Anatomy of Ear

Introduction:
The anatomy of the ear is composed of the following parts :

 External ear (auricle).

 Middle ear (tympanic): Malleus, incus, and stapes.
 Inner ear (labyrinthine): Semicircular canals, vestibule, cochlea.
 The ear is a multifaceted organ that connects the central nervous system to the external
head and neck. This structure as a whole can be thought of as 3 separate organs that work
in a collective to coordinate certain functions, such as hearing and balance. Any
disharmony in this continuum may disrupt the ear's functionality.

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External ear

The auricle and external acoustic meatus (or external auditory canal) compose the external ear.
The external ear functions to collect and amplify sound, which then gets transmitted to the
middle ear. The asymmetric shape of the external auricle introduces delays in the path of sound
that assist in sound localization.
Auricle
The concha surrounds the opening to the external auditory meatus (external auditory canal),
whereas the auricle consists of the following (see the image below):

 Root/crus of helix
 Helix
 Antihelix
 Scaphoid fossa
 Triangular fossa
 Crura of antihelix (superior, inferior)
 Antitragus
 Lobule
 Tragus

The arterial supply of the auricle is composed of the posterior auricular artery, the anterior
auricular branch of the superficial temporal artery, and the occipital artery, which also
contributes. Veins accompany the corresponding named arteries.
Sensory innervation of external ear
The sensory innervation of the external ear has been well studied and is composed of the
following:

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  The great auricular nerve originates from C2-3 branches of the cervical plexus; the
sensory territory of this nerve is the lower two thirds of the anterior and posterior external
ear
 The sensory innervation to the anterior superior one third of the ear (tragus, crus helix,
superior helix) is the auriculotemporal nerve (branch of V3)
 The lesser occipital nerve derives its origin from the C2 branch of the cervical plexus and
supplies sensory information from the posterior (cranial) surface of the superior one third
of the external ear
 The auricular branch of vagus nerve (Arnold nerve) innervates the external auditory canal
floor and concha

External acoustic meatus (external auditory canal)

The external acoustic meatus (external auditory canal) is formed by cartilage and bone
(temporal).
The canal measures about 4 cm in length (from the tragus) to the tympanic membrane and is
curved in an S shape.
Sensory nerve supply to the external acoustic meatus (external auditory canal) consists of the
following:

 The auriculotemporal nerve (from the mandibular branch of the trigeminal nerve)
provides sensory information from the anterior wall and roof
 The posterior wall and floor sensibility is carried in the nerve fibers of the auricular
branch of vagus (Arnold nerve)
 The tympanic plexus offers some contributions

The arterial supply includes the posterior auricular artery, deep auricular branch of the
maxillary artery, and superficial temporal artery.
Applied anatomy: Collection of wax (secretion from glands in the ear) in the external acoustic
meatus can cause pain.

Tympanic membrane (**** Important Short note)

Introduction: The tympanic membrane (TM) is an oval, thin, semi-transparent membrane that
separates the external and middle ear (tympanic cavity).
Shape: Oval
Diameter: 8-10 mm
Attachment: Tympanic sulcus.
Parts of Tympanic membrane:
The tympanic membrane is divided into 2 parts:

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  Pars flaccida The area of the tympanic membrane superior to the umbo is termed the
pars flaccida. It is between anterior and posterior malleolar folds.
 Pars tensa: the remainder of the tympanic membrane is the pars tensa.
 The handle of the malleus is firmly attached to the medial tympanic membrane; where the
manubrium draws the tympanic membrane medially, a concavity is formed. The apex of
this concavity is called the umbo.

Structure of Tympanic membrane: It contains three layers: outer layer formed by skin, Middle
layer formed by radian and circular fibers and inner layer is formed by mucus membrane.
Function: Air vibrations collected by the auricle are transferred to the mobile tympanic
membrane, which then transmits the sound to the ossicles.
The sensory nerve supply to the tympanic membrane includes the following:

 Auriculotemporal nerve (mandibular branch of trigeminal nerve)

 Auricular branch of vagus nerve (Arnold nerve)
 Tympanic branch of glossopharyngeal nerve (Jacobson nerve)

The blood supply is derived from the stylomastoid branch of the posterior auricular, deep
auricular and anterior tympanic branches from the maxillary artery.

