Acute otitis media

In acute otitis media, otoscopy reveals characteristic signs such as an opaque, thickened, bulging, or protruding tympanic membrane, indicating increased pressure in the tympanic cavity due to purulent or mucous exudate. Coloration may vary from diffuse hyperemia to yellow or gray, and fluid levels or air bubbles may be observed behind the membrane. Tympanic membrane mobility is reduced or absent on pneumatic otoscopy, a highly suggestive finding. Another important sign is the loss of the tympanic light reflex. Purulent otorrhea, when present, indicates associated tympanic perforation. The differential diagnosis includes otitis media with effusion, where there is fluid in the middle ear but no signs of acute inflammation, as well as other causes of earache, including external otitis or Eustachian tube dysfunction.