Bullous myringitis, also known as hemorrhagic bullous myringitis, is an acute inflammation of the tympanic membrane and the skin adjacent to the external auditory canal, mostly during the epidemics of acute viral upper respiratory tract infection, but also sporadic. It is common in children and young adults, with no gender difference, mostly unilateral.
Etiology
It is generally believed that this disease is caused by viral infection, such as influenza virus and poliovirus. Few patients are associated with Mycoplasma pneumoniae infection, drugs or physical stimulation, and allergic reactions.
Clinical manifestations
Severe dull or sharp pain in the deep ear suddenly occurs, and can be relieved after the bullae rupture. Aural fullness is accompanied, and there may be mild hearing impairment. Examination shows that the tympanic membrane and the skin adjacent to the external auditory canal are congested, and one or multiple light yellow or purple bullae often occur on the posterosuperior tympanic membrane, and sometimes several bullae can merge into a large bulla. Bullae are in the epithelium of the tympanic membrane and contain blood or plasma. When bullae rupture, little bloody exudate may flow out, thin scab is formed, and the lesion gradually heals. In mild patients, the fluids in the bullae can be completely resorbed, and there is no tympanic membrane perforation.
Figure 1 Bullous myringitis
Diagnosis
If patients have a history of cold or flu before the disease, and bulla occurs on the tympanic membrane or the skin adjacent to the external auditory canal, a diagnosis can be readily established. The disease should be distinguished from acute myringitis, early acute suppurative otitis media, idiopathic hemotympanum, and various diseases causing blue tympanic membrane.
Treatment
Antiviral treatment is applied to relieve otalgia and prevent secondary infections. Painkillers and sedatives can be administered, diathermy can promote fluid resorption, and the bullae can be punctured under aseptic conditions. Antibiotic ear drops and systemic antibiotics are used to prevent secondary bacterial infection.