EAR

Embryology
Development of pinna(auricle=visible part of E.ear)
• The 1st and 2nd branchial arch mesoderm
(surrounding 1st branchial cleft/groove) gives rise to 6
mesodermal thickenings (auricular tubercles) known as
“HILLOCKS of HIS” which fuse to form pinna[6th-20thwk]
• 1st arch →1st Hillock → Tragus + crus & root of helix
• 2nd arch →next 5 hillocks→rest of Pinna
Developmental Anomalies of pinna
1. Failure of fusion of 1st & 2nd arch = pre-auricular sinus
most commonly between tragus and root of helix
 If asymptomatic → no treatment
 If infected + discharge on and off → surgical excision
2. Malformation of pinna = anotia, microtia

Surgical reconstruction is done at ≥ 6 year because

• Completely formed pinna attains adult size by 5-6 yr
• The costal cartilage to be used as graft here also
develops by 6 yr
3. Thickening at the junction of upper 1/3rd + middle
1/3rd of Helix = Darwin’s tubercle [ U/L or B/L ] d/t
unequal turning of helix in some fetus
 Development of external auditory canal
• 1st branchial cleft [i.e. ectoderm at 8th week of IUL ] →
meatal plug →recanalization(deeper to outer) of plug →
epithelial lining of EAC →adult shape EAC (28 wk IUL) →only
cartilaginous part complete by birth (TM horizontal) BUT
bony part grow for 4-5 yr to reach adult size (TM angulation
55°) →
Developmental anomalies of EAC
Normally ventral part of 1st cleft that connects EAC & neck,
disappears

If persists abnormal connection of EAC (internal opening) and

Neck (external opening between SCM and angle of mandible)
called as Call-aural fistula; if infected and discharge on & off
→ surgical excision
 Development of middle ear
• Tympanic membrane(TM) develops from
1st branchial membrane that consists of :-
ectoderm→ outer epithelial layer
mesoderm→ middle fibrous layer
endoderm→ inner mucosal layer
• Middle ear cleft :
 [1st pharyngial pouch + small part of 2nd pharyngeal
pouch] → tubotympanic recess → middle ear cleft
(eustachian tube +middle ear cavity+mastoid antrum )
 The malleus and incus develops from Meckel cartilage
derived from NCC within pharyngeal arch 1 (dorsal
end)
 The stapes develops from Reichert cartilage derived from
NCC within pharyngeal arch 2 (dorsal end) except its footplate
and annular ligament that develop from otic capsule (bony
labyrinth) development (endochondral ossification).
Developmental anomalies of middle ear cleft
 Fixation of stapes is the MC congenital middle ear anomaly
 Small TM in congenital rubella syndrome
 Congenital cholesteatoma (epidermoid cyst) – due to
↑proliferation of endodermal lining in middle ear & MC in
anterosuperior qaudrant(deep to TM)
Development of Mastoid (the mastoid air cell system):
 Mastoid (=spongy bone with multiple air cells) develops
from superficial squamous and deep petrous parts of
Temporal bone with petro-squamous suture in between ,
that disappears normally
• Mastoid antrum = largest mastoid air cell that develops
from tubotympanic recess.
• TM + middle ear cavity + ear ossicles + mastoid antrum +
labyrinth (both)→completely developed(adult size) at birth.
• The mastoid (except mastoid antrum) develop – 90% by 6
years and 100% by 18 years of age.
• Persistent petro-squamous suture = “KORNER’S SEPTUM”
• The mastoid antrum lies in the petrous part deep to the
Korner’s septum.
• Mastoid tip absent at <2 yrs. of age→ the facial nerve lies
very superficial just below the skin → So in a child below 2
years with post auricular abscess, the incision should be
superior and horizontal to avoid damage to facial nerve.
 Surgical importance of korner’s septum
 if present, the surgeon might confuse the Korner’s
septum with medial most wall of antrum→ d/t fear
of entering posterior cranial fossa the surgeon stops
the surgery at the Korner’s septum(but actually not
yet entered the antrum →lead to incomplete
clearance of disease from the mastoid.
