Approach to the External Ear

Clinical Anatomy
The external ear is composed of the auricle(pinna) and the external
auditory meatus. Its function is to collect and transmit sound to the
tympanic membrane.

Auricle
 Develops from 6 nodules from 1st 2 branchial arches and the
overlying skin
 Formed by a skeleton of yellow elastic cartilage covered in skin

External Auditory Meatus

 Tube connecting the conchal bowl to the tympanic membrane
 Outer 1/3 is cartilaginous, Inner 2/3 is bony
 24 – 25mm long in adults
 Skin of outer third of meatus is hair-bearing and contains wax and
sebaceous glands (which are absent in inner bony meatus)
 The 2 portions of the meatus have slightly different directions – the
cartilaginous part goes upwards and backwards, the bony part goes
forward and downward

Nerve Supply of the External Ear

Knowledge of the nerve supply is important as patients may present with
otalgia caused by stimulation of the nerves elsewhere in their course.
Auriculotemporal  Most of the anterior half of the auricle and the
branch of trigeminal EAM
nerve
Greater auricular  Posterior and cranial side of the auricle
nerve (C2, C3)
Branches from
lesser occipital
nerve (C2)
Small sensory  Around concha and posterior meatus
branches of CN IX  Near the tympanic membrane
and X  It is these branches that when stimulated during
examination of the ear, especially in children),
can cause an episode of coughing due to vagal
stimulation (recurrent laryngeal n.)

The skin of the lateral surface of the tympanic membrane and ear canal is
unusual. It is not simply shed as is the skin from the rest of the body, but it
is migratory and travels radially outwards from the ear drum and thence
out along the ear canal. Thus, the ear canal is largely sefl-cleaning.

Causes of Referred Otalgia Diseases of the External Ear

Parotid, TMJ, Sinuses, Teeth,  Congenital (micro/macrotia,
Tongue base, Tonsil, Larynx, meatal stenosis/atresia, bat ears)
Pharynx, Upper esophagus, Cervical  Traumatic
spine  Infective/inflammatory
 Neoplastic
 Metabolic (gouty tophi)
 Idiopathic (wax impaction)