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Photo illustrations of Bullous Myringitis

What is Bullous Myringitis ?
Bullous myringitis is painful inflammation blisters of the tympanic membrane and surrounding deep canal skin with the formation of serum or blood filled bullae. Petechial subcutaneous hemorrhages around the base of the bulla are characteristic.

Bullous Myringitis was thought that Mycoplasma pnumoniae was the most common pathogen but, recent studies have demonstrated that the pathogens are similar to otitis media. Bacteria are responsible for most cases of bullous myringitis. Streptococcus pneumoniae is the most common, followed by Haemophilus influenzae and Moraxella catarrhalis.

Examination shows a vesicular or bullous eruption over the tympanic membrane and adjacent bony canal wall. In the early stages, the vesicles are erythematous and surrounded by injected epithelium. In the later stages, they are larger and filled with fluid which may be clear and serous or blood filled. In this photograph, the bulla has now been incised with a myringotomy knife and the fluid drained. Notice the petechial hemorrhage around the base of the bulla and extending into the attic area.
Treatment of bullous myringitis requires strong analgesics because of the associated pain. Rupturing the bullae for relief of pain is controversial. Topical antibiotic eardrops are probably useful in preventing the development of a secondary bacterial otitis externa. The use of erythromycin has been advocated by those who believe that Mycoplasma is the prime etiologic agent. The tympanic membrane in this case is diffusely inflamed, with the presence of petechial hemorrhage over the attic and an associated hemotympanum

A large bulla filled with serous fluid has developed on the superficial surface of the tympanic membrane in the region of the umbo

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