 Postnatal ossicular remodelling only in Malleus &
Incus NOT in Stapes
Development Pinna EAC Middle ear Inner ear
(Weeks of IUL)
Begins at 6th 8th 3rd 3rd

Completes by 20th 28th 30th 20th

• All ear ossicles reach adult size by 16th week of IUL
• Ossicles form by endochondral ossification
 Development of internal ear (the labyrinth)
 Surface ectoderm thickening (otic placode) → otic placode
invaginates into the underlying mesoderm (mesenchyme)
adjacent to Rhombencephalon → otic vesicle (otocyst) →
membranous labyrinth (develops earlier) :-
 pars superior (utricular part)- develops early (older part)
• Utricle
• 3 Semicircular ducts (order: superior-posterior-lateral )
• Vestibular (Scarpa’s) ganglion of CN VIII
• Semicircular ducts and sac
 pars inferior (saccular part) - develops later
• Saccule
• Cochlear duct/ scala media/ membranous cochlea
• Cochlear (spiral) ganglion of CN VIII
After membranous labyrinth, bony labyrinth develops.
 Mesenchyme surrounding membranous labyrinth
condense→ cartilaginous(hyaline) model →
endochondral ossification (14 centers) → bony
labyrinth (otic capsule):
• 3 semicircular canals
• Vestibule
• Bony cochlea(scala vestibuli-2nd & scala tympani-1st)
 Internal ear develops completely in 3rd- 20th week
and fetus can hear thereby.
Developmental anomalies of internal ear:
• Scheibe’s dysplasia: dysplasia of saccule + cochlea
(most common anomaly )
• Mondini’s dysplasia :- cochlea has only 1.5 turns
• Alexander’s dysplasia: deformity of the basal turn of
cochlea →High frequency sound affected
• Michel aplasia :complete absence of labyrinth (both bony+
membranous) + vestibulocochlear nerve →so cochlear
implant can’t be done
• Cochlear implant – Tx (surgical) of Scheibe’s aplasia,
Mondini’s aplasia and Alexander’s aplasia
• Superior Semicircular Canal Dehiscence (SSCD)
→The bone between SSC and brain tissue (on anterior slant
surface of petrous bone facing middle cranial fossa) is missing
or very thin(dehiscence=opening/split/burst)→ third mobile
window (others - round and oval windows) in inner ear
→exposure to changes in intracranial pressure → vestibular
disorder
 ANATOMY OF EAR
Human ear has 3 parts :
1. EXTERNAL EAR : consists of
a.Pinna (Auricle)
b.External auditory canal (EAC)
c.Outer epithelial lining of tympanic
membrane
2. MIDDLE EAR
3. INNER EAR/INTERNAL EAR (LABYRINTH)
 Temporal Bone (TB)
• A pair of pneumatic irregular bones in humans situated
at sides and base of skull that houses human ear .
• Embryologically 4 separate elements eventually fuse to
form the TB (total 8 centers of ossification excluding ear
ossicles and bony labyrinth): - the petromastoid
complex (4), the squamous part (1) , the tympanic bone
(1) and the styloid process (2)
• Squamous and tympanic parts – membranous
ossification & Rests – endochondral ossification
 squamous part :- smooth, flat & largest part of TB
 forms roof and upper ½ of posterior wall of bony EAC
 Important bony landmark – supramastoid triangle
 Forms articular part of mandibular (glenoid) fossa
• The squama separated from tympanic part (that
forms non-articular part of mandibular fossa) by
squamo-tympanic fissure which is divided by
tegmen tympani of petrous bone into :
• Anterior – petrosquamous fissure
• Posterior – petrotympanic (Glaser) fissure
• Medial end of Glaser fissure allows :-
 Exit of chorda tympani nerve via its anterior
canaliculus (aka Huguier canal or Civinini canal)
 Entry of anterior tympanic branch of maxillary A.
 Passage of anterior ligament of malleus
 Supramastoid (MacEwen’s) triangle
 Aka mastoid fossa
Boundaries :
• Superiorly–inferior temporal line (supramastoid
crest)
• Anteriorly –posterosuperior margin of BONY external
auditory canal (EAC) opening (=meatus)
• Posteriorly –vertical tangent drawn to mid-point of
posterior wall of of EAC
• Content : suprameatal spine (spine of Henle)
Clinical importance : surgical landmark for mastoid
antrum that lies 12-15 mm deep to triangle in adults
and 2 mm deep in neonates [grow at 1 mm/year].
