EXTERNAL AND MIDDLE EAR

CLASS: JC3 2013

COURSE: NEUROSCIENCE
CODE: NS 43
LECTURER: DR ROHANA OCONNELL
DATE: 29/10/13 1600-1700

LEARNING OBJECTIVES
Structure of external ear
Tympanic membrane
Conductive deafness
Middle ear: ossicles, round and oval
windows
Tensor tympani and stapedius
Mastoid air cells

PINNA

NERVE SUPPLY TO PINNA

EXTERNAL AUDITORY CANAL

25mm long
Outer 1/3 cartilage

Inner 2/3 bony

Apopilosebaceous glands
Hair follicles
Sebaceous gland
Ceruminous gland
The skin is tightly bound
to the underlying
cartilage. Inflammation
here is painful because of
the limited potential for
swelling.

EXAMINING AN ADULTS EAR

EXAMINING A CHILDS EAR

TYMPANIC MEMBRANE
EAC terminates at the tympanic membrane TM
In newborns the TM is horizontal
In adults , the TM sits at a 55 degree angle
Ossication of EAC causes changes in angle of TM
until about age 5 when it reaches adult position

TYMPANIC MEMBRANE
Three Layers of TM

- Ectoderm (cutaneous) - continuous with EAM

- Mesoderm (brous)
- Radial Fibers
- Concentric Fibers
- Endoderm (mucous) - continuous with Tympanic
Cavity
Pars Tensa contains all three layers.
Pars Flacida DOES NOT contain brous layer.

TYMPANIC MEMBRANE

Only epidermal and mucosal layer

MIDDLE EAR

MIDDLE EAR
Tympanic Cavity
Ossicles
Eustachian Tube
Middle Ear Muscles

Consists of 4 walls , a ceiling and a floor

OSSICLES

THE CEILING
Tegmen tympani
Paper thin.
Separates the tympanic cavity from the middle cranial
fossa which houses the temporal lobe.
Inammatory conditions of middle ear can pass through
the petrous-squamosal suture in children directly to the
meninges of temporal lobe of cortex.

MEDIAL WALL
Prominence of lateral semicircular canal

Prominence of facial canal

Oval window
Promontory (basal turn of cochlea)
Round window

POSTERIOR WALL
Mastoid wall
Aditus ad antrum
Pyramidal eminence
Jugular wall and jugular vein

ANTERIOR WALL
Carotid wall
Carotid artery
Eustachian tube

LATERAL WALL
Membranous wall
Tympanic membrane

THE FLOOR
Jugular wall
Formed by tympanic plate

STAPEDIUS
Smallest muscle
Nerve to stapedius
Pyramidal eminence to neck of
stapes

When it contracts, it reduces the

action of the stapes
( it reduces amplification)
Contracts just before speaking
and chewing (can be loud
enough to cause damage)

TENSOR TYMPANI
Originates from cartilaginous portion
of ET and inserts into the handle of
malleus
Tense the tympanic membrane
Reduces the effectiveness of sound
transmission, protecting the inner ear
during louds sounds

Supplied by V3

EUSTACHIAN TUBE

EUSTACHIAN TUBE
Differences between adults and infants
Angle of ET
Adults - about 40 degrees
Children - more horizontal
Length
Adults - about 35 mm
Children - shorter
Flaccidity
More accid in children

MUSCLES OF EUSTACHIAN TUBE

EUSTACHIAN TUBE
Function:
Tensor palatini denitely involved in opening ET.
Levator palatini role is not clear.
Clearance of middle ear fluid
Protect middle ear from nasal secretion

Equalising middle ear pressure

MASTOID ANTRUM

MASTOID AIR CELLS

Mastoid air cell system served as an reservoir of air and
serves as buffer system to replace air in the middle ear
cavity temporarily in case of Eustachian tube dysfunction.
The mean volume of air in the mastoid air cell system could
be about 5-8 ml. CT scan evaluation of temporal bone is
considered to be the best modality to assess mastoid air
cell system.
Patients with poor pneumatization of mastoid air cell system
are more prone to develop adhesive otitis media following
middle ear infections as the normal buffering system of the
mastoid pneumatization is not adequate in them.

CT TEMPORAL BONE

MASTOID ABSCESS

ROUND WINDOW / OVAL WINDOW

HEARING LOSS

CONDUCTIVE HEARING LOSS

Is the result of sounds not being able to pass freely to the
inner ear.
Usually due to blockage in the outer or middle ear

Ear wax
Otitis externa
Stenotic or atretic ear canal
Perforated tympanic membrane
Otosclerosis
Usually can be corrected

SENSORINEURAL
HEARING LOSS

Sensory, cochlear, neural or inner ear hearing loss.

Damage to the hair cells within the cochlea or the

hearing nerve (or both).

Causes:

Presbycusis

Regular and prolonged exposure to loud sounds.

Ototoxic drugs

Certain infectious diseases, including Rubella

Complications at birth

Injury to the head

Benign tumours on the auditory nerve

Genetic predisposition some people are especially

prone to hearing loss