Otoscopic evaluation of the tympanic membrane

Component of examination	Description	Potential significance
Position	Neutral	Normal TM
	Bulging or full	Characteristic of AOM
	Retracted	Negative pressure in the middle ear (Eustachian tube dysfunction)
Mobility	Normal	Normal TM
	Absent or decreased	Fluid in the middle ear* Tympanosclerosis
	Increased	Atrophy of the TM Site of previous perforation or tympanostomy tube
Translucency	Translucent	Normal
Translucency	Cloudy, opaque, or semi-opaque	Fluid in the middle ear*
Color	Pearly gray or pink	Normal TM
	White or pale yellow	Pus in the middle ear (AOM)
	Amber, gray, blue	OME
	Red or hemorrhagic	Inflammation Vasodilation (eg, from manipulation of the ear canal, crying, or high fever)
Other findings	Bubbles or air-fluid levels	Middle ear fluid (more suggestive of OME than AOM unless the TM is bulging)
	Perforation	AOM if associated with purulent otorrhea and not caused by external otitis Injury to TM
	Otorrhea	AOM if associated with perforation and not caused by external otitis External otitis Chronic suppurative otitis media Tympanostomy tube drainage
	Bullae	Inflammation of TM, associated with AOM
	Myringosclerosis	Complication of frequent middle ear disease
	Focal atrophy	Possible sequela of AOM or tympanostomy tube
	Retraction pocket	Possible sequela of AOM or tympanostomy tube
	Cholesteatoma	Possible sequela of AOM

This table is meant for use with UpToDate content on AOM in children. Refer to UpToDate content for additional details and pictures.

TM: tympanic membrane; AOM: acute otitis media; OME: otitis media with effusion.
* This finding does not distinguish AOM from OME.

Adapted from: Kaleida PH. The COMPLETES exam for otitis. Contemp Pediatr 1997; 14:93.

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