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Venous drainage includes the external jugular from veins on the superficial aspect of the
tympanic membrane and veins from the deep surface of the tympanic membrane draining to the
transverse sinus and dural veins.
Applied Anatomy:
 Infection of tympanic membrane is known as Myringitis.
 During otitis media pus may rupture the membrane and come out through external ear.
Artificial opening is done in the tympanic membrane to drain the pus from middle ear.
This procedure is known as Myrigotomy.
 Repair of rupture of tympanic membrane is known as Myringoplasty.

Middle ear (tympanic cavity)

(***** Most Important Short note)

Introduction: The middle ear located in the petrous portion of the temporal bone and is filled
with air secondary to communication with the nasopharynx via the auditory (eustachian) tube.
Extent: The tympanic cavity (middle ear) extends from the tympanic membrane to the oval
window and contains the bony conduction elements of the malleus, incus, and stapes.
Parts:
It is divided into two parts: Tympanic cavity proper which is opposite to tympanic membrane
and epitympanic recess which is above the level of tympanic membrane.
Shape: Biconcave
Dimensions:
 Vertical and Anteroposterior: 15 mm
 Transverse diameter:
 Upper part: 6 mm
 Middle part: 2 mm
 Lower part: 4 mm

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 Tegmental wall formed by tegment tympani and related to
temporal lone of brain

Carotid wall
contain
opening for
Fenestra tensor tympani tensor
Facial canal
Mastoid wall vestibuli tympani
contain Auditory tube
muscle and
Promontory
opening to Fenestra auditory
mastoid Mastoid cochleae tube and
antrum and air cells ICA related to
related to Internal
mastoid air carotid
cells artery
Bulb of
IJV

Jugular wall formed by jugular fossa and related to Superior

bulb of internal jugular vein

Boundaries of tympanic cavity:

Roof: (Tegmental Wall): Formed by a thin plate of bone, the tegmen tympani, which separates
the cranial and tympanic cavities.
Floor: (Jugular Wall): Narrow, and consists of a thin plate of bone (fundus tympani) which
separates the tympanic cavity from the jugular fossa and related to superior bulb of internal
jugular vein.
Posterior wall (Mastoid wall): contains the mastoid antrum and communicates with the mastoid
air cells

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Anterior wall (Carotid wall): The anterior wall is also termed the carotid wall, because a thin
plate of bone separates the carotid canal containing internal carotid artery and tympanic cavity.It
has following features:

 Opening for the canal of tensor tympani muscle

 Opening of auditory opening
 Both the openings are separated by a bony process known as Processus
cocholeariformis.

Medial Wall (Labyrnthic wall): is vertical in direction, and presents for examination the
fenestræ vestibuli and cochleæ, the promontory, pyramid and the prominence of the facial
canal.
Features in Medial wall:
 The promontory is a rounded hollow prominence, formed by the projection
outward of the first turn of the cochlea; it is placed between the fenestræ
 The fenestra vestibuli (fenestra ovalis-oval window) is a reniform opening
leading from the tympanic cavity into the vestibule of the internal ear; located
posterosuperior to promontory occupied by the base of the stapes.
 The fenestra cochleæ (fenestra rotunda-round window) is located
posteroinferior to promontory, leads into the cochlea of the internal ear; in the
fresh state it is closed by a membrane, the secondary tympanic membrane.
 Prominence for Facial canal is located at junction of posterior and medial wall
and contains the facial nerve.
 Pyramid: It is elevation between fenestrae behind the promontory and apex of it
gives origin to stapedius mucle.

Lateral wall (Tympanic wall): The lateral wall contains the tympanic membrane and separates
tympanic cavity from the external acoustic meatus.

