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Acute Otitis Media (AOM): An Endoscopic Findings at Its Early Stage

This image shows the appearance of the deeper ear canal and the eardrum at an early stage of acute otitis media.  An increase vascularity was noted at the umbo region and the vascular strip area superiorly.

Hyperaemia and inflamed auditory meatus with evolving middle ear effusion.

Established Acute Otitis Media: Pre-suppurative Stage

Severely inflamed osseous canal with bulging eardrum

and purulent middle ear fluid at its peak of inflammation.

 Inflamed and bulging eardrum with visible non-purulent effusion seen beyond it.

Acute Otitis Media: Suppurative Stage

 Figure shows a bulging and inflamed tympanic membrane with dual-layered appearance of middle ear fluid; the lower one represent formed mucopus whilst the upper layer by tenacious mucous.

 Acute otitis media with pus formed at lower quadrant of middle ear cavity 5 days after onset of right earache with concurrent upper respiratory tract infection.

Figure shows an increased vascularity of osseous canal with air-pus meniscus level behind the eardrum.

 Thick pus with clear demarcation of air-fluid level.

Pus formed within 24 hours of earache onset.  The superior segment of the eardrum is obviously inflamed and crescentic haemorrhage seen near its lower rim.

Figures show cumulated pus in the middle ear (beyond tympanic membrane) in the later stage of acute otitis media.  Increasing pus with ischaemic pressure necrosis complicates into eardrum rupture and discharging pus into the ear canal.

 Fully-formed pus with bulging tympanic membrane in a 3 year old boy.


Full-formed pus with very bulging tympanic membrane.

 Bulging of eardrum prior to rupture.


An extremely bulging superior segment of the eardrum with yellow tinge of pus seen.


Another extreme bulging predominantly involving posterior pars tensa.  In classic myringotomy, a curvilinear incision (crescentic) is made here (postero-inferior segment of pars tensa) to release the pus under pressure and relief the otalgia.