Bullous Myringitis: A Case-Control Study

Abstract

Prior studies have shown that bullous myringitis (BM) accounts for <10% of acute otitis media (AOM) cases, and that the distribution of viral and bacterial pathogens in BM is similar to that in AOM without BM, except for a relative increase in the proportion of Streptococcus pneumoniae in BM. We studied 518 cases of AOM in children aged 6 months to 12 years. Using tele-otoscopy to assist the diagnosis, we identified 41 cases (7.9%) with BM. Children who had AOM with BM were older than AOM patients without BM (median age: 4.3 years vs 18 months). We compared 41 cases of AOM with BM to 41 control cases of age-, race-, and gender-matched AOM patients without BM. When compared with this matched control group, children with BM had more severe symptoms at the time of diagnosis and were more likely to have bulging of the tympanic membrane in the quadrants that were not obscured by the bulla. Children with AOM and BM may require aggressive pain management. Although parents and clinicians may agree that a watchful waiting approach is appropriate for older children with mild AOM, children experiencing painful AOM with BM may not be successful candidates for a watchful-waiting approach, because parents may resist postponement of antibiotic therapy in children who are more symptomatic.

Symptoms or Symptom-Based Scores Cannot Predict Acute Otitis Media at Otitis-Prone Age

“…After careful cerumen removal, we systematically assessed the middle-ear status (position, translucency, color, hyperemia, light reflex, mobility of the tympanic membrane, and possible airfluid interfaces) by using pneumatic otoscopy (Macroview otoscope model 23810 [Welch Allyn]); the otoscopy score (8 grades) (OS-8) 13 ; and which ear had the worse status. Digital pneumatic video otoscopy (Jedmed, St Louis, MO) was used to document the findings.…”

Symptoms and Otoscopic Signs in Bilateral and Unilateral Acute Otitis Media

“…We calculated this score from our symptom questionnaire and from our systematically recorded otoscopic signs. Second, immediately after the otoscopic examination, we recorded the otoscopy score, 8 grades (OS-8 score), which McCormick et al 12 developed to measure the severity of tympanic membrane inflammation (range, 0-7). Third, we asked parents to assess their child' s overall condition (range, 0-7) at its worst within the preceding 24 hours and at study clinic, by the AOM-faces scale, which was developed by Friedman et al 13 Fourth, we used the modified AOM total severity index (AOM-Si) as suggested by McCormick et al 14 to determine the severity of AOM.…”

“…Third, we asked parents to assess their child' s overall condition (range, 0-7) at its worst within the preceding 24 hours and at study clinic, by the AOM-faces scale, which was developed by Friedman et al 13 Fourth, we used the modified AOM total severity index (AOM-Si) as suggested by McCormick et al 14 to determine the severity of AOM. We calculated the AOM-Si score (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] by summing up the highest OS-8 score and the highest AOM-faces scale at its worst within 24 hours. Fifth, based on our symptom questionnaire, we calculated the AOM severity of symptom scale (AOM-SOS; version 3.0), which Shaikh et al 15 created.…”

Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale

“…McCormick et al [9] have created the OS-8 that focuses more on TM redness compared to the OMGRADE scale. The OS-8 also lacks the classification of a wet and contourless/ perforated TM, described as "chagrinated" in the OMGRADE scale.…”

“…Different scoring systems and a single AOM grading scale have previously been presented [7][8][9][10][11]. However, in our opinion, the aforementioned systems tend to overestimate the value of the parameter "redness of the TM" despite colour having been found to be of limited value in diagnosing AOM [11,12].…”