 Tympanic part
• Curved plate of bone below squamous and in front
of mastoid parts
• Anteriorly related to parotid gland
• Forms entire anterior wall & floor + lower ½ of
posterior wall of bony EAC.
• Medial end has sulcus tympanicus (tympanic sulcus)
in which fits the annulus tympanicus (tympanic
annulus) of TM
• Lateral border has tympanomastoid fissure via
which exits the Arnold’s nerve (posterior to EAC)
• A deficiency in anteroinferior part = “foramen of
Huschke”
 Styloid process
• 2.5 cm long bony process with :
• 3 muscles –a. styloglossus (hypoglossal nerve)
b. stylopharyngeus (glossopharyngeal n.)
c. stylohyoid (Facial nerve)
• 2 ligaments: stylohyoid (from 2nd arch) and
sphenomandibular ( from investing layer of DCF)
• Stylomastoid foramen – Between mastoid process
and styloid process
• Facial nerve and stylomastoid artery (from post
auricular artery) emerges via stylomastoid foramen.
Petromastoid complex =petrous + mastoid parts
Mastoid part
• Thick bone with multiple air cells within, antrum
being the largest .
• Sigmoid sulcus on internal surface ( lies in posterior
cranial fossa)
• Mastoid process absent in children upto 2 years and
develops in adult by pulling of SCM
• Mastoid foramen for 1 emissary vein near the
posterior limit of bone→sigmoid sulcus
• Groove behind mastoid process for posterior belly
of digastric m. anteriorly and occipital artery (post.)
 Petrous part (Lt. petrosus = stone-hard)
• Most important part of TB
• Pyramidal shape with Base facing laterally and
Apex(PA) anteromedially + 3 surfaces and 3 borders.
• Base merges with squamous and mastoid parts.
• Petrous Apex (PA) directed anteromedially forms
posterolateral boundary of foramen lacerum
• PA contains anterior (cranial) carotid canal opening
• Tip of PA joined to petrosal process of dorsum sella
of sphenoid by petrosphenoid ligament that forms
Dorello’s canal for CN VI
• 3 surfaces : anterior , posterior and inferior
• 3 borders : anterior, superior and posterior
●Anterior border in lateral part fuses with squamous
part and has 2 bony canal openings : upper and lower
(at fusion site separated by a bony partition) directed
posterolaterally to communicate with anterior wall of
tympanic cavity (upper canal -tensor tympani muscle
& lower canal= bony part of auditory tube )
• Superior border – groove for superior petrosal sinus
• Posterior border – medial part + occipital bone →
groove for inferior petrosal sinus and lateral part →
superolateral boundary of jugular foramen
• Anterior slant surface : From medial to lateral –
 Trigeminal impression (close to PA)- converted into
cavum trigeminale (Meckel’s cave) by duramater
 Shallow bony roof of Internal Acoustic Canal
 Arcuate eminence produced by superior SCC and it
also form roof of vestibule of bony labyrinth
 Tegmen tympani (= extremely thin plate of bone) –
roof of middle ear cleft and has 2 foramina: Lateral
for Lesser petrosal and medial for GSPN
• Posterior slant surface : from medial to lateral –
1) Internal acoustic meatus (IAM) leading into 1 cm
long bony canal (IAC)
 Lateral end of IAC = fundus of IAC divided into 3
anatomical compartments that allows 4 structures:-
 Horizontal bony plate (Falciform crest) divides IAC
fundus into upper and lower parts.
 The upper part is again divided into anterior and
posterior parts by vertical bony plate (Bill’s bar).
 Antero-superior quadrant →Facial nerve
 Antero-inferior quadrant (tractus spiralis
foraminosus) →cochlear nerve (→cochlear duct)
 Postero-superior quadrant →superior division of
vestibular nerve (→the superior and lateral SCCs
the utricle and a part of the Saccule).
 Postero-inferior quadrant → inferior division of
vestibular nerve (→Saccule)
 Foramen singulare in posteroinferior quadrant→
singular nerve (→posterior SCC)
2.Subarcuate fossa(prominent only in children) lodges
Subarcuate artery [supero-lateral to IAM]
3. Oblique slit with operculum (bony shelf) – inferolateral to
IAM and anteromedial to sigmoid sulcus & it leads upwards to
a bony canal, vestibular aqueduct that lodges endolymphatic
duct and sac.
