Myringitis can develop with viral, bacterial (particularly Streptococcus pneumoniae), or mycoplasmal otitis media. Pain occurs suddenly and persists for 24 to 48 hours. Hearing loss and fever suggest a bacterial origin. Diagnosis is based on otoscopic visualization of vesicles on the tympanic membrane.
Because differentiation among a viral, bacterial, and mycoplasmal cause is difficult, antibiotics effective against organisms causing otitis media are prescribed (see Treatment of Otitis Media). Severe, continued pain may be relieved by rupturing the vesicles with a myringotomy knife or by oral analgesics (eg, oxycodone with acetaminophen). Topical analgesics (eg, benzocaine, antipyrine) may also be beneficial.