Cart Wheel sign is seen in -
Otoscopy Signs for ASOM:

There is congestion of pars tensa
Leash of blood vessels appear along the handle of malleus and at the periphery giving it a cartwheel like appearance.
Transluscency is reduced.
Later tympanic membrane appears red and bulging with loss of landmarks.
Tympanic membrane is immobile n pneumatic ostoscopy
ASOM
AOM
OME
CSOM