Plate 37: Acute Necrotic Otitis Media (otitis media necrotica acuta) (Scarlatinal otitis media, reparative process) Nature's attempt at repair is the in growth of epidermis from the external canal through the marginal perforation so as to blanket the granulating surface in the middle ear with a cloak of epithelium. This is the primary stage of a "pseudocholesteatoma".