Plate 11: Acute Purulent Otitis Media, Infant (otitis media exudata acuta neonatorum (Spontaneous Perforation) A spontaneous rupture in the infant ear occurs most frequently in the postero-inferior quadrant. The perforation can be visualized only after the external auditory canal has been thoroughly cleansed of purulent exudate. When perforation occurs pain disappears and fever usually subsides.