• Inferior surface : medial/anterior to lateral/posterior
 Near PA origin of Levator veli palatini and lateral part form
Sulcus tubae
 Lower opening of carotid canal (inverted-L shape in petrous
bone)
 Jugular fossa for superior bulb of IJV
 Tympanic canaliculus in keel (bony ridge between carotid
canal and jugular fossa) for tympanic nerve (jacobson’s
nerve) from inferior ganglion of CN IX
 A triangular depression for inferior ganglion
(sensory) of glossopharyngeal N. (petrosal ganglion)→
from its apex cochlear canaliculus extends upward.
 Mastoid canaliculi (lateral wall of jugular fossa) for
the entry of
“Arnold’s nerve” .
Jugular fossa
tetetnd
 Medico-legal importance of petrous bone
• In 2015 , it was found that petrous bone has
remarkably well-preserved DNA
• In 2017, it was concluded from different DNA study
that the inner part of petrous bone and dental
cementum are currently recognized as the best
substrate for ancient DNA study
• The average endogenous DNA content in
Petrous bone = 40%
Dental cementum =16.4%
 EXTERNAL EAR
• Pinna (auricle) :
• Funnel-shaped cartilaginous structure projects
from side of skull at variable angle & has some
function in collecting sound
• Made of single piece of yellow elastic cartilage
except lobule
• Has 2 surfaces : lateral & medial (cranial)
Lateral surface :
Has characteristics prominences and
depressions (unique for each individual).
• Helix –curved rim of cartilage covered with skin
• Darwin’s tubercle –prominence on helix sometimes.
• Antihelix –anterior & parallel to Helix
• Triangular fossa –between 2 superior crura of
antihelix
• Scaphoid fossa –between helix & superior crus of
antihelix
• Concha –in front of antihelix & partly encircled by it
divided into 2 parts by crus of Helix:-
 Superiorly –cymba concha (smaller) → Overlies
bony MacEwen’s triangle medially
 Inferiorly –cavum concha (larger)
• Tragus – small triangular prominence pointing
posteriorly below crus of helix and overlapping EAC
• Antitragus –below tragus (inferior limit of antihelix
and betn tragus & antitragus– intertragic notch)
• Incisura terminalis –no cartilage between tragus &
crus of Helix
an incision here will not cut cartilage & so used for
endaural approach in surgery of EAC & mastoid.
• concha and scaphoid fossa has fine hairs &
sebaceous glands.
Medial (Cranial) surface:
• Eminentia concha –elevation of corresponding
conchal depression
# pinna skin on lateral side -closely adhered to
perichondrium & on medial side -slightly loose
• The whole pinna (except lobule+incisura terminalis)
and cartilaginous part of EAC –made of single piece of
yellow elastic cartilage
Ligaments & muscles of pinna
• Intrinsic ligaments join different parts to each other
• Intrinsic muscles (6) – insignificant
• 2 extrinsic ligaments:–
 Anterior ligament joins tragus & crus of helix to root of
zygoma
 Posterior ligament joins concha & mastoid
 3 extrinsic muscles : auricularis anterior, posterior & superior
(posterior auricular N.) all insert into epicranial aponeurosis
 Blood supply to pinna
Arteries:
• Posterior auricular A.(major artery)→cranial surface (all
except lobule)+concha+Lower2/3rd helix+1/3rd antihelix
• Superficial temporal A.(anterior auricular branches)→
upper helix & antihelix +triangular fossa +lobule+tragus
• Occipital artery – upper part of cranial surface
Veins:
• Accompany arteries & drain into superficial temporal and
external jugular veins
Arterio-Venous Anastomoses(AVA) are numerous beneath
the pinna skin that get dilated on exposure to cold
atmospheric temperature and thus skin crack might occur in
winter so people cover pinna in winter for comfort!
Lymphatic drainage – common to pinna & EAC
• Medial (cranial) surface →Mastoid tip nodes
• Tragus →preauricular nodes
• Rest parts →Deep cervical nodes
Nerve supply to pinna
 Medico-surgical Importance of pinna
• Source of several graft materials
• Cartilage from tragus, perichondrium from tragus/
concha & fat from lobule are frequently used for
reconstructive surgery of middle ear
• The conchal cartilage used to correct depressed
nasal bridge
• Composite grafts of skin+cartilage from pinna used
to repair defects of nasal ala.
