Bullous myringitis

Background

• Most commonly caused by S. pneumoniae and same AOM organisms
• Historically strongly associated with pna caused by M. pnuemoniae, but literature suggests it is a rare cause and may deserve same treatment as AOM

Presentation

• Peds - symptoms more often present in BM than AOM:
  • Severe earache
  • Fever
  • Ear rubbing, more irritability

Dx

• Painful fluid filled vesicles on TM
• Possible blood effusion

Complications

• TM perforation
• Extension of suppuration to adjacent structures
  • Mastoiditis
  • Meningitis
  • Abscess
  • Sigmoid sinus thrombosis

Management

• See Acute otitis media