How is acute bullous myringitis differentiated from acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Pneumatic otoscopy is an important diagnostic tool for differentiating AOM from acute bullous myringitis. The latter condition, in its purest form, manifests 10-14 days after a viral infection and causes severe localized otalgia without middle ear effusion.

The bullae or blebs may contain serous or hemorrhagic fluid and may extend onto the adjacent canal wall. Pain is relieved by puncturing the bleb. Similar blebs may occur in association with AOM. These patients demonstrate more systemic symptoms and continue to have pain associated with purulent middle ear effusion, which persists following rupture of the blebs.

It should be kept in mind that the findings described above apply to patients who are immunocompetent. Children who are immunosuppressed, particularly those undergoing chemotherapy, may not manifest the typical inflammatory responses. In these patients, the simultaneous appearance of systemic sepsis and a serous middle ear effusion might be the only indicators of AOM.

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