Bullous Myringitis – November 16, 2023

Bullous Myringitis – November 16, 2023

A 15 month-old-female is brought into the pediatrician’s office with concern for fever and ear-tugging. The child has been in day care where there have reportedly been kids sick with viral symptoms. Yesterday the child became “punky” with a fever of 102.5 F. The parents report that she has been pulling on her left ear. They have been treating the symptoms with over-the-counter analgesics.  She does not have a history of ear infections. She continues to eat and drink but with less enthusiasm. On exam, she is an ill, but not toxic appearing child with rhinorrhea and a cough. She appropriately resists the exam. A Wispr digital otoscope provided this image of her left ear.

What is the next step in treatment?

The child has bullous myringitis. This is classified as a severe form of acute otitis media (AOM) with fever. Antibiotics should be started.

The child has the hallmarks of AOM including bulging of the ear drum, loss of bony landmarks, and erythema. In addition, the child has blisters on the ear drum, the hallmark of bullous myringitis. The American Academy of Pediatrics recommends antibiotics for severe AOM which includes temperature above 102.2 F.

The child was started on antibiotics. At a follow-up appointment 3 days later, the eardrum had improved with the blistering resolved. There was still bulging of the eardrum but the child looked much better, and the fever was resolved.

WiscMed has an article on the resolution of AOM over time in images. It can be found here.

WiscMed thanks Dr. Campos for this week’s interesting case.

Here are the complete video exams of the initial presentation and three days post-treatment.

Initial Bullous Myringitis Video


Post 3 Days Bullous Myringitis Video