The tympanic membrane (drumhead) is an ovoid, pale gray, translucent membrane which is positioned obliquely at the medial end

of the external auditory canal. In the normal state the tympanic membrane appears almost avascular, although after prolonged crying or after syringing, the radial vessels may become quite prominent. The tympanic membrane is formed of three layers: the outer epithelial layer which is contiguous with the s in of the external auditory canal! the fibrous middle layer! and an inner mucosal layer which is contiguous with the mucosal lining of the middle ear cleft.

Middle ear cholesteatoma. This is a typical primary acquired cholesteatoma in its earliest stages. Attic cholesteatoma. This perforated tympanic membrane has been photographed with a KARL STOR !op"ins Rod Teleotoscope inserted #ia the e$ternal auditory canal. .

. This #iew shows the true shape of both the perforation and the tympanic membrane and emphasi%es the optical illusion inherent in otoscopy.This perforated tympanic membrane has been photographed with a KARL STOR !op"ins Rod Teleotoscope inserted #ia a hole drilled at right angles to the plane of the tympanic membrane.

(hile "eratin patches present on the surface of all tympanic membranes' they not always #isible) the angle of incident light and its intensity may be inadequate to demonstrate these microscopically raised surface structures. . Maceration of the outer face of the tympanic membrane by moisture or edema of the drum *as in acute otitis media+ usually enhances their #isibility.&f the tympanic membrane is e$amined with sufficient illumination' multiple discrete' thic"ened patches of "eratin' which appear as white linear strea"s' can be seen on the lateral surface of the normal tympanic membrane. !istologically these "eratin patches are composed of tiny mountains or stac"s of "eratinocytes.

The positi#e pressure phase is handled more easily by the tympanic membrane which can mo#e inward with the natural mo#ement of the malleus) the air within the middle ear can be e$pelled down the eustachian tube.ote the linear hematoma along the handle of the malleus and the e#erted inferior margin of the perforation. the insertion of a cotton tipped applicator or a bobby pin+. Traumatic perforations of the drum only occur in the pars tensa.g. . The detonation of high e$plosi#es *a form of se#ere impulse type A noise+ results in pressure wa#es which can cause a sudden and se#ere change in the air pressure within the e$ternal canal. . After the inward e$cursion of the tympanic membrane and the e$pulsion of air) the relati#e negati#e pressure within the middle ear tends to hold the membrane inward.This young student was slapped on the left ear by an irate schoolmaster.a #iolent change in the atmospheric pressure within the e$ternal canal *e. There is an initial short positi#e pressure phase *the condensation phase+' followed by a longer negati#e pressure phase *the rarefaction phase+. There is a moderately large anteroinferior perforation. (hile the fibrous middle layer of the tympanic membrane pro#ides a reasonable degree of strength' the membrane can be ruptured if sufficient force is applied. !owe#er' the negati#e pressure phase cannot be as readily or rapidly accommodated because the outward e$cursion of the tympanic membrane is limited.g. There are two distinct mechanisms by which the tympanic membrane may be ruptured. an e$plosion or a slap on the ear+ or direct mechanical trauma *e.

urulent middle ear effusion and tympanic membrane with a loss of landmar"s and characteristic bagel or doughnut appearance .Retracted Tympanic Membrane with a Myringostapediope$y .