A 7-year old female is brought in to the emergency department with concerns of right ear pain and symptoms for one day. The child has a history of ear infections. The discomfort associated with this episode seems worse. The mother has tried alternating ibuprofen and acetaminophen, but it has not significantly helped the symptoms. The examination reveals an afebrile child, crying and rocking on the gurney, and holding her right ear. This image is obtained with the Wispr Digital Otoscope.
The child has bullous myringitis.
Bullous myringitis is an inflammation of the tympanic membrane (eardrum) that produces blisters. It occurs as part of the spectrum of acute otitis media (ear infection). It can be a dramatic finding in an uncomfortable child.
Historically, bullous meningitis was thought to be caused by Mycoplasma pneumoniae. However, as Mellick(1) shows in his letter, it is a component of severe AOM whose underlying cause may be a number of infectious agents.
Treatment is focused on providing pain relief along with treating the underlying infection. An anesthetic such as topical lidocaine can be introduced in the ear canal to provide timely pain relief. Treatment of the underlying infection is the same as for acute otitis media.
WiscMed thanks Dr. Andrew Schuman of medgizmos for the submission of this image.
(1) Mellick and Verma, Letter, Pediatric Emergency Care, Volume 26, Number 12, December 2010