Crying or physical exertion may cause the blood vessels of the Stia Vascularis to dilate. This results in a vasodilatation of the blood vessels of the Stia Vascularis [the leash of blood vessels that run from the bony canal down the handle of the malleus]. This results in increased reddening in the superior deep bony canal simulating an acute otitis media. This is referred to as the "red reflex".
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