Myringitis

Myringitis is an inflammation of the tympanic membrane. It can develop as a complication of viral, bacterial (particularly Streptococcus pneumoniae), or mycoplasmal otitis media (1, 2). Myringitis is commonly associated with the formation of bullae on the tympanic membrane (bullous myringitis) and/or hemorrhage (hemorrhagic myringitis). Pain occurs suddenly and persists for 24 to 48 hours. Hearing loss and fever suggest a bacterial origin.

The diagnosis of bullous myringitis is based on otoscopic visualization of vesicles on the tympanic membrane. Myringitis does not itself cause middle ear effusions, but because of its co-occurrence with acute otitis media, many patients with myringitis also have effusions.

Treatment approaches in myringitis include the use of topical agents or infrequently surgery. Because differentiation among viral, bacterial, and mycoplasmal causes is difficult, antibiotics effective against organisms causing otitis media are prescribed (see Treatment of Otitis Media) (3). Combination antibiotic and glucocorticoid (eg, ciprofloxacin plus dexamethasone) ear drops typically control the infection and decrease pain as the glucocorticoid reduces inflammation. Severe, continued pain may be relieved by rupturing the vesicles with a myringotomy knife or by using oral analgesics (eg, oxycodone with acetaminophen). Strict dry ear precautions are required because water exposure can prolong infection. Dry ear precautions include occluding the external canal (eg, using a cotton ball lathered with petroleum jelly) while bathing and showering and avoiding swimming.