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What Is Bullous Myringitis?

Reviewed by Dan Brennan, MD on April 22, 2021

Bullous myringitis, sometimes called infectious myringitis, is a condition where painful blisters (“bullae”) form in the ear, specifically along the tympanic membrane inside the ear. Both children and adults can get it, but bullous myringitis is more common in children and is known to cause hearing loss.

Who’s At Risk of Getting Bullous Myringitis?

Bullous myringitis is especially common among male children, between two and eight years old, during the winter months. It’s generally thought that the ear’s Eustachian tube, a structure of the middle ear, works less efficiently and becomes more vulnerable to infection in a cold climate.

There are about 400,000 cases of bullous myringitis in the United States every year, and it can affect both of the ears simultaneously. As young children grow into adolescents, bullous myringitis tends to become more common in female children instead of males, although the reasons for this aren’t clear.

The same infectious viruses and bacteria that lay behind middle ear infections can also cause bullous myringitis. This is also why anyone with a cold, flu, or ear infection is at greater risk of developing bullous myringitis. 

Causes of Bullous Myringitis

Doctors consider bullous myringitis to be a variation of acute otitis media, that is to say, an ear infection. Streptococcus pneumoniae is one of the most common pathogens responsible for ear infections like acute otitis media or bullous myringitis. 

Another pathogen that could be to blame is mycoplasma pneumoniae. It often causes mild respiratory illnesses in children that can spread to the ear and bring on bullous myringitis. Knowing which pathogen is behind the infection is important for prescribing the right antibiotic. Different pathogens typically respond best to different medications. 

Doctors aren’t exactly sure about how these organisms attack the middle ear. They believe that the painful blisters of bullous myringitis are the result of a strong inflammatory response in the middle ear after coming into contact with the invading bacteria or viruses.

Symptoms and Diagnosis

More than half of people with bullous myringitis infections have some kind of hearing loss along with it, making this a clear indicator for doctors looking to diagnose the condition. 

Continued

Other important symptoms include:

  • Fever
  • Pain while chewing or moving the neck
  • Decreased mobility in the neck area
  • Strong pain in the ear, caused by blisters and inflammation
  • Drainage flowing out of the ear

Younger children may not be able to vocalize the pain they’re feeling, in which case you should look for restlessness, rubbing at the ear, or more crying than usual. Since the same viruses and bacteria are probably involved, be on the lookout for cold and fever symptoms, especially a cough.

Treating Bullous Myringitis

Treating bullous myringitis depends on how much the condition has progressed. A warm compress to the ear, applied several times daily, with over-the-counter pain relief like ibuprofen may be enough in some cases. If bacteria are present in the ear canal, doctors will recommend a course of antibiotics, either by mouth or in the form of ear drops, to root out that infection.

If the blisters are extremely painful, your doctor can cut into them with a small knife to drain them out of the ear. In general, you can expect the symptoms of bullous myringitis to start clearing up about 24 to 48 hours after treatment starts.

Possible Complications and Outlook

Complications for bullous myringitis are similar to those for other ear infections. Short-lived hearing loss is often seen in people with bullous, but if the condition is allowed to go untreated for too long, damage to the ear may become permanent.

Other than that, bullous has a good prognosis. Since hearing loss is caused by swelling in the ear canal, your hearing should return to normal after the bacteria or virus that caused the inflammation is treated. In fact, 95 percent of people start feeling relief for their symptoms within just three to five days, though it can take as many as five weeks for the entire ear to be free of infection.

How to Prevent Ear Infections and Bullous Myringitis

Contrary to popular opinion, ear infections are only indirectly contracted from other people. They happen because of trapped germs inside the ear, but the germs are more likely to be trapped while you have a cold or flu. That cold or flu can be contracted from someone else, which can in turn cause your ear infection.

Here are a few fast tips to help you or your kids avoid contracting something like bullous myringitis in the future:

  • Avoid cigarette smoke. It can actually get in your ears and make it harder for them to clean themselves.
  • Also avoid touching your mouth, nose, and eyes.
  • Wash your hands several times a day to keep from spreading germs.
WebMD Medical Reference

Sources

SOURCES:

African Journal of Emergency Medicine: “Bullous Myringitis: A cause of hearing loss.”

Centers for Disease Control and Prevention: “Mycoplasma pneumoniae Infections.”

Connecticut Children’s: “What Is an Ear Infection?”

Kids Health From Nemours: “Middle Ear Infections (Otitis Media).”

PediatricEducation.org: “How Common Is Bullous Myringitis?”

StatPearls Publishing: “Bullous Myringitis.”

University of Florida Health: “Infectious myringitis.”

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