How does otitis media typically present on the tympanic membrane?

In cases of otitis media, the presentation of the tympanic membrane (TM) is characterized by a bulging appearance, often accompanied by purulent effusion. This occurs because otitis media involves inflammation and fluid accumulation in the middle ear, typically due to an infection.

The bulging of the TM is a direct result of increased pressure from the accumulated fluid in the middle ear, causing the membrane to protrude outward. Additionally, purulent effusion indicates the presence of bacterial infection, leading to pus formation, which can also increase the fluid's viscosity and contribute to the bulging effect. The presence of redness and inflammation may be evident but is secondary to the significant pressure and fluid buildup that causes the TM to bulge.

Other types of presentations such as a flat and clear tympanic membrane or a dry and perforated TM do not align with the typical symptoms of otitis media. A flat and clear TM suggests normal middle ear function without fluid or infection, and a dry and perforated TM indicates past or chronic issues rather than acute otitis media. A red and inflamed TM could potentially be observed in various conditions, including acute otitis media, but the hallmark findings are the bulging membrane and purulent effusion. Thus,