Anatomy of middle ear

BY
KURIACHAN JOSEPH
 Embryology of the MIDDLE EAR

•
Develops from the 3 germinal layers
• Auditory tube extends from the 1st pharyngeal pouch.
• 1st and 2nd pharyngeal arches give rise to the malleus, incus, and stapes.
• Auditory tube surrounds the ossicles → tympanic cavity
• Tympanic membrane
• Inner layer (endoderm) 
• Middle layer (mesoderm) 
• Outer layer (ectoderm)
ANATOMY OF MIDDLE EAR

 Tympanic cavity
• Bony membranous cavity shaped like a 6-sided prism and filled with air
• Contains the ossicles, muscles, and nerves
• The roof consists of the tegmental wall, which separates the malleus and incus from the
middle cranial fossa.
• Labyrinthine or medial wall contents:
• Oval window (connects to vestibule of the internal ear)
• Round window (secondary tympanic membrane) 
• Promontory
• Prominence of the facial canal
• Relations:
• Lateral wall: tympanic membrane
• Posterior wall: 
• Mastoid antrum
• Communicates with mastoid air cells
• Anterior wall (carotid wall): 
• Thin layer of bone separating the cavity from the carotid artery
• Pierced by the tympanic branch of the internal carotid artery and deep petrosal nerve
• Contains the auditory tube
• Floor (jugular wall): separates the cavity from the internal  jugular vein
• Auditory ossicles:
• Amplify sound waves and transmit them to the labyrinth of the inner ear
• Connect the tympanic membrane to the oval window
• Smallest bones in the human body
• Lateral → medial: malleus, incus, stapes
MUSCLES OF MIDDLE EAR

 Middle ear muscles are responsible for movement of the tympanic membrane.

• Tensor tympani muscle:
• Origin:
• Cartilaginous part of eustachian tube
• Greater wing of the sphenoid
• Semicanal for tensor tympani (petrous part of temporal bone)
• Insertion: superior part of the handle of the malleus
• Innervation: mandibular branch of the trigeminal nerve (CN V3)
• Function:
• Pulls the handle of the malleus medially 
• Tenses the tympanic membrane
• Stapedius muscle:
• Origin: cartilaginous/bony margins of eustachian tube
• Insertion: neck of stapes
• Innervation: facial nerve (CN VII)
• Function:
• Pulls stapes posteriorly  
• Prevents excessive oscillation of the ossicles
Muscles and ossicles of the middle ear
 Eustachian tube (auditory tube)
• Controls pressure within the middle ear and on both sides of the tympanic membrane
• Located anterior to the tympanic cavity
• Connects the middle ear to the nasopharynx
STRUCTURE BLOOD SUPPLY LYMPHATICS
INNERVATION
Tympanic cavity •Anterior tympanic artery Retroauricular cervical lymph •Tympanic cavity: tympanic
•Posterior, inferior, anterior, and  nodes nerve (branch of CN IX)
superior tympanic arteries •Muscles: tensor tympani nerve
•Mastoid branch of the occipital (CN V) and stapedius nerve (CN
 artery VII)
Clinical Relevance

• Otitis externa: inflammation of the external acoustic meatus. Otitis externa is a bacterial

infection that most commonly occurs in children. The typical causative organisms are 
Pseudomonas and Staphylococcus aureus. Presentation is with exquisite tenderness on
manipulation of the external ear. Treatment is with antibiotic eardrops.
• Acute otitis media: acute inflammation of the middle ear due to viral or bacterial 
infections. The condition is most common in children ages 6–18 months. Presentation is
with fever, symptoms of upper respiratory tract infection, and ear pain. The majority of
cases are caused by viruses, but antibiotics should be initiated if a bacterial etiology is
suspected.
• Vertigo: sensation of movement between oneself and surroundings. Vertigo is not limited
to a feeling of rotation but may include other forms of movement, such as upward lifting,
swaying, rocking, or nonsystematic movement. It is usually a symptom of an underlying
condition such as labyrinthitis, Ménière disease, or an adverse reaction to medications.
• Ménière disease: characterized by a symptom triad of vertigo, tinnitus, and 
hearing impairment. The episodes of vertigo in Ménière disease can last from a few
minutes to several hours, and the hearing impairment mostly affects low frequencies.
Treatment is geared toward nausea prevention and physical therapy to maintain physical
functionality.
• Hearing loss: hearing impairments are classified into conductive hearing loss and 
sensorineural hearing loss. Conductive hearing loss stems from damage to the middle ear,
which prevents the proper transmission of sound. In sensorineural hearing loss, the
hearing organ is damaged.
• Tinnitus: perception of noise or “ringing in the ears.” Tinnitus is a common condition
that is experienced in the absence of an external auditory stimulus. The sound perceived is
described as whistling, hissing, buzzing, ringing, and/or pulsating. Tinnitus may be related
to underlying conditions such as Ménière disease, ear and sinus infections, and brain
 tumors.