Anatomy of Ear

& Mastoid
Dr. Vishal Sharma

Embryology

Parts of ear
External ear: Pinna / auricle
External auditory canal
Middle ear cleft: Eustachian tube
Tympanic cavity (middle ear)
Mastoid air cell system
Inner ear (labyrinth): Cochlea
Vestibule
Semicircular canals

External Ear

External auditory canal

24 mm long; Lateral 1/3 Cartilaginous (8 mm): up +
back + medial. Medial 2/3 Bony (16 mm): down +
forward + medial. Pinna pulled up + back + lateral
to straighten external auditory canal.
Only cartilaginous skin has hair follicles: furuncle
Cartilaginous fissure of Santorini & bony foramen
of Huschke: passage of infection to and from
parotid gland

Nerve supply of E.A.C.

Middle ear cleft

Consists of:
Eustachian tube
Tympanic cavity (middle ear)
Aditus
Mastoid air cell system

Develops from tubo-tympanic recess

Middle Ear

Tympanic membrane
Pearly white semi-translucent membrane
Obliquely placed at 550 to floor
2 parts: pars tensa and pars flaccida
3 layers of pars tensa: outer epithelial, middle
fibrous & inner mucosal
Fibrous layer disorganized in pars flaccida
Annulus deficient superiorly as notch of Rivinus

Timpani or kettle drum

Otoscopic view

1. Epitympanum: Bounded laterally by scutum + pars

flaccida & medially by bone above tympanic part of
facial nerve
2. Mesotympanum: Middle ear cavity lying opposite
pars tensa & bony tympanic annulus
3. Hypotympanum: Middle ear cavity below level of
bony tympanic annulus
4. Posterior tympanum: Middle ear cavity behind
bony tympanic annulus
5. Anterior tympanum or Pro-tympanum: Middle ear
cavity in front of bony tympanic annulus

Walls of middle ear

Roof: Tegmen tympani, middle cranial fossa
Floor: Jugular bulb, carotid artery
Anterior: Tensor tympani, ET orifice, carotid artery
Posterior: Aditus, fossa incudis, pyramidal eminence,
facial recess, sinus tympani
Lateral: Tympanic membrane, scutum
Medial: Promontory, oval window, round window,
lateral SCC, facial nerve (tympanic part)

Lateral wall
Membranous:
a. Tympanic membrane
Bony
a. Lateral attic wall above pars flaccida (Scutum)
b. Lateral wall of hypotympanum

Posterior wall
Aditus ad antrum
Fossa incudis for short process of incus
Bulge produced by lateral semicircular canal
Pyramidal eminence for stapedius tendon
Bulge produced by vertical part of facial nerve
Sinus tympani
Facial recess

Sinus Tympani
Boundaries:
Superior: Ponticulus
Inferior: Subiculum
Lateral: Mastoid Segment of Facial Nerve
Medial: Posterior semicircular canal
It evades direct surgical visualization during
surgery. Site for cholesteatoma recurrence

Anterior wall
Chorda tympani nerve exits via canal of Huguier
Canal for tensor tympani on top
Eustachian tube opening below
Internal carotid artery is related inferiorly

Medial wall
Lateral semicircular canal
Tympanic part of bony facial nerve canal
Processus cochleariformis
Promontory: formed by basal turn of cochlea
Oval window
Round window

Contents of middle ear

Air
3 ossicles: malleus, incus and stapes
2 muscles: tensor tympani & stapedius
2 nerves: chorda tympani & tympanic plexus
Mucosal folds & ligaments
Blood vessels

Eustachian Tube

Anatomy
36 mm long in adults
Directed anteriorly, inferiorly & medially from
anterior wall of M.E., forming angle of 450 with
horizontal & sagittal planes
Enters naso-pharynx 1.25 cm behind posterior
end of inferior turbinate

Parts
Lateral 1/3 is bony
Medial 2/3 is fibrocartilaginous.
Junction b/w 2 parts
is isthmus, narrowest
part of Eustachian
Tube.

Anatomy of medial 2/3rd

Cartilage plate lies
postero-medially &
consists of medial +
lateral laminae separated
by elastin hinge. Fibrous
tissue + Ostmanns fat
pad lie antero-laterally.

Adult vs. Child (< 7 yr)

ADULT

INFANT

Length

36 mm

18 mm

Angle with horizontal

45 0

10 0

Lumen

Narrower

Wider

Angulation at isthmus

Present

Absent

Cartilage

Rigid

Flaccid

Elastic recoil

Effective

Ineffective

Ostmanns fat

More

Less

Adult vs. Child (< 7 yr)

Functions
1. Ventilation & maintenance of atmospheric
pressure in middle ear for normal hearing
2. Drainage of middle ear secretions into
nasopharynx by muco-ciliary clearance,
pumping action of Eustachian tube & presence
of intra-luminal surface tension

Functions
3. Protection of middle ear from:
Ascending nasopharyngeal secretions due
to narrow isthmus & angulation between 2
parts of E.T. at isthmus
Pressure fluctuations
Loud sound coming through pharynx

Inner Ear

Cochlear Hair Cells

Inner Hair Cells Outer Hair Cells

3500

12,000

Single row

Three or four rows

Flask-shaped

Cylindrical

Primarily afferent

Primarily efferent

Transmit auditory stimuli

Modulate inner hair cell

Resistant to damage

Vulnerable to damage

Vestibular Hair Cells

Temporal Bone

MacEwens Triangle
Superior: supramastoid crest
Anterior: postero-superior margin of bony
external auditory canal opening
Posterior: tangent drawn to mid-point of
posterior wall of external auditory canal
Contains spine of Henle
Mastoid antrum lies 12-15 mm deep to triangle

Trautmanns triangle
Boundaries
Superiorly: superior petrosal sinus
Posteriorly: sigmoid sinus
Anteriorly: solid angle (semi-circular canals)
Pathway to posterior cranial fossa from mastoid
cavity & vice versa

Mastoid cells
Central group

Accessory group

Mastoid antrum

Squamous

Peri-antral

Occipital

Peripheral group

Styloid

Dural

Peri-tubal

Sino-dural

Zygomatic

Peri-sinus

Petrous apex

Tip
Retro-facial

Facial Nerve

Thank You