Myringitis can develop with viral, bacterial (particularly Streptococcus pneumoniae), or mycoplasmal otitis media. Pain occurs suddenly and persists for 24 to 48 hours. Hearing loss and fever suggest a bacterial origin. Diagnosis is based on otoscopic visualization of vesicles on the tympanic membrane.
Because differentiation among a viral, bacterial, and mycoplasmal cause is difficult, antibiotics effective against organisms causing otitis media are prescribed (see Treatment of Otitis Media Treatment Acute otitis media is a bacterial or viral infection of the middle ear, usually accompanying an upper respiratory infection. Symptoms include otalgia, often with systemic symptoms (eg, fever... read more ). Severe, continued pain may be relieved by rupturing the vesicles with a myringotomy knife or by oral analgesics (eg, oxycodone with acetaminophen). Topical analgesics (eg, benzocaine, antipyrine) may also be beneficial and should be given before myringotomy.