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Diseases of Ear, Nose and Throat ( PL Dhingra) 4th Ed, Pg

Diseases of Ear, Nose and Throat ( PL Dhingra) 4th Ed, Pg

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08/17/2013

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NATOMY
OF
EAR
e<lf
is
divided into:
Ex
t~rnal
ear_11dd
le
earI
me
rnalear or
th
e
labyrinth
.
HE EXTERNAL
EAR
e_
ternalearconsists
ofthe
(i)
auricleor
pinna,
(ii)
ma
lacoustic
canal
a
nd
(iii)
the
tympanicmembrane
_
l.l
A).
Auricle
orPinna
ent
ire
pinna, except
itslobule, and
theouter
part
of
ma
lacoust
ic
canal
aremade upofaframework
of
a_e piece of yellowelastic
cartila
ge
coveredwith
skin.
lat
ter
is
closelyad
herent
to
the
perichondrium on
'e
ral surface whileit
is
slightlylooseon
the
medial
--e.
The
variouselevations
and
depressions seenoneralsurface
ofpinn
a are
shown
in
Fi
g.
1.1
B.
ere
is
no
cartilage
betweenth
etragus
and
crus
of
elLX,
and
thisareais
called
the
incisura tenninalis
l.
IC).
An
incisionmade inthisareawill
notcut
2b
the
cartilage
and
is
usedfor
endaural approach
Le
ry
ofthe
external
auditory
canal
or
the
mastoid
External
Middle
Internal
ear
ear
ear
(see
page
357).
Pinna
is
also
the
source
of
se
veralgraftmaterialsfor
the
surgeon.Cartilagefrom
the
tragu
s,
peri
chondrium
from
the tr
ag
us
or
concha,
and
fatfrom
the
lobulearefrequently usedforrec
onstr
uctivesurgery
ofthe
middleear.
The
conchal
cartilage has also
been
usedto
correct
the
depressednasalbridgewhile
the
composite
grafts
ofthe
skinandcartilagefrom
thepinna
are
so
metimes used f
or
repair
of
defects
of
na
salala.
2.
External Acoustic (Auditory)
Canal
It
extend
sfrom
th
e
bottom
of
the conch
a
to
the
tym
panic membraneand
measures
about
24mmalongits posteriorwall. It
is
not
a
straight
tube; its outer
part
is
directed
upwards,backwardsa
nd
mediallywhileits
innerpart
is
direct
ed
downw
a
rd
s,forwards
and
medially.
Therefore,
to
see
the
tympanic membr
an
e,
thepinna
has
to
bepulledupwards,backwards
and
laterallysoas
to
bring
the
two
part
sin
alignment.
Th
e
canal
is
divided
into
twoparts:(a)cartilaginous a
nd
(b) bony.
(a)
Cartilaginous
Part
It forms o
uter
one-third
(8
mm)
of
the
canal.
Cartilage
is
a
continuationof
the
cartilage
which
forms
the
fr
amework
B
Triangul
ar
fossa
HelixCymbaconchoe
--I
.......
~
Antihelix ConchaCrus ofhelixTragusAntitragusLobuleAuricle-Internalocoustic meatusE
xt
ernalacoustic
r
conal
Canilage
TympanicmembranePharynx-Pharyngotympanictube
c
Concha
~"--+
Toil
of
helix
\,
Antitragus
Fig. 1.1
(A)
The
ear
and
its divisions.
(8)
The
elevations
and
depressions
on
the
lateral surface of pinna.
(C)
The
auricular
cartilage.
3
 
