Tympanic membrane vascular engorgement before and after modified Valsalva maneuver

(A) Otoendoscopic view of a normal right tympanic membrane.
(B) The same tympanic membrane after modified Valsalva maneuver. Note vascular engorgement of canal and tympanic vessels. Vessels of the central drum are spared. The drum remains variegated in color and in normal position. A similar pattern of engorgement occurs during crying.