Myringitis is a form of acute otitis media in which vesicles develop on the tympanic membrane.
Myringitis can develop in patients 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. Myringitis does not cause middle ear effusions.
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). Severe, continued pain may be relieved by rupturing the vesicles with a myringotomy knife or by using oral analgesics (eg, oxycodone with acetaminophen). A combination antibiotic and corticosteroid (eg, ciprofloxacin plus dexamethasone) ear drops typically control the infection and decrease pain as the corticosteroids reduce inflammation. 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.
