Surgical anatomy of the ear

Diksha Cheetoo
Roll number 10

Table of content
Anatomy of the External auditory
meatus vs the eustachian tube
The anatomy of the middle Ear and
the tympanic membrane
The anatomy of the inner ear
especially the scala media
The middle Ear Transformer
mechanism
The important triangles and their
significance

Anatomy of the middle Ear

1. The middle ear cleft
Middle ear + ET+ aditus+ antrum+
mastoid air cells
The hypotympanum
2. Middle Ear
Lies below pars tensa

Mesotympanum
Lies opposite the
pars tensa

Epitympanum
Lies above pars
tensa

The middle ear can be

linked to a six- sided box.

The roof

The
tegmen
tympani

The floor
A thin plate
of bone
which
separates
tympanic
cavity from
the jugular
bulb

The

Promontory- bulge
medial
wall
due to coil of
cochlea
Round
window/fenestra
cochlea- lies postinf to scala
tympani
Oval window-opens
in scala vestibuli,
foot plate of stapes
is fixed to it
Prominence of
facial nerve canallies above oval

 The processus
cochleariformi
s- ant to oval
window, hook
like projectionfor the tendon
of tensor
tympani

The lateral wall

The tympanic
membrane
It is
semitransparent
Pearly grey
Thickness is 0.10.15mm
Placed at 55
degrees from the
floor
It separates the
EAM from ME

 Peripheral part of the

TM is thickened to
form a
fibrocartilaginous ring
attached to the
tympanic sulcus
Membrane 1. tense part is called
pars tensa
2. flaccid part is
called pars
flacida/shapnells
membrane

 Outer TM- 3 layers

1. outer cuticular
2. middle fibrous of
inner circular and
outer radiating fibres
3. inner mucosal
Blood supply-1. deep
auricular branch of
maxillary artey 2.post
auricular artery 3.
tympanic branch of
maxillary artery
Veins- ext jug vein
and transverse sinus

The posterior
wall
Lies close to
mastoid air cells
Presents a bony
projection called as
the
pyramid/pyramidal
recess- contains
the stapedius
muscle
Aditus- opening
through the attic,
communicates with
the antrum- lies

 Facial nerve runs

behind the pyramid

Facial recess/
suprapyramidal
recess
Collection of air cells
lying lateral to facial
nerve
Medially- ext genu of
facial nerve
Lat-chorda tympani
Sup- fossa incudis
Anterolaterallytympanic membrane.

 The
importan
ce of this
recess is
that one
can
approach
the ME
without
disturbin
g the
post
meatal
wall

MCQ
True about the
facial recess is :
A. Bony landmark on
the lateral wall of
middle ear
B. Separates facial from
vestibular nerve
C. Lateral boundary by
fossa incudis
D. One can enter middle
ear without removing
posterior bony
meatal wall

Facial recess is
bounded laterally
by :
A. Facial nerve
B. Chorda tympani
nerve
C. Short process of
incus
D. ponticulus

MCQ
Facial recess is
bounded by all
except :
A. Facial nerve
B. Chorda
tympani nerve
C. Short process
of incus
D. ponticulus

Anatomy of the EAM vs ET

EAM

ET

LENGTH

36mm
Also called
pharyngotympanic
tube
Osseus part is 12mm
from ant tympanic
wall, narrows to the
end to attach to the
cartilaginous part -24
mm

24mm
Outer 1/3rd is
cartilaginous and
inner 1/3rd is
bony

Length

EAM

ET

COURSE

Descends at an angle of
45 degrees with sagital
plane and 30 degrees with
horizontal plane
In infants the auditory
tube is wide and short and
is placed horizontally

Forms a mild s shape

Curve is directed
medially upwards and
forwards and then
medially backwards
downwards

EAM
RELATIONS
1. Floor and ant part of the
meatus are longer than
the roof and post part
2. ant, inf and post bony
part is formed by the
tympanic part of the
temporal bone and roof
is formed by the
squamous part of the
petrosal bone
3. The meatal recess is
present in relation to the
inf wall of the meatus
4. Ceruminous glands and
hair are present mostly
in sbc tissue of

ET

1.
.
.
.

The muscles of ET are

Tensor palati
Levator palati
Tensor palati separates
the ET from the ottic
ganglion, mandibular
nerve , chorda tympani
nerve and middle
meningeal artery

EAM

ET

SUPPLY
Nerve supply
The ant and sup wall are
supplied through the
auriculotemporal branch
of mandibular nerve and
inf wall is supplied by the
auricular branch of vagus

Tympanic plexus and

pharungeal branches of
pterygopalatine
ganglion.

Anatomy of the inner Ear

internal ear

Bony labyrinth

Membranous
labyrinth

bony labyrinth
Vestibu
le

Semici
rcular
canals

Forms
central
part of
bony
labyrint
h

Ant

cochl
ea

3 scc

pos
t

late
ral

Conical
snail
shell
At its base
3 openingsoval window,
round
window and
cochlear
canaliculus

Membranous labyrinth
utricle

Scd open in it
through 5
ampullary
ends
The sensory
part is called
macula
Concerned
with linear
acc and dec

saccul
e

Connected to
utricle
through the
utricosacular
duct

Semici
rcular
ducts
3 in number
Correspond
to 3 bony
canals. They
open in
utricle. The
ampullated
end of each
duct contain
neuro
epithelium
called crista
ampullaris

Cochear duct/ Scala Media

Lies within the
bony cochlea
It is a blind coiled
tube
Occupies the
middle part of the
cochlear canal
between the scala
vestibuli and scala
tympani
It is

Floor- basilar
membrane
Roof vestibular
membrane
Outer wall- stria
vestibulariscontains vascular
epithelium and
secretes endolypm
The basilar
membrane
supports the organ
of corti
The OOC is

 The ganglion is
present within the
spiral canal present
within the modiolus
at thebase of spiral
lamina
The central process
of the ganglion
form the cochlear
nerve
Post the scala
media is connected
to saccule by the
ductus reuniens

OOC consists of2

rows of cells
External rod cells
( 4000)
Internal rod cells
(6000)
Supporting cells of
deiters are found
between the outer
hair cells
Cells of hesners lie
outside the deiter
cells

Middle ear transformer

mechanism/ impedance
matching

Impedance
matching is the
process in which
the TM and
auditory ossicles
convert the sound
energy to
mechanical
vibrations in the
fluid of inner ear
with min loss of
energy by

 Hydaulic action of
the TM
Effective vibratory
area of the TM is
nearly 45- 55
mmsq as
compared to
footplate of stapes
(3.2 sqmm). Hence
it is 14 X greater.
Hence when sound
waves fall on the
TM part of the
sound is

 Lever action of the

ossicles
Handle of malleus
is longer than the
incus by 1.3 X so
the pressure
exerted at the oval
window works out
to be 14x 1.3=
18.3 times

Important triangles and

their significance
Macewans
triangle
Sup- suprameatal
recess
Antero-inf by the
post sup margin of
the EAM
Post- tangent
drawn from
zygomatic arch
Significance-

 Trautmanns
triangle
Post- sigmoid sinus
Ant- bony labyrinth
Sup-sup petrosal
sinus
Significance
Inf into the post
cranial fossa can
spread through this
triangle and be can
be approached by
removing bone in