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 medial wall

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

 The processus cochleariformisant to oval window, hook like projection- for 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 above the pyramid

 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 Anterolaterally- tympanic membrane.

 The importance of this recess is that one can approach the ME without disturbing 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 May 2013

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

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

EAM
COURSE
Forms a mild s shape Curve is directed medially upwards and forwards and then medially backwards downwards

ET
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

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 cartilaginous part.

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 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

ET Tympanic plexus and pharungeal branches of pterygopalatine ganglion.

Anatomy of the inner Ear

internal ear

Bony labyrinth

Membranous labyrinth

bony labyrinth
Vestibule Semicircu lar canals cochle a

Forms central part of bony labyrinth

3 scc

Conical snail shell

Ant

post

later al

At its base 3 openings-oval window, round window and cochlear canaliculus

Membranous labyrinth
utricle saccule
Semicircu lar ducts

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

Connected to utricle through the utricosacular duct

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 vestibularis- contains vascular epithelium and secretes endolypm The basilar membrane supports the organ of corti The OOC is innervated by peripheral process of bipolar cells located in the spiral ganglion

 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 matching the impedance offered by fluid

 Hydaulic action of the TM Effective vibratory area of the TM is nearly 4555 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 transmitted through the ossicles

 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 Significance1. Spine of henle lies in the triangle 2. Mastoid antrum lies 15mm deep

 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 between the triangle.