Severe Adhesive Otitis Media
||The entire tympanic membrane in this patient has become retracted onto the medial wall of the middle ear where it is fixed by adhesions.
At first glance, it appeared that this patient had a large subtotal perforation of the tympanic membrane.
On closer inspection, it became apparent that the tympanic membrane was thin and atrophic and 'plastered onto the medial wall of the middle ear.
Note the collection of white keratin squame debris under the anterior bony annulus which suggests the possibility of a cholesteatoma