knife and the fluid drained. Notice the petechial hemorrhage around the base of the Bullous Myringitis and extending into the attic area.

Topical antibiotic eardrops are probably useful in preventing the development of a secondary bacterial otitis externa. The use of erythromycin has been advocated by those who believe that Mycoplasma is the prime etiologic agent.
The tympanic membrane in this case is diffusely inflamed, with the presence of petechial hemorrhage over the attic and an associated hemotympanum.

What are the causes of Bullous myringitis ?

Bullous myringitis can be caused by bacteria or a virus. The bacteria and viruses that cause such disease are the same ones that cause other types of ear infections and conditions such as the flu, common cold, and strep throat. Streptococcus pneumoniae, which is a type of bacteria that causes strep throat, is a particularly common cause of bullous myringitis.

What are the symptoms of Bullous myringitis ?

It’s Symptoms are similar to other types of ear infections. Symptoms may include:

  1. Severe pain. The pain comes on suddenly and lasts 24 to 48 hours.
  2. Hearing loss in the affected ear. Hearing loss will usually go away once the infection clears.
  3. Fever.
  4. Fluid draining from the ear. This will only happen if one of the blisters breaks. Unlike other types of middle ear infections, that doesn’t cause a buildup of fluid or pus in the ear, but other middle ear infections can occur at the same time.
  5. Full feeling in the ears.
  6. Irritability. If your young child has bullous myringitis, they might seem irritable from the pain.
  7. Tugging or pulling at ear. A child too young to vocalize their ear pain might tug or pull at their ear in an attempt to relieve the pain.

What are the risk factors?

Bullous myringitis is more common in people who already have an upper respiratory tract infection, such as the flu or cold. This is because it can irritate the eustachian tubes or otherwise stop them from draining fluid properly.

Fluid that contains bacteria or viruses from the respiratory infection then moves into the ear and causes an infection called Bullous Myringitis.

It is also more likely to occur in people with a middle ear infection. This is because they’re both caused by the same viruses and bacteria.

How is this Bullous myringitis diagnosed?

If your only symptom of these disease is pain, you can wait a day or two to see if the pain goes away before calling your doctor. If the pain is very severe, which is common in bullous myringitis, or if you have a fever, call your doctor immediately. Also call your doctor if you have trouble hearing or have fluid coming from your ears.

If your child is showing signs of ear pain, you should always call a doctor, especially if they have a history of ear infections such as Bullous Myringitis.

Your doctor will take your medical history and ask about your symptoms and how long you’ve had them. They’ll also use a handheld device called an otoscope. This device has a magnifying glass and light to help your doctor see inside your ear and figure out if you have an ear infection.

If you do have an ear infection such as Bullous or any thiny other infection, your doctor will determine if it’s bullous myringitis or another type of infection. If you have been infected with it, they’ll be able to see the blisters on your eardrum. Your doctor might also do a hearing test to assess any hearing loss from the infection.

What are the treatment options?

Treatment options for this disease usually includes over-the-counter pain relievers and antibiotics. Both of these can be taken either by mouth or in ear drops. It will depend on preference and age.

Although viruses can cause bullous myringitis, antibiotics are usually prescribed. This is because it can be hard to tell if a virus or bacteria have caused the infection. Symptoms usually improve within two days.

If pain relievers don’t help reduce your pain, your doctor might break open the blisters on your eardrum with a small knife to allow them to drain. This won’t cure the infection as Bullous Myringitis, but it will help relieve your pain while you take antibiotics.

Are there ways to prevent this?

It is caused by the same types of viruses and bacteria that cause respiratory infections, colds, and other ear infections. Bullous myringitis itself isn’t contagious, but the other infections that can lead to it are. The best way to prevent it is to take steps to avoid catching colds or other infections.
Some of the best ways to avoid these infections are:

  1. Stay away from people with colds or other contagious infections as much as possible.
  2. Wash your hands regularly.
  3. Try not to touch your eyes, nose, and mouth.
  4. Get a good night’s sleep.
  5. Keep surfaces in your home clean, especially if someone in your household has recently had a cold.


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