THE TYMPANIC PLEXUS

An Anatomic Study

SAMUEL ROSEN, M.D.

NEW YORK

NEW THEORETIC considerations concerning the role of the

tympanic plexus and chorda tympani nerve in deafness, tinnitus
and vertigo have focused attention on these long-neglected nerve struc-
tures.1 It is important to gather intimate knowledge of the structure,
relations, distribution and variations of the tympanic plexus in order
to evaluate properly the effects of surgical interruption of the plexus.
The main trunk of the tympanic plexus is Jacobson's nerve, which
arises from the glossopharyngeal, pierces the floor of the tympanum
and extends upward on the promontory and anastomoses with
the lesser superficial petrosal nerve. The sympathetic components arise
from the carotid sympathetic plexus and anastomose with Jacobson's
nerve anteriorly. Smaller branches of Jacobson's nerve go to the oval
and round windows posteriorly. A large branch of Jacobson's nerve
goes to the eustachian tube. This delicate group of ramifying nerves
may function as a significant link in the mechanism of deafness, tinnitus
and vertigo.
The present study is based on observations made on 100 fresh cada¬
ver specimens, most of which were operated on on both sides. All
observations were made after the fenestration operation was completed
and the tympanomeatal flap removed. The tympanum was enlarged to
the limit, superiorly, anteriorly and inferiorly, as in the radical mas¬
toidectomy. The inner tympanic wall and tympanic plexus were thus
exposed for visualization. The observations were made with the Zeiss
magnifying glasses alone, except for a few with added magnification.
In a few instances inspection was made with a 10 magnification loupe
after the temporal bone had been removed.
It.is interesting to note that there was no bilateral symmetry in the
distribution of the plexus or any characteristic anatomic difference in
race or sex. Each plexus is individual and unique. No two plexuses
From the Department of Otolaryngology, Mount Sinai Hospital.
1. Rosen, S.: Chorda Tympani Nerve Section and Tympanic Plexectomy :
New Technic Used in Cases of Deafness, Tinnitus and Vertigo, Arch. Otolaryng.
50:81-90 (July) 1949.

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 were found be identical in all respects. The two schematic dia¬
to
grams (figs.1 and 2) include, therefore, most of the major and minor
similarities and differences in this study.
Not infrequently, all that could be seen of the plexus, on one side,
was Jacobson's nerve and its large anterior branches. The posterior
branches were not visible. On the opposite side of the same cadaver,
the posterior fine branches of Jacobson's nerve to the oval and round
windows and to the tympanic mucosa could be seen in a rich anasto¬
mosis. Again, there was no relation between the composition of the
plexus and the abundance or absence of pneumatic cells in the tym¬
panum. In some specimens Jacobson's nerve was very large and could
be dissected out. The branches to the windows were clearly visible.
In other specimens Jacobson's nerve was very thin and its branches to
the windows could scarcely be seen.

Fig. 1.—1 indicates the carotid artery; 2, lacobson's nerve; 3, caroticosympa-

thetic branches : 4. branch of the eustachian tube ; 5, round window ; 6, branch to
round window ; 7, oval window ; 8, branch to oval window ; 9, anastomotic branch
from facial nerve to Jacobson's nerve ; 10, lesser superficial petrosal nerve ; 11.
greater superficial petrosal nerve ; 12, geniculate ganglion ; 13, facial nerve, and
14, semicanal for tensor tympani muscle.
The following observations on the tympanic plexus were made in
100 cases.
1. Jacobson's nerve was encased in a deep bony canal from the
tympanic floor to the level of the lower border of and just anterior
to the round window (inferior bony canaliculus). The nerve appeared
on the promontory at this point in 80 of the cases. In the remaining
20 cases, the nerve appeared on the promontory closer to the floor of
the tympanum or closer to the upper level of the round window.
2. At the level of the processus cochleariformis, Jacobson's nerve
was encased in another deep bony canal (superior canaliculus) on its

path upward to its connection with the facial nerve or geniculate gan-

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 glion and superficial petrosal nerve. From the processus cochleariformis
upward, Jacobson's nerve passed internal to the semicanal for the tensor
tympani muscle in all 100 cases.
3. The direction of Jacobson's nerve on the promontory was vertical
or leaned forward on its upward course in 88 cases. In 12 cases it
leaned slightly posteriorly. Jacobson's nerve was not found to be tortu¬
ous in any instance.
4. The promontorial portion of Jacobson's nerve, between the super¬
ior and inferior canaliculi, was superficial and could be shelled away
with the mucosa of the inner tympanic wall in 59 cases. Of the remain¬
ing 41 cases, Jacobson's nerve was embedded in a shallow or deep
bon semicanal in 22 cases and in a complete bony canal in 19 ca,ses.

Fig. 2.—1 indicates the carotid artery ; 2, Jacobson's nerve ; 3, caroticosympa-

thetic branches ; 4, tubai branches ; 5, round window ; 6, branch to round window ;
7, oval window ; 8, branches to oval window ; 9, interfenestral branch ; 10, branch
above eustachian tube ; 11, greater superficial petrosal nerve ; 12, geniculate
ganglion; 13, facial nerve; 14, semicanal for tensor tympani muscle, and 15,
anastomotic branch from facial to Jacobson's nerve at junction of lesser superficial
petrosal nerve.

In all 19 cases in which Jacobson's nerve was in a complete bony canal

and in many of the cases in which it was in a semicanal, Jacobson's
nerve could be removed only with great difficulty.

5. In 50 cases an anastomotic branch from the facial nerve con¬

nected with Jacobson's nerve ; in 36 cases an anastomotic branch from
the geniculate ganglion connected with Jacobson's nerve, and in the
remaining 14 cases, no anastomosis to the facial or the geniculate nerve
was seen. In all 100 cases Jacobson's nerve continued forward to con¬
nect with the small superficial petrosal nerve.

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 6. Jacobson's nerve gave off small branches posterior to the oval and
round windows and to the mucosa between the fenestra. In 58 cases
there were one or more branches to the oval window ; in the remaining
42 cases no branch was seen. In 65 cases there were one or more
branches to the round window ; in the remaining 35 cases no branch
was seen. In only 38 of the 100 cases could an interfenestral branch
be seen. Often, fine anastomotic twigs could be seen connecting the
posterior branches.
7. The larger anterior branches of Jacobson's nerve were directed
to the eustachian tube above and to the carotid plexus below. The
former branch was present in 97 cases, the latter branch in 98. Some¬
times there were two branches to the eustachian tube and two or more
to the carotid plexus. A branch to the carotid plexus above the
eustachian branch was encountered only twice. Fine anastomotic twigs
could frequently be seen connecting the anterior branches.
8. In 4 cases the tubai, in 3 cases the carotid and in 2 cases the
window branches were encased in complete bony canals. Of these 9
cases, the promontorial portion of Jacobson's nerve was situated in a
complete bony canal only once.
9. In 69 cases one of the caroticotympanic branches was found at the
level of, or just below, the lower border of the oval window. In the
remaining 31 cases this branch was found considerably above this level.
It is hoped that anatomic studies of this plexus will form the basis
for future clinical experiments.
101 East Seventy-Third Street.

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