Contents of Middle Ear Cavity:

Multiple structures are contained within the confines of the tympanic cavity (middle ear).
Muscles, nerves, and the auditory tube occupy space within the tympanic cavity. The cavity is
covered in mucoperiosteum.
Ossicles

 Incus (anvil)
 Stapes (stirrup

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  These bony elements serve to transmit and amplify sound waves from the air to the
perilymph of the internal ear. This bony conduction amplifies 10 times the sound wave
from air.

Muscles

 Tensor tympani: Tenses the tympanic membrane and supplied by mandibular nerve.
 Stapedius: Prevents over-movement of spates and supplied by facial nerve.

Nerves:

 Chorda tympani: Branch of facial nerve.

 Tympanic branch of glossopharyngeal nerve
 Tympanic plexus
 Lesser petrosal nerve
 Greater petrosal nerve.

Nerve supply:
Sensory information about the tympanic canal (middle ear) is carried by multiple nerves that
contribute to the tympanic plexus located on the promontory of the medial wall.
Vascular supply
The arterial supply of the cavity includes the tympanic branch of the maxillary (tympanic
membrane), stylomastoid branch of the posterior auricular (posterior cavity and mastoid),
petrosal branch of the middle meningeal, branch of the ascending pharyngeal, tympanic branch
of the internal carotid, and a branch from the artery of the pterygoid canal (follows the auditory
tube). Venous drainage is to the pterygoid plexus and the superior petrosal sinus.
Applied Anatomy:
 Infection of middle ear known as Otitis Media. It can occur due to blockage of auditory
tube opening in the pharynx in upper respiratory infections in children.
 Complications of Otitis media can lead to rupture of tympaninc membrane, spread of
infection to brain and sigmoid sinus.

Auditory tube (** Important Short note)

The auditory tube (Eustachian tube) is the channel through which the tympanic cavity
communicates with the nasal part of the pharynx.
Its length is about 36 mm., and its direction is downward, forward, and medialward, forming an
angle of about 45 degrees with the sagittal plane and one of from 30 to 40 degrees with the
horizontal plane.
Shape: Trumpet shaped.
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It is divided in to two parts:
The osseous portion is about 12 mm. in length. It is formed partly of bone, partly of cartilage
and fibrous tissue.
The cartilaginous portion, about 24 mm. in length, is formed of a triangular plate of elastic
fibrocartilage, the apex of which is attached to the margin of the medial end of the osseous
portion of the tube, while its base lies directly under the mucous membrane of the nasal part of
the pharynx, where it forms an elevation, the tubal elevation.
Narrow region between osseous and cartilaginous part is known as Isthmus.
Its function is to equalize pressure across the tympanic membrane.
Contraction of the tensor veli palatini and the salpingopharyngeus outside of the tympanic cavity
(middle ear) dilate and open the auditory tube.
Applied anatomy: Upper respiratory tract infections in children can block the opening of
auditory tube in the pharynx and lead to collection of fluid in middle ear and cause secondarily
otitis media.

Inner ear (labyrinthine cavity)

The inner ear, also called the labyrinthine cavity, functions to conduct sound to the central
nervous system (CNS) as well as to assist in balance. Auditory transduction, the conversion of
acoustic (mechanical) energy to electrochemical energy, takes place within the labyrinthine
cavity.
The labyrinthine cavity is essentially formed of the membranous labyrinth encased in the bony
osseus labyrinth. The osseus labyrinth is a series of bony cavities within the petrous temporal
bone; the membranous labyrinth is the communicating membranous sacs and ducts housed
within the osseus labyrinth. The membranous labyrinth is cushioned by the surrounding
perilymph and contains the endolymph within its confines. The membranous labyrinth also has
cochlear, vestibular, and semicircular components.
Inner ear: bony and membranous labyrinths.
The osseus labyrinth consists of the cochlea, vestibule, and semicircular canals. These bony
cavities are lined with periosteum and contain perilymph. The fenestra vestibuli or oval window
is an opening in the lateral wall of the vestibule of the osseous (bony) labyrinth. It articulates
with the footplate of the stapes from the middle ear and opens into the fluid-filled inner ear.
It is supplied by Vestibulocochlear nerve responsible for transmission of impulses from cochlea
for hearing and from semicircular canals for maintenance of balance.

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