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Year : 2018  |  Volume : 24  |  Issue : 3  |  Page : 207-208

Bilateral bullous myringitis in a teenager

Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia

Date of Web Publication11-Jan-2019

Correspondence Address:
Dr. Mohd Khairi Md Daud
Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_52_18

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Bullous myringitis is commonly encountered in otorhinolaryngology clinic. The most common presenting symptoms are otalgia, reduced hearing, and tinnitus. It can affect patients of any age in spite of the fact that children are frequently affected. In our recent encounter in our clinic, a teenager presented with bilateral otalgia with reduced hearing. Otoscopic findings revealed bilateral bullous myringitis that is indeed rare. He responded well with antibiotic treatment and recovered completely.

Keywords: Earache, otitis media, tympanic membrane

How to cite this article:
Abdull Rasid NS, Chew SC, Md Daud MK. Bilateral bullous myringitis in a teenager. Indian J Otol 2018;24:207-8

How to cite this URL:
Abdull Rasid NS, Chew SC, Md Daud MK. Bilateral bullous myringitis in a teenager. Indian J Otol [serial online] 2018 [cited 2020 Sep 22];24:207-8. Available from: http://www.indianjotol.org/text.asp?2018/24/3/207/249874

  Introduction Top

Bullous myringitis is an infection involving the tympanic membrane. It usually begins with a head cold causing severe pain in the ear, hearing loss, and fever. It is commonly found in hot and humid climates of our country.[1] The pathogenesis of bullous myringitis is poorly understood, but it is said to be due to infection caused by the same viruses or bacteria that lead to other ear infections. We report a boy with bullous myringitis occurred in both of his ears.

  Case Report Top

A 13-year-old boy presented to our otorhinolaryngology clinic with a history of sudden onset of severe bilateral ear pain, reduced hearing, and tinnitus for 1-week duration. On further questioning, he had a positive history of cold and fever a week back, but he had not taken any treatment. However, he denied history of ear digging or recent ear trauma. He did not have any other medical conditions and did not use any topical eardrop previously.

Examination of the ears showed outer ear canal skin lining was healthy. There is no mastoid tenderness. Otoendoscopic examination of the ear revealed a bulging and inflamed tympanic membrane with bullae over it in both the right [Figure 1] and left [Figure 2] ears without any discharge seen. Nasal, oral, and throat examinations were unremarkable.
Figure 1: Otoendoscopic examination of the right ear showing bullae over the tympanic membrane

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Figure 2: Otoendoscopic examination of the left ear showing bullae over the tympanic membrane

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Based on the history, symptoms, and clinical findings, the patient has been diagnosed as having bilateral bullous myringitis. He was prescribed with antibiotic and painkiller. The symptoms subsided within 3 days postmedication. Subsequent follow-up 1 week later revealed complete resolution of the bullae.

  Discussion Top

The exact etiology of bullous myringitis is still obscure, with several causative relationships being proposed, such as viral and Mycoplasma pneumoniae infections.[2] The bullae are derived from the epidermis of the tympanic membrane as the result of the infection.[1]

As far as the patient's presentation is concern, it is thought to be associated with flu-like symptoms as in our case. Symptoms of upper respiratory tract infection were the commonest in bullous myringitis. Kotikoski et al. reported that rhinitis was present in 80 (93%) and cough in 63 (73%) of 86 events.[3] Ear-related symptoms were also commonly present whereby earache was reported in 58% and rubbing of the ear in 65% of the events.

Regarding earache, it is often sudden, severe, and throbbing in nature and may radiate to the mastoid process, occiput, temporomandibular joint, and occasionally the face. In most patients, the pain subsides in 1 or 2 days, but some discomfort is usually present up to 3–4 days. The blister is believed to arise between the richly innervated outer epithelium and middle fibrous layers of the tympanic membrane. The stimulation of the sensory nerves by the inflammatory irritation or by the piercing of the tympanic membrane layers may result in severe earache.[3]

In our case, this is indeed rare, as it occurs bilaterally in a teenager. The patient presented with bilateral ear symptoms that include otalgia and tinnitus with hearing loss without ear discharge. In this reported case, the patient had experienced severe pain but resolved after 3 days.

The diagnosis of bullous myringitis is based on the revealing of the appearance of one or more blisters on the tympanic membrane irrespective of other findings in pneumatic otoscopy. The number of blisters on the tympanic membrane varies. Otoscopy typically reveals either blood-filled, serous, or serosanguinous blisters involving the tympanic membrane.[4] Blisters may spread out into the external ear canal.[3] Therefore, the diagnosis of bullous myringitis should be made by meticulous otoscopic examination.

Therapy should target for pain relief with oral analgesics. Systemic or topical antibiotic is necessary only when there is a secondary bacterial infection.[5] Antibiotics of choice are the one effective against organisms causing otitis media.

The prevalence of ear diseases can be up to 15% in school population.[6] The children with bullous myringitis usually present to the primary care physicians. However, the patients are frequently referred to otologist. This is not surprising, as the patients are in painful condition, and the otoscopic findings are obviously abnormal. In the normal clinical course of acute bullous myringitis, general practitioners can treat the condition in a usual way like treating acute otitis media.

  Conclusion Top

The diagnosis of bullous myringitis is based on clinical findings. Thus, a proper history of presenting symptoms as well as experienced clinical skills will help to identify the typical findings of the condition. Although the condition is self-limiting, timely initiation of symptomatic relief and antibiotic accordingly promises good outcomes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kumar S, Venkatraman R. Bullous Myringitis: An enigmatic disease and insights into its management. Online J Otolaryngol 2014;4:1.  Back to cited text no. 1
Drendel M, Yakirevitch A, Kerimis P, Migirov L, Wolf M. Hearing loss in bullous myringitis. Auris Nasus Larynx 2012;39:28-30.  Back to cited text no. 2
Kotikoski MJ, Palmu AA, Puhakka HJ. The symptoms and clinical course of acute bullous myringitis in children less than two years of age. Int J Pediatr Otorhinolaryngol 2003;67:165-72.  Back to cited text no. 3
Marais J, Dale BA. Bullous myringitis: A review. Clin Otolaryngol Allied Sci 1997;22:497-9.  Back to cited text no. 4
Wetmore SJ, Abramson M. Bullous myringitis with sensorineural hearing loss. Otolaryngol Head Neck Surg (1979) 1979;87:66-70.  Back to cited text no. 5
Khairi Md Daud M, Noor RM, Rahman NA, Sidek DS, Mohamad A. The effect of mild hearing loss on academic performance in primary school children. Int J Pediatr Otorhinolaryngol 2010;74:67-70.  Back to cited text no. 6


  [Figure 1], [Figure 2]


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