External Auditory Canal (EAC)
• Extends from (cavum)concha to TM (outer surface)
• EAC = lateral 1/3rd cartilage + medial 2/3rd bony
• EAC dimension= 24 mm (length)× 10 mm(diameter)
• Lateral 1/3rd (8 mm) = yellow elastic cartilage (aka
membranous part)→directed up+back+medial in
adults & so pulled up+back+lateral to straighten the
EAC
• Medial 2/3rd (16 mm)= mastoid + tymapnic parts of
TB→ directed down+forward+medial
• In neonates, bony EAC not developed well & TM
more horizontal (than adult ,55°) so pinna should be
pulled gently down and back to visualize TM well
• In adult auricular cartilage is continuous with EAC
cartilage except at incisura terminalis
• Skin of cartilaginous part – thicker, mobile and
endowed with sebaceous and ceruminous glands
• Sebaceous glands → sebum(oily secretion)
• Ceruminous gland [&mammary gland+ciliary
gland /Moll’s gland] = modified apocrine sweat
gland→ cerumen (watery secretion)→becomes
dark, semi-solid & sticky as it dries.
• As sebaceous glands open in hair follicle root →
furunculosis only in cartilaginous part
• Skin of bony canal –thin, immobile and lacks skin
appendages & rete pegs/ridges (=epidermal papilla)
• Skin = keratinizing stratified squamous epithelium
• Note: rete pegs(rete ridge/epidermal papilla) =
epidermal extensions into underlying connective
tissue ; present in all skin & mucus membrane→ shear
strength (absent in scar tissue →shear off easily).
• Skin of EAC (& pars flaccida of TM): basal cells of
epidermis divide & migrate (at rate - 0.1 mm/day)
obliquely outward → desquamated cells do not
accumulate in canal →no obstruction
• Skin of other body parts : basal cells of epidermis
divide & migrate directly towards surface (e.g., skin of
scalp →↑proliferation→dandruff = desquamated cells
trapped by hairs)
• Skin of pars tensa : basal cells of epidermis divide &
migrate → if
 intact →centrifugally towards the tympanic annulus
 Underlay graft at perforated part → centripetally to cover
the graft
 2 types of hairs in EAC : Vellus(fine) hairs & terminal
(coarse) hairs
 Terminal hairs – aka Tragi hairs in ear → more prominent
in males →grow towards meatus→ prevent foreign body
entry
• Ear Wax = desquamated cells + cerumen + sebum
 2 types of human ear wax – dry & wet
 Dry wax – no cerumen; yellow/grey & brittle
 Wet wax –cerumen ; brown & sticky (dominant type)
• Single nucleotide polymorphism in ABCC11 gene→
determines type of wax in human ear
 AA genotype → dry wax
 GA or GG genotype → wet wax
 The area of EAC that produce cerumen has local Ab–
mediated immune response.
 Wax not found in deep ear canal ; if wax on upper TM (pars
flaccida or attic region) – is most probably cholesteatoma (=
dry & oxidized wax)
 2 horizontal fissures in anteroinferior quadrant of
cartilaginous part of EAC = fissures of Santorini → conduit
for spread of infection/ tumor to/from superficial lobe of
parotid gland or the mastoid
 Bony EAC has 2 sutures : anterior – tympanosquamous &
posterior –tympanomastoid
→EAC has 2 constrictions:–
 One constriction at bony-cartilaginous junction
 One constriction at 5 mm lateral to TM = Isthmus →
where anterior wall prominence ↑ to ↓ the canal
diameter.
 Deep to isthmus , anteroinferior part of canal dips
forward forming wedge shaped anterior recess
 In children(4 yrs.) & sometimes in adults a foramen in
anteroinferior part of BONY EAC = foramen of
Huschke
Blood supply to EAC
• Arteries : superficial temporal artery auricular
branches → roof + anterior part of EAC
• Deep auricular artery (maxillary artery I) → supply
epithelium of anterior canal wall and TM
• Posterior auricular artery → posterior part of EAC
Veins : drain into the external jugular vein, the
maxillary veins and the pterygoid plexus.
Lymphatics drainage follows that of the auricle.
Nerve supply :
sensory innervation by → cranial nerves V, VII, IX & X
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