Myringitis

Disease Description (Causes and Symptoms)

• Definition: Myringitis refers to inflammation occurring in the tympanic membrane. In particular, when vesicles (blisters) or hemorrhagic bullae develop, it is called “bullous myringitis.”
• Causes: It most commonly develops in association with upper respiratory tract infections (colds, influenza) or otitis media, and may be caused by bacterial infections (e.g., Streptococcus, Staphylococcus, etc.) or viral infections (or, in some cases, infections associated with Mycoplasma). It may also result from injury to the external auditory canal or the entry of contaminated water.
• Pathophysiology: Infection causes inflammation of the surface of the tympanic membrane, leading to the formation of vesicles beneath the epidermis or hemorrhagic lesions; in some cases, tympanic membrane perforation or the spread of inflammation into the middle ear cavity may occur.
• Main symptoms: Ear pain (which may be stabbing in severe cases), tympanic membrane redness and vesicles/bullous lesions, tinnitus, hearing loss, a feeling of fullness or a foreign body in the ear, fever, and headache. If tympanic membrane perforation occurs, discharge of pus (purulent discharge) and relief of pain may occur.

Treatment Methods

• General principles
  • Symptom relief (analgesia and anti-inflammatory treatment) and elimination of the infectious cause (antibiotic treatment) are performed together.
  • Treatment varies depending on the condition of the tympanic membrane (whether perforation is present, severe necrosis of the tympanic membrane, etc.).
• Medication treatment
  • Pain control: NSAIDs (e.g., ibuprofen) or, if necessary, short-term opioid analgesics.
  • Antibiotics:
    • Systemic antibiotics: When associated with otitis media or systemic symptoms (high fever, progressive worsening), oral antibiotics (e.g., amoxicillin ± clavulanate) may be used.
    • If an atypical pathogen (e.g., Mycoplasma) is suspected, macrolides may be considered (at the physician’s discretion).
    • If the tympanic membrane is perforated, discharge is present in the external auditory canal/middle ear cavity, and bacterial infection is suspected, topical ear antibiotics (e.g., ofloxacin ear drops, or other agents that can be used when the tympanic membrane is perforated) may be used.
  • Local treatment: When the tympanic membrane is intact, the effect of topical drops is limited. If inflammation of the external auditory canal is also present, cleaning of the external auditory canal and application of topical medication may be performed.
• Procedures/Surgery
  • If severe pain is present or drainage is needed, micro-myringotomy (incision and drainage of the tympanic membrane, myringotomy) may be performed in children and adults.
  • In recurrent or chronic cases, tympanostomy tube insertion may be considered.
• Lifestyle management and precautions
  • Keep the ear dry (avoid water activities and swimming), and do not forcibly pick at the ear or try to remove water from it.
  • To remove water from the ear, point the ear downward and gently shake it, or allow it to dry naturally (using a fan/hair dryer on a low-temperature setting from a certain distance is recommended).
  • If using earplugs, keep them clean (although there is folk-remedy information recommending sealing with petroleum jelly, product instructions and hygiene must be followed).
• Potential complications
  • Tympanic membrane perforation, acute or chronic otitis media, permanent hearing loss, and, rarely, inner ear or petrous nerve complications (dizziness, facial nerve palsy) may occur.
• Follow-up observation
  • Immediate re-evaluation is necessary if symptoms do not improve or if drainage, worsening hearing, vertigo, facial paralysis, high fever, or other symptoms develop.

Outpatient Visit Checklist (Items to Prepare and Things to Check Before the Visit)

• Items to prepare
  • A list of medications currently being taken (including prescriptions, OTC medications, and dietary supplements) and a record of allergies (particularly drug allergies).
  • Medical history: Whether there is a history of chronic otitis media, ear surgery (e.g., ear tube insertion), trauma, or an immunocompromised state.
  • Symptom diary: The date symptoms began, pain intensity (by time of day), whether fever is present, discharge (presence, color, and odor), and changes in hearing.
  • Bring previous test results, if available (hearing tests, tympanometry, previous imaging, etc.).
• Information to tell the doctor during the visit (examples)
  • Any recent history of a cold or respiratory infection, recent swimming or water entering the ear, and whether self-treatment was attempted (ear drops or folk remedies).

Examples of General Questions to Ask the Doctor

• “What are the expected side effects of this medication (the prescribed antibiotic/painkiller)?”
• “What is the prognosis (approximately how long will recovery take)?”
• “When should I return for a follow-up visit if my symptoms do not improve?”
• “When can I resume daily activities (swimming, showering, air travel, etc.)?”

Examples of Condition-Specific Questions

• “Are the vesicles (or hemorrhagic lesions) on my tympanic membrane the cause of the pain? Is drainage or a myringotomy necessary?”
• “Is there a risk that hearing loss will remain? If necessary, when should I undergo a hearing test (pure-tone audiometry, impedance testing)?”

Additional Reference (Tests and Emergency Indicators)

• Diagnostic support: Otoscopy, pneumatic otoscopy (assessment of tympanic membrane movement), tympanometry, pure-tone audiometry, and pus culture (when drainage is performed), etc.
• Signs requiring immediate emergency care/re-evaluation: Severe persistent pain, high fever, a large amount of pus from the ear (purulent discharge), sudden hearing loss, dizziness, or facial paralysis.