Plate 36: Acute Necrotic Otitis Media (otitis media necrotica acuta) (Scarlatinal otitis media) Within a short period, at times less than a day, the entire pars tensa is destroyed. The tympanic mucosa is also destroyed. The long process of the malleus is involved in the mass necrosis.Otoscopy shows an angry granulating middle ear, where only remnants of the drum persist. Seen years later this condition is the "Chronic purulent otitis media Due to bone necrosis."