High-Frequency Sensorineural Involvement and Recovery in Bullous Myringitis: A Retrospective Audiometric Cohort Study

Background/Purpose: Bullous myringitis (BM) is commonly regarded as a cause of conductive hearing loss, yet the frequency, pattern, and reversibility of sensorineural involvement remain poorly defined. We aimed to characterize affected-ear audiometric findings and longitudinal recovery in a clinically adjudicated BM cohort.

Methods: Retrospective analysis of 124 patients with clinically diagnosed BM at a tertiary medical center. Air- and bone-conduction thresholds, air–bone gap, 8000-Hz thresholds, word recognition scores (WRS), and hearing-loss phenotype were analyzed. True follow-up audiometry was evaluated using paired threshold changes.

Results: Mean age was 31.6±21.1 years; 31 patients (25.0%) were children. Bone-conduction data were available in 113 patients. At presentation, mean air-conduction PTA was 34.1±19.4 dB HL, bone-conduction PTA 18.6±14.2 dB HL, air–bone gap 16.4±11.0 dB, and 8000-Hz threshold 48.5±26.3 dB HL. WRS was largely preserved (97.3±9.7%). Mixed hearing loss was the most common phenotype (32.7%), followed by conductive hearing loss (31.9%), normal hearing (19.5%), and isolated sensorineural hearing loss (15.9%). Overall, 48.7% demonstrated a sensorineural component. Adults had higher bone-conduction PTA than children (20.4 vs. 13.2 dB HL, p=0.0007). Among patients with true follow-up, significant improvement was observed in air-conduction PTA (−17.6 dB), bone-conduction PTA (−7.4 dB), air–bone gap (−11.9 dB), and 8000 Hz (−23.4 dB; all p<0.0001).

Conclusion: BM is frequently associated with mixed hearing loss and a reversible, high-frequency–predominant sensorineural component. Routine bone-conduction and high-frequency audiometry should be considered.