Clinical Study of Patients with Bullous Myringitis (BM)

Is BM Merely an Acute Otitis Media (AOM)?

Abstract

Bullous myringitis (BM) is an acutely painful condition of the ear characterized by bulla formation on the tympanic membrane. The etiology is unknown despite its recognition over a hundred years ago by Lowenberg (1892). BM was described in early articles as occurring in association with acute otitis media; however, BM has different features from AOM: usually unilateral, more often in school age children and frequently in adults, and almost always with a self-limited clinical course.
We studied 74 patients with BM aged 0 to 83 years (average age: 8.53), of which 65 patients had allergic rhinitis and others nasal disorders. Most patients had a sudden onset of very severe otalgia, but rarely had a high temperature. In all cases, bulla formations on the tympanic membrane were unilateral, and 54 of 69 patients had significant bulging of the pars tensa, whereas only 44 of 69 patients had significant middle ear fluid. As other findings of the tympanic membrane, including a patient who strongly blew the nose, 24 of 72 patients had bleeding and 32 of 36 patients with analysis of recorded photography had significant bulging of the pars flaccida.
Merifield (1966) considered that BM is a mechanical injury, which follows upper-respiratory infection of any sort (eg, Eustachian tube insufficiency, fever etc). We thought that BM might be a middle ear barotrauma: abnormal nasopharynx pressure due to allergic rhinitis and others nasal disorders caused a sudden reflux of secretions and air from the nasopharynx into the middle ear such that a vibration and positive pressure suddenly struck the tympanic membrane.