Bullous Myringitis - Causes, Diagnosis, and Treatment

Introduction:

Ear - The sensory organ aids us in hearing and provides a sense of balance. It consists of the outer, middle, and inner portions. The eardrum (tympanic membrane) is between the exterior and the middle ear. Our eardrum is responsible for transmitting external sound into vibrations that enter the inner ear, thus aiding hearing. Therefore, any defect or abnormality in the eardrum leads to hearing disturbances. This article illustrates the infectious condition of the eardrum in detail.

What Is Bullous Myringitis?

Bullous myringitis is an infectious condition that leads to the formation of fluid-filled blisters on the eardrum. The infection does not affect the middle or outer ear. The incidence is high during the winter season, and there is a chance of the disease spreading to the middle ear. Children between 2 to 8 years of age, especially boys, are more commonly affected. However, studies show the occurrence of bullous myringitis in infants below two years of age.

What Causes Bullous Myringitis?

Bullous myringitis arises due to viral (most common) or bacterial infections. They are listed below:

1) Virus -

• Respiratory syncytial virus (RSV).

• Influenza virus.

• Epstein-Barr virus.

2) Bacteria -

• Streptococcus pneumoniae.

• Staphylococcus aureus.

• Mycoplasma.

• Streptococcus group A.

• Moraxella catarrhalis.

3) Rarely, fungal species also cause bullous myringitis.

4) In a few instances, the chemical irritation of the middle ear may lead to an eardrum infection.

How Does Bullous Myringitis Appear?

The classic features of infectious myringitis are as follows:

• Sudden ear pain.

• The ear pain is sharp or sometimes dull and may or may not extend to the surrounding structures (jaw joint, back of the head, or face).

• Fluid drainage from the ear if the blister breaks.

In young children, the following symptoms are noted -

• Disturbed sleep.

• Increased cry.

• The child may continuously rub their ear.

• Lack of proper feeding.

• Fever, runny nose, and cough may also occur.

What Are the Signs That the Doctor Looks For?

The doctor shines a light over the tympanic membrane during the ear examination to observe the following signs of bullous myringitis:

• The red and thickened appearance of the eardrum.

• Usually, the normal eardrum reflects the light passed on it; in the case of bullous myringitis, there is a lack of light reflex.

• The doctor notes the presence of fluid-filled blisters on the eardrum.

• Loss of hearing in the affected ear may occur.

How Long Does It Last?

The symptoms, as mentioned above, develop suddenly and may last for one to two days. However, several studies show that with proper treatment, the ear pain resolves within three days, and the fluid draining from the ear may take five days to a few weeks to resolve. The mild hearing loss also subsides as soon as the infection heals.

What Could Be the Risk Factors?

Those who already have an upper respiratory tract infection, such as the flu or cold, are more likely to develop bullous myringitis. This is due to the possibility that these infections will irritate the eustachian tubes or prevent them from adequately draining fluid. Other risk factors include:

• Cold climate.

• Pacifier use.

• Recent ear infection.

• Family history of ear infection.

• Climate changes.

• Exposure to smoke.

How Is Bullous Myringitis Diagnosed?

• Physical Examination - An otoscope is used to visualize the eardrum and the ear canal and identify abnormalities. The ENT (ear, nose, and throat) specialist uses the otoscope that shines light over the tympanic membrane and detects the presence of blisters in case of bullous myringitis.

• Laboratory Investigations - The doctor may order blood and urine analysis, urine culture, and cerebrospinal fluid (CSF) analysis in babies below 28 days of age who show fever and bullous myringitis. The American Academy of Pediatrics (AAP) has approved guidelines for evaluating complete workups in febrile babies (having fever) to diagnose other congenital or systemic disorders.

• Imaging Test - It is not necessary to diagnose infectious myringitis; however, its complications need to be diagnosed with either computed tomography (CT) or magnetic resonance imaging (MRI).

• Tympanocentesis - The ENT specialist uses a small needle to puncture the tympanic membrane to remove fluids and relieve pain. It is rarely followed, but it is done in severely affected children.

What Are the Similar Conditions?

• Acute Otitis Media - It is an infectious condition of the middle ear that is behind the eardrum. It is more common in infants and may also affect adults. The symptoms look similar to those of bullous myringitis.

• Otitis Media With Effusion - It refers to fluid accumulation in the middle ear (behind the tympanic membrane). It provides a sense of fullness in the ear.

What Are the Complications?

• Hearing Loss - If bullous myringitis is left untreated, it may lead to complete deafness.

• Labyrinthitis - It is the infection of the inner ear caused by viruses or bacteria. In addition, certain factors like colds, allergies, alcohol, and certain drugs trigger the swelling and infection of the internal ear parts. As a result, the affected individual may experience hearing loss and loss of balance.

• Mastoiditis - The infection of the tympanic membrane may spread to the part of the skull (mastoid) behind the ear and causes ear pain, redness, discharge from the ear, hearing loss, etc.

• Meningitis - Rarely does the untreated viral or bacterial ear infection extend to the coverings of the brain (meninges) to cause severe illness. It can occur both in infants and adults.

How to Treat Bullous Myringitis?

Immediate management of bullous myringitis is essential to control its recurrence. It includes:

• Antibiotic Therapy - Amoxicillin is the most preferred drug, as suggested by AAP. The combination of Amoxicillin and Clavulanic acid is prescribed in individuals who had a recent course (30 days) of Amoxicillin. In the case of Penicillin allergy, the doctor might suggest Azithromycin, Cefpodoxime, etc.

• Steroid Therapy - Several studies prove that the addition of steroids to antibiotic therapy controls common hearing loss. However, the use of steroids in patients with bullous myringitis has been discontinued.

• Myringotomy - In severe cases, the specialist may create a hole in the eardrum to drain the accumulated fluid and pus, referred to as myringotomy.

How to Prevent Bullous Myringitis?

Preventing colds and other infections is the best way to prevent bullous myringitis. Several effective methods to prevent these infections include:

• Avoid people who have colds or other infectious diseases as much as possible.

• Hand hygiene is important.

• Try to keep the corners of your mouth, nose, and eyes free.

• Take care by eating well and getting enough sleep.

• Particularly if someone in the home has recently had a cold, keep the surfaces in the house clean.

Conclusion

Bullous myringitis is a painful condition and rarely causes severe complications. An early diagnosis is essential to provide relief and avoid hearing loss. In addition, several medical devices are available to identify the degree and severity of hearing loss. Therefore, early treatment is necessary to improve well-being.