Is it possible to have otitis media or interna with a ruptured tympanic membrane when on otoscopic exam the ear looks clean?

If the otoscopic exam views the total drum, not obscured by wax or other material, any rupture will be visible. Otitis media is visible on such an exam. Otitis interna is a viral infection of the cochlea and is never visible on otoscopic exam. It is diagnosed clinically from history & symptom pattern.

If your Physician can clearly visualize the intact Tympanic membrane with the Otoscope and get an unobstructed view, then the possibility of a ruptured Tympanic membrane is ruled out. Usually, Otitis media can be diagnosed when you are able to clearly see the Tympanic membrane. However, Otitis interna cannnot be diagnosed with an Otoscope alone and a proper H&P is important to make that diagnosis.