Plate 9: Acute Purulent Otitis Media, Infant (otitis media exudata acuta neonatorum) (Early Stage) The bulging of Shrapnell's membrane and the postero-superior quadrant is evident. All landmarks are obliterated. The antero-inferior quadrant becomes a dullish gray. Pain is an associated symptom. Where this picture results from intra-tympanic congestion it will subside under local palliative therapy.