OtoRhinoLaryngology Portal

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OtoRhinoLaryngology Portal Video Collections

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Small-Size Eardrum Perforation in Chronic Suppurative Otitis Media (CSOM)

     Small perforation can appear as                With dense myringosclerosis.

a "black dot" on otoscopic examination. 

Small anterior quadrant perforation during inactive stage of CSOM.

Another small anterior quadrant perforation, now involving the right eardrum.

 Small anterosuperior marginal perforation (arrow) with myringosclerotic plaque (+).

Medium-Size Eardrum Perforation in Chronic Suppurative Otitis Media (CSOM)

A medium-sized perforation (estimated 30%) with healthy middle ear mucosa.



A similar lesion as the above image.


A medium-size perforation (estimated 25%) with thickened edges.  Myringosclerosis plaque seen involving the posterior-inferior quadrant of the TM.



Medium-size posterior pars tensa perforation in inactive stage.

Large-Size Eardrum Perforation in Chronic Suppurative Otitis Media (CSOM)

 Large central perforation in inactive stage.  The middle ear

mucosa and hypotympanic air cells can be seen clearly.


Large central perforation showing the hypotympanum and Eustachian tube opening anterior-inferiorly.  Posterior pars tensa sclerosis and small fibrous nodule noted at the anterior edge of the perforation.


A very large central perforation with sclerotic plaques seen (+).

A large central perforation of left tympanic membrane.


Watch video of large tympanic membrane perforation @ YouTube

Subtotal Eardrum Perforation

Visible promontory and hypotympanic air cells.

Subtotal perforation in quiescent stage with visible ossicles.

 Visible middle ear structures with concurrent osseous canal otomycosis.


The tensor tympani tendon (arrow).


Right subtotal perforation with posterosuperior pocket.

[Credit of this image to Dr Indu Batumalay]

Anatomy of medial wall of the middle ear cavity. [PR - promontory, M - tip of malleus handle, P - pyramid, (+) - round window niche, yellow dot - oval window with underlying stapes footplate, white arrow - Eustachian tube opening, black arrows - crus of stapes, green arrow - incudostapedial joint, red arrow - stapedius tendon]


NB: In total perforation, the whole tympanic membrane inclusive

of its fibrocartilaginous annular ring is absent.


Hyperplastic middle ear mucosa with polyp formation. 

The eardrum edges became abnormally thickened.  No obvious mucopus seen.