Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida.