1. anatomy of ear and mastoid
TRANSCRIPT
Anatomy of ear and mastoid
Dr. Krishna Koirala
• Paired sensory organs comprising of • Auditory system involved in the detection
of sound• Vestibular system involved in maintaining
body balance and equilibrium• Divided anatomically and functionally into• External ear• Middle ear• Inner ear
• All three regions are involved in hearing • Inner ear is involved in body balance and
equilibrium
External Ear (Outer Ear)
Pinna Framework formed by yellow elastic
cartilage except in the lobule and incissura terminalis
Functions
Collect and direct sound waves through the ear canal to the tympanic membrane
Protect the tympanic membrane Importance : Graft material for middle ear &
other reconstructive surgeries
Helix: Slightly curved rim of the auricle Antihelix: Broader curved eminence anterior
to helix Concha : Deep cavity in front of the helix Cymba conchae : Depression between the
antitragus and ascending crus of the helix (surface landmark of mastoid antrum)
Tragus Lobule : Structure made up of areolar tissue
& fat without cartilage
Sensory Nerve supply of pinna Lateral surface
Upper 2/3 : Auriculotemporal nerve (cranial nerve V)
Lower 1/3 : Greater auricular nerve (C2,3) Medial Surface
Upper 1/3: Lesser occipital nerve (C2) Lower 2/3 : Greater auricular nerve (C2, 3)
Posterior concha and antihelix : Auricular b/o Vagus
Facial : Small region at the root of concha
External Auditory canal
Extends from bottom of concha to the tympanic Membrane
24 mm long in adults Lateral 1/3 (8 mm) Cartilaginous : Directed
upwards, backward and medially Medial 2/3 (16 mm) Bony : Directed
downwards, forward and medially Pinna to be pulled upwards, backwards and
laterally to straighten the external auditory canal in adults
Only cartilaginous skin has hair
follicles, ceruminous and
pilosebaceous glands (wax)
Cartilaginous fissure of Santorini and
bony foramen of Huschke present in
anterior wall infection / metastasis
to and from the parotid gland
Middle EarMiddle Ear
Middle ear cleft Middle ear cavity
Attic ,aditus, antrum
Mastoid air cell system
Eustachian tube
Middle ear cavity
Epitympanum Mesotympanum Hypotympanum Protympanum Post- tympanum
Contents of middle ear cleft 3 Ossicles : malleus, incus, stapes
2 Nerves : Chorda tympani, Tympanic plexus
2 Muscles :Tensor tympani, stapedius
Air Mucosal folds & ligaments Blood vessels
ET
MEME
ATTICADAnt
Tympanic Membrane Partition between the external and
middle ear
Obliquely set with 550 to floor
Dimension: 10 mm x 8 mm x 0.1 mm
Parts Pars Tensa Pars Flaccida (Shrapnel's membrane)
PF
PT
Landmarks of TM1. Short process
of malleus2. Anterior and
posterior malleolar folds
3. Handle of malleus
4. Umbo5. Cone of light 6. Annulus
tympanicus
Layers of tympanic membrane
1) Outer layer of squamous epithelium continuous with that of the meatus
2) Middle layer of fibrous tissue that has radial and circular fibres
3) Inner layer of mucous membrane continuous with the lining of the tympanic cavity
Fibrous layer disorganized in pars flaccida Annulus deficient superiorly as notch of
Rivinus
Four Quadrants of pars Tensa
AS
AI
PS
PI
Borders of middle ear cavity Roof : Tegmen tympani
Floor : Separates tympanic cavity from jugular bulb
Medial wall Promontory : Bulge formed by basal turn of
cochlea Oval window : Communicates between middle
ear and the vestibule of the inner ear, closed by footplate of stapes
Round window :Communicates between scala tympani and tympanic cavity, covered by secondary tympanic membrane
Lateral wall Largely by TM Scutum (outer attic wall) Bone inferior to TM
Anterior wall Thin plate of bone Openings of canal for tensor tympani and
Eustachian tube Posterior wall
Separates middle ear cavity from mastoid bone
Contains aditus ,pyramid
The mastoid antrum and air cell system Mastoid antrum : Largest and most consistent air cell
of mastoid air cell system, well developed at birth
Relations
Roof : Part of floor of MCF
Floor : Digastric muscle, sigmoid sinus
Posterior : Bony covering of sigmoid sinus
Lateral : Squamous temporal bone (corresponds to suprameatal or Macewan’s triangle and Cymba conchae)
Mac Ewan’s Triangle ( Suprameatal triangle)
• Boundaries• Superior : Posterior prolongation of
upper border of root of zygoma • Anterioroinferior : Posterosuperior
margin of bony external meatus • Posteroinferior : Vertