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Otitis Media - Clinical Images

Here is a curated visual guide to otitis media, covering the key types with otoscopic and histologic images from authoritative ENT textbooks and clinical resources.

1. Acute Otitis Media (AOM) - Otoscopy

Bulging, erythematous tympanic membrane - the hallmark of AOM. The TM loses its normal landmarks, light reflex is distorted, and there is outward bulging from purulent middle ear fluid.

Acute Otitis Media - bulging erythematous tympanic membrane

Acute otitis media: markedly erythematous, thickened TM with visible vascularity and purulent discharge at the margin (TeachMeSurgery)

2. Spectrum from Normal to AOM (WiscMed Digital Otoscope)

The four-panel comparison below shows the diagnostic spectrum: (top-left) normal TM with visible ossicular shadows; (top-right) middle ear effusion with amber discolouration; (bottom-left) AOM with opacification and loss of landmarks; (bottom-right) erythematous TM with dilated vessels.

Spectrum of AOM otoscopy - normal to AOM

Normal TM to AOM spectrum (WiscMed)

3. Otitis Media With Effusion (OME) - "Glue Ear"

Amber-coloured effusion behind an intact TM. A small air-fluid level or bubble may be visible near the light reflex. The TM is not bulging or erythematous.

Otitis media with effusion - amber effusion behind intact TM

Fig. 25-2: OME - amber-coloured effusion behind intact TM with a small bubble near the light reflex (Shambaugh Surgery of the Ear)

4. Chronic Otitis Media - Retraction Pocket

Retraction of the pars flaccida region of the TM down onto the neck of the malleus and incudostapedial joint. No keratin debris (distinguishing it from cholesteatoma).

Chronic otitis media - pars flaccida retraction pocket

Fig. 25-9: Retraction pocket in pars flaccida - TM retracted onto malleus neck and incudostapedial joint (Shambaugh Surgery of the Ear)

5. Histology: Acute Otitis Media (H&E, Temporal Bone)

Hematoxylin & eosin stained temporal bone section showing acute inflammatory exudate (PMNs + eosinophilic secretions) filling the tympanic cavity and mastoid air cells. The TM and middle ear mucosa are both thickened.

Acute otitis media histology - temporal bone H&E with inflammatory exudate

Fig. 25-1: AOM histology - PMN-rich exudate in tympanic cavity, thickened TM and mucosa (Shambaugh Surgery of the Ear)

6. Histology: Chronic OM - Retraction Pocket (H&E, Temporal Bone)

Cross-section at the level of the stapes footplate. The TM is displaced inward (dry retraction pocket) with subclinical eosinophilic exudates within the tympanic cavity. The facial nerve is in close proximity.

Chronic otitis media retraction pocket - H&E temporal bone histology

Fig. 25-10: Inactive chronic OM with retraction pocket - TM displaced toward facial nerve (Shambaugh Surgery of the Ear)

Summary of Otoscopic Findings by Type

Type	TM appearance	Colour	Landmarks	Mobility
Normal	Concave, translucent	Pearly grey	Clear (malleus visible)	Normal on pneumatic otoscopy
AOM	Bulging, opaque	Red/yellow	Obscured	Reduced
OME	Retracted or neutral	Amber/grey	May be visible	Reduced (flat tympanogram)
Chronic OM	Retracted / perforated	Pale/white	Distorted	Absent
Retraction pocket	Focally retracted	Normal to dull	Partially visible	Restricted

Key diagnostic pearl from Shambaugh Surgery of the Ear: Otoscopy in AOM reveals an erythematous TM that is often bulging or ruptured with purulent drainage. Impedance tympanometry shows a flat tympanogram with absent acoustic reflexes, and audiometry shows conductive hearing loss.

For more clinical images with diagnostic grading, the University of Wisconsin AOM image library has an excellent annotated collection with cases ranging from hemorrhagic AOM to bullous myringitis.

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