Bacterial etiology of acute myringitis in children less than two years of age

Background. Acute myringitis is an inflammation of the tympanic membrane th at occurs alone or in association with external otitis or otitis media. The two clinical entities, based on physical examination, are bullous myringit is and hemorrhagic myringitis. Objectives. To investigate the association of concomitant middle ear diseas e with acute myringitis and to analyze the bacteriologic findings of the mi ddle ear fluid in children with acute myringitis. Methods. A prospective longitudinal cohort study of 2028 children age 7 to 24 months at primary care level in the Finnish Otitis Media Vaccine Trial. Matched case control design for analysis of bacterial pathogen distribution , Results. There were 82 children in whom 92 ears were diagnosed with acute b ullous myringitis and 37 children in whom 40 ears were diagnosed with hemor rhagic myringitis during the follow-up. Middle ear disease was associated w ith bullous myringitis in 97% of ears and with hemorrhagic myringitis in 82 % of ears. Bacterial pathogen distribution was similar to that of acute oti tis media, although a higher proportion of Streptococcus pneumoniae was det ected in both bullous and hemorrhagic acute myringitis. Conclusions. Middle ear fluid was present in vast majority of ears with acu te myringitis in young children. The same etiologic bacteria were found in acute myringitis as in acute otitis media, but S. pneumoniae was the major pathogen. Acute bullous myringitis should be treated as acute otitis media in children <2 years of age.