From the Guidelines
The tympanic membrane in a middle ear infection typically appears red, bulging, and opaque, with decreased mobility and possible loss of normal landmarks, as seen in studies such as 1. During otoscopy of a middle ear infection, the tympanic membrane often exhibits distinct visual signs, including:
- Redness, which can range from slightly red to strongly red, as noted in 1
- Bulging, which is a key characteristic of acute otitis media (AOM), with moderate to severe bulging being highly associated with the presence of a bacterial pathogen, as reported in 1
- Opacity, with the membrane appearing cloudy, as seen in 1
- Decreased mobility, which can be observed using pneumatic otoscopy, due to fluid accumulation behind the membrane, as mentioned in 1
- Possible loss of normal landmarks, such as the light reflex, malleus, and pars flaccida In severe cases, the tympanic membrane might appear yellow if pus is present in the middle ear space, or actual fluid levels or air bubbles might be visible behind the membrane, as described in 1. Sometimes, perforations develop, allowing drainage of purulent material into the ear canal, and the surrounding ear canal may also appear red and inflamed, as noted in 1. These visual changes occur because the infection causes inflammation, increased vascularity, and accumulation of fluid or pus in the middle ear space, which alters the normal appearance and position of the tympanic membrane, as explained in 1. Early recognition of these signs allows for prompt diagnosis and treatment of otitis media, which is crucial for preventing complications and improving patient outcomes, as emphasized in 1.
From the Research
Tympanic Membrane Visual Signs on Otoscopy of Middle Ear Infection
- The visual signs of a middle ear infection on otoscopy include a full or bulging tympanic membrane with middle ear effusion 2.
- The tympanic membrane may also show moderate to severe bulging, or new-onset otorrhea not caused by acute otitis externa 3.
- In some cases, the tympanic membrane may exhibit mild bulging with recent-onset ear pain (less than 48 hours) or intense erythema of the tympanic membrane 3.
- Histological changes of the tympanic membrane in purulent, serous, and chronic otitis media have been discussed in the literature, highlighting the importance of the tympanic membrane in the middle ear defense system 4.
Key Findings
- The diagnosis of acute otitis media (AOM) is based on the visualization of a full or bulging tympanic membrane with middle ear effusion, among other symptoms 2, 3.
- The treatment of AOM includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral 3.
- The use of antibiotics in AOM has been shown to have a limited effect on primary and secondary outcomes compared to placebo, with a substantial number of patients experiencing adverse events 5.