Hemorrhagic Bulla

A previously healthy 5-year-old male presents to the emergency department complaining of left ear pain. Four days ago, the child had a cough and sore throat. Yesterday, he began to develop a fever to 101.5 F and left ear pain. The mother has been treating with ibuprofen and acetaminophen. She is concerned that his symptoms are not getting better. This image of his left ear was obtained with the Wispr. The child has acute otitis media with a hemorrhagic bulla. The image shows all the classic features of acute otitis media. These features include bulging of the eardrum, erythema, and loss of bony landmarks. The lateral process of the malleus is barely discernable. What’s interesting in this image is the dark area in the middle. This appears like bullous myringitis which is blistering of the tympanic membrane from infection. In this case, the central blistering likely occurred over a superficial capillary of the tympanic membrane causing a blood-filled or hemorrhagic bulla. Treatment of this condition is the same as acute otitis media or bullous myringitis. A course of standard antibiotics along with analgesia with ibuprofen and acetaminophen. Careful return precautions should be given to the family in the event of worsening symptoms despite treatment. Here is the complete video exam of the child’s left ear: