Bullous Myringitis

Bullous myringitis (BUH-lus myr-in·GI-tis) is an infection that causes painful blisters on your eardrum. Healthcare providers may also refer to this condition as bullous hemorrhagic myringitis or fungal myringitis.

You can develop bullous myringitis if you have a cold or an ear infection (acute otitis media). The condition typically affects children ages 5 to 8. But it can also affect younger children and adults.

Symptoms of bullous myringitis

Symptoms of this condition include:

• Severe ear pain that comes on suddenly
• Fever
• Trouble sleeping
• Hearing loss
• Fluid draining from the affected ear that may be clear, bloody or both
• Crying, ear rubbing and poor appetite (in small children)

Bullous myringitis causes

You develop bullous myringitis when viruses or bacteria infect your eardrum. Your eardrum reacts to the infection by becoming irritated or inflamed. The inflammation causes small, fluid-filled bullae between your eardrum’s middle and outer layers.

The same bacteria or viruses that cause colds and related ear infections cause bullous myringitis. It’s likely that respiratory syncytial virus (RSV) and other viruses cause most cases. But bacteria — including Streptococcus pneumoniae (pneumococcus) and mycoplasma — may also cause the condition.

Do acute middle ear infections always cause bullous myringitis?

No, they don’t. One study shows that for every 20 children under 2 years old with a middle ear infection, only 1 has bullous myringitis.

Risk factors

It’s diagnosed more often in the winter months. This is likely because the cold air thickens the mucus around your eustachian tubes. These structures drain fluid from your middle ear. Thickened mucus can cause these tubes to become blocked, trapping fluid and germs inside.

In older children and adults, it’s more common in females. In younger children, it’s more common in males.

How doctors diagnose this condition

A healthcare provider will use an otoscope to look for blisters on your eardrum. They may order a pure-tone hearing test to check for hearing loss.

What is a pure-tone hearing test?

A pure-tone hearing test is the most common type of hearing test. Audiologists perform hearing tests, including pure tone hearing tests. Here’s how it works:

1. You sit in a sound-treated room.
2. You wear headphones or insert earphones.
3. The audiologist uses a machine called an audiometer. Audiometers deliver sounds at different frequencies and loudness levels.
4. You raise a hand, press a button or say “yes” when you hear sounds.
5. The audiologist records your responses on an audiogram. Audiograms chart your hearing loss patterns. If you have hearing loss, the audiogram shows the degree of hearing loss you have.

How is bullous myringitis treated?

Treatments may include:

• Antibiotics
• Nasal decongestants
• Pain medication

Healthcare providers may use a small, sharp knife to drain the blisters. This often relieves the pain.

When should I see my healthcare provider?

Contact your provider if your symptoms continue or get worse after treatment.

What can I expect if I have this condition?

Treatment cures bullous myringitis. One study measuring the recovery time of children with bullous myringitis showed that 95% felt better in three days. Ear drainage stopped in five days.

Is there anything I can do to feel better?

Treatment, including pain medication and antibiotics, helps most people feel better within a few days. Sometimes, placing a warm compress on the outside of your ear also helps with ear pain.

Can this be prevented?

The best way to prevent bullous myringitis is to protect yourself and your child from infections. You may not be able to dodge every cold and ear infection. But the following may help:

• Wash your hands. Cold viruses spread from your hands to your eyes, nose and mouth. Handwashing is one of the best ways to keep cold viruses from spreading.
• Use hand sanitizers. Use alcohol-based hand sanitizer when you can’t wash your hands with soap and water.
• Clean frequently used surfaces. Viruses can live on doorknobs and other places people often touch.
• Strengthen your immune system. Get enough sleep, eat nutritious foods and exercise so your body is ready to fight off germs.
• Avoid spreading germs to others. Stay home when you’re sick. Keep your children home from school or daycare if they’re sick.
• Don’t smoke or be around smoke. Exposure to secondhand smoke increases the risk of ear infections. Be sure no one smokes around your child.
• Manage allergies. Inflammation and mucus caused by allergic reactions can block your eustachian tube. This makes ear infections more likely. Ear infections increase your chance of developing bullous myringitis.
• Get vaccinations. Being vaccinated against infections reduces your risk of colds that could lead to bullous myringitis.

What’s the difference between bullous myringitis and a middle ear infection?

Ear infections happen when bacteria or viruses infect and trap fluid behind your eardrum, making it swell and hurt. Bullous myringitis doesn’t cause the same fluid buildup as a middle ear infection. Instead, viruses or bacteria infect your eardrum.

The symptoms are similar. But for most people, bullous myringitis causes more severe ear pain than a middle ear infection.