A Cause of Severe Ear Pain: Bullous Myringitis
Bullous Myringitis Definition and Causes
It is a very painful type of otitis media in which bullae filled with bloody or serous fluid are seen in the eardrum and sometimes in the external auditory canal as a result of infection of the external auditory canal or eardrum by the virus-like microbe "Mycoplasma pneumoniae". It is a viral infection characterized with bullae (vesicles- fluid-filled blisters) in areas adjacent to the eardrum or on the tympanic membrane). In the treatment, it is recommended to spatter the bullae with a sterile spindle, use antibiotic drop treatment, and use antibiotics containing trimethoprim sulfamethoxazole or erythromycin orally.
Mycoplasma pneumoniae is a very small bacterium of the Mycoplasma class without a cell wall. Sterol is found in the cytoplasm membrane. It causes mycoplasma pneumonia, a form of atypical bacterial pneumonia. It is related to cold agglutinin disease.
A 6-year-old patient, seen in the photograph, presented with an increasing ear pain after an upper respiratory tract infection. The vascular hyperemic appearance in the eardrum, the bulla filled with purulent content, the highlight of the ilithabi yellow secretion behind the membrane are remarkable.
Bullous Myringitis Symptoms
In addition to the infection in the eardrum, as in claisk acute otitis media, signs and symptoms begin to emerge as inflammation begins to accumulate behind the membrane. T
hese findings:
- Hearing loss
- Feeling of pressure in the ear
- Seevere ear pain
- Signs of infection such as fever and malaise
In cases where the inflammation comes out by bursting the eardrum outward, the pain and the feeling of pressure can be eliminated by the discharge of the inflammatory discharge into the ear canal. In a healthy person, acute otitis media can be seen as a simple situation and even if the eardrum is pierced; It almost always improves when water is not leaked and appropriate treatment is given.
Bullous Myringitis Treatment
The clear or inflammatory bubble-shaped bullae seen here are caused by the infection that occurs between the layers of the eardrum. Sometimes the bulla may burst spontaneously, mixed with blood, and discharge may come from the external auditory canal. Generally, in this case, patients' complaints are reduced. In patients with extreme pain, these bullae can be exploded in office conditions. Unlike other bacterial acute otitis media, antibiotics of the lactamase group are not effective (antibiotics such as penicillin that disrupt cell wall synthesis are not effective because the active bacterium does not have a cell wall). Antibiotics such as Tetracycline, Erythromycin, Quinolones, Azithromycin are used in treatment.
More pain may occur in this infection than in other bacterial acute otitis media (due to separation of the eardrum layers, formation of bullae).
In the treatment, it is important to protect the ear from sud contact for about 2 weeks. Generally, it takes a few weeks for hearing to become normal.
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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