<prompt> The cart-wheel appearance of the tympanic membrane in ASOM is due toPerforation of tympanic membraneEdema of tympanic membraneGranulation tissue on tympanic membraneCongested blood vessels along malleus  <response>: In the stage of pre suppuration of ASOM, there is congestion of pars tensa. A leash of blood vessels appears along the handle of malleus and at the periphery of tympanic membrane imparting it a cart-wheel appearance. 