Bullous Myringitis in an adult with chronic noise exposure

Bullous Myringitis (BM) is an acute painful infection in which vesicles or bullae form on the tympanic membrane. It is rare in adults and could be present with acute otitis media (AOM) if the middle ear is involved. This case report details a 55-year-old male with a history of recurrent childhood ear infections, chronic military noise exposure, smoking, and Crohn's disease presenting with severe right ear pain, hearing loss, and fever. Examination revealed signs of AOM with perforations in the tympanic membrane and purulent drainage. Initial management included antibiotics and analgesics, but symptoms progressed, requiring further investigation. Imaging showed complete opacification of the R ear structures without bone erosion. Despite initial treatment, the patient's condition worsened with bilateral hearing loss and intermittent peripheral vertigo. Ear, nose and throat (ENT) consultation and advanced diagnostics led to a diagnosis of BM with AOM, and asymmetric sensorineural hearing loss. The treatment was escalated to include high-dose steroids, azithromycin, valacyclovir, and daily aspiration of effusion. His symptoms improved, and he was discharged with oral antibiotics and scheduled follow-up. This case highlights the complexity of diagnosing BM that complicates AOM in an adult and the importance of detailed history, underlying past medical conditions pertinent to early diagnosis, consideration of less common pathogens, and comprehensive treatment.