Severe pain and crying.

Last round of antibiotics was for an AOM age 11 months.

Tympanogram totally flat, no compliance, no peak.

This child has AOM associated with bullous myringitis. The bullae are well-demarcated and located within the epithelial layers of the tympanic membrane.

About 5% of ears we examine with AOM have bullae. Bullae of the TM need to be carefully differentiated from acquired or congenital cholesteatomas or infectious bullae of the ear canal.  Treatment with oral antibiotics is normally effective.

Warn the parent to watch for spontaneous rupture of the TM. Rupture may occur with sudden amelioration of the pain, purulent drainage from the ear canal, and sometimes spontaneous bleeding from the canal. When this occurs, a topical antibiotic drop such as ofloxacin can be prescribed.