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Acute bullous myringitis (BM) is a clinical manifestation with blisters on the inflamed tympanic membrane. It occurs alone or in association with external otitis or acute otitis media (AOM). The most characteristic symptom of BM is the sudden onset of severe ear pain. However, in children with acute infections, the symptoms are usually nonspecific.

The objective of the study is to evaluate the frequency of different symptoms and determine whether there are any specific features in BM in comparison with AOM in children less than 2 years of age.

Children (2028), aged 7–24 months, were used in a prospective cohort study in the FinOM Vaccine Trial in 1997–1999. AOM was defined as an abnormal finding in the otoscopy suggesting middle ear effusion together with at least one of the following symptoms: fever, earache, irritability, diarrhea, vomiting, otorrhea, rhinitis, cough. BM was defined as an inflamed tympanic membrane with blister(s). The presence of each symptom in the preceding 7 days was separately asked and the results were recorded in a structured questionnaire.

Children (82) were found with 86 events of BM, and 1309 children with 1876 events of AOM. Earache was seen in 58% and rubbing of the ear in 65% of children with BM. More unspecific symptoms such as restless sleeping were reported in 90%, and excessive crying in 80% of children. Fever (>38 °C) was present in 62% of children. Rhinitis was present in 93% and cough in 73% of children (Fig. 1).

Fig. 1. The preceding symptoms before the office visit in bullous myringitis (BM) and acute otitis media (AOM) in children less than 2 years of age.

A significantly higher proportion of children with BM was reported to have ear-related symptoms (earache (58% vs. 29%), rubbing of ear (65% vs. 52%) and fever (62% vs. 41%) compared with children with AOM. Poor sleeping and excessive crying were also more common in BM. The occurrence of rhinitis (93% vs. 91%) and cough (73% vs. 79%) in BM was similar to that of AOM (Fig. 1).

Earache and fever ( ³ 38 °C) are more often present in BM compared with AOM. Viral upper respiratory symptoms (rhinitis and cough) are equally common in BM and AOM.