Bullous myringitis is a condition where fluid-filled blisters form on the eardrum, caused by viruses like influenza or bacteria like mycoplasma pneumoniae. It presents with sudden, severe pain in one ear following an upper respiratory infection, along with blood-stained discharge from the ear canal and hearing loss. On examination, blisters can be seen on the eardrum and inner ear canal. It is usually diagnosed based on symptoms and examination findings. While the eardrum heals within days, sensorineural hearing loss affects between 15-67% of patients, though often improves within 3 months with antibiotics.

1. 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%.

2. Management options
Analgesic & 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.