Bullous myringitis

Background

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

Clinical Features

• Painful fluid filled vesicles on TM
• Possible blood effusion

Differential Diagnosis

Ear Diagnoses

External

• Auricular hematoma
• Auricular perichondritis
• Cholesteatoma
• Contact dermatitis
• Ear foreign body
• Herpes zoster oticus (Ramsay Hunt syndrome)
• Malignant otitis externa
• Otitis externa
• Otomycosis
• Tympanic membrane rupture
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss