The cherry red small mass of granulation tissue arising from the Pars Flaccida of this left tympanic membrane strongly suggests that there is an underlying cholesteatoma in the attic area. Deep to the granulation tissue there was a perforation through the pars flaccida which connected with the underlying attic cholesteatoma. Note that continuing discharge from the granulation tissue has caused the surface epithelia of the tympanic membrane to become edematous and thickened giving the surface a thickened whitish appearance.