This patient has a severe acute otitis media in the left ear. Note bulging laterally of the tympanic membrane caused by the accumulating purulent debris in the middle ear. The inflammation has involved tympanic membrane and the keratin patches On the surface of the tympanic membrane are easily visible due to swelling. One would expect perforation to develop in the tympanic membrane allowing the purulent material in the middle ear to drain into the external canal [mother nature's myringotomy].
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