DISEASES
OF
EAR
of
thepinn
a. It has two
deficiencies-the
"fissures
of
Santorini"
in this
part
ofthe
cartilage
and
through
themthe
parotid
or
supelficial m
as
toid infections
can
appearin
the
canal,
or
vice versa.
The
skin,
covering
th
ecartilaginous
canal
is
thick
and contains
ceruminous
and
pilo
se
baceousglands
which
secrete
wax.
Hair
isonlyconfinedto
the
outer
canal
and
theref
o
re
furuncles(staphylo
cocc
alinfectionof
hair
follicles)are seenonlyin
the
outer
oneth
irdof
the
canal.
(b) Bony Part
It forms
inner
two-thirds (16 mm).
Skin
lining
the
bony
canal
is
thinand
continuous
over
the
tympanicmem brane. It
is
devoid
of
hair
and
cerumin
o
us
gland
s.
About
6
mm lateral
to
tympanic
membr
an
e,
the
bonyme
at
uspresentsanarrowingcalled
the
isthmus.
Foreign bodies lodgedmedialto
the
isthmu
s,
getimpacted,and aredif ficult to
remove.
Antero-inferior
part
of
the
deep
meatus,beyo
nd the
isthmus, presentsarecesscalled
the
anterior
recess
which
acts
as
acesspool fordischarge
and
debrisincases
of
external
and
middle earinfections.
Antero
inferior
part
of
the
bony canalm
ay
present adeficiency
(f
ora
men
of
Huschl<e)
in
children
up
to the
ageoffouror sometimes in adults,
permitting
infections toandfrom
the
parotid.
3. Tympanic
Membrane
or the Drumhead
It
forms
thepartition
betweenthe
external
acousticcanal andthe middle ear. It
is
obliquelysetand as a
re
sult,itspos terosuperior
part
ismore lateral
than
itsantero-inferiorpart.
It
is
9-10mm
tall,8
-9
mm
wide
and
0.1
mmthick
.
Tympanic membrane
can
be divided
into
twoparts:
(a) Pars
Tensa
It
forms most
of
tympanic membrane. Itsperipheryis
thickened
to formafibrocartilaginousringcalled
the
annulustympanicus
which
fitsin
the
tympanicsulcus.
The
central part
of
parstensa istentedinwardsat
the
level
of
the
tip
of
ma
ll
e
us
and
is
called
the
umb
o.
A brig
ht
cone
of
light
can
beseen radiating from
the
tip
of
malleusto
the
periphery in
th
eanteroinferior
quadrant
(Fig. 1.2).
(b) Pars Flaccida (Shrapnel's
Membrane)
This
issituated above
th
elateralprocess
of
malleusbet ween
the
notch ofRivinusandtheanteriorand
posterior malleal folds(earliercalled
the
malleolarfolds
).
It isnot sota
ut
and
mayappears
li
ghtlypinkish. Variousland markss
een
on
the
lateralsurfaceof ty
mpanic membrane
are
shown
inFig.1.2.
Layers
of
Tympanic
Membrane
Ty
mpanic membrane
consists
of
three
layers:
(i)
Outer
epithelial
layer,
which
is
continuous
with
the
skinlining
the
meatus.(ii)
Inner
mucosal layer,
which
is
continuouswith
the
mucosa
of
the
middleear.
Lateral process
of
malleusPosterior
--
-;:r"""'-
--,
mallealfold Shadow
of
roundw
indowAnnu
l
us
tympanicus S
hrapnell'smembrane
Pars
tensa
Fig.
1.2
Landmarks of a normal tympanic membraneof right
side.(iii)Middlefibrouslaye
r,
which
encloses
the
handle
ofmalleusa
nd
has
three
types
of
fibres-the
radia
l,
circular
andthe
parabolic.Fibrouslayer in
the
paraflaccida
is
thin
andnotorgan ised
into
variousfibres
as
in pars
ten
sa.
Relations of External Acoustic
Meatus
Superiorly:Middle
cranial
fossaPosteriorly:Masto
id
aircellsand
the
facial
ner
veInferiorly:Parotidgland Anteriorly: Temporo
mandibular
joint
Posterosuperiorpart
of
deepercanal
near
the
tympanic
membrane
isrelatedto
the
mastoid
antrum.
"Sagg
ing"
of
thisareamaybenoticed in
acute
mastoidi tis
(
see
page 76).
Nerve
Supply of
the
External Ear
Pinna
(i)
Greater
auricular
ner
ve
(C
Z,3)
supplies most
of
themedialsurface
ofpinnaand
onlyposterior
part
ofthe
lateralsurface (Fig.1
.3
).(ii)
Le
ss
er
occipital
(C
z)
supplies upper
part
of
medialsurface.(iii)
Auriculotempor
al
(V
3)
supplies tragu
s,
crus
of
helixa
nd the
ad
jacent
part
of
th
ehelix.
(i
v)
Auricularbra
nch
of
vagus
(CN
X), also
ca
lled
Arn
old'snerve,supplies
theco
nch
a
and
correspo
nding
eminenceon
the
medialsurface.
(v)
Facial nerve,
which
isdistributed withfibresof auricular
branch
of
vag
us,
supplies
the
co
nch
a andretroauricular
groove.
External
Auditory
Canal
(i)
Ante
riorwallandroof:auriculotemporal (V
3
(ii) Posteriorwall
and
fl
oor: auric
ul
arb
ranchof
vagu,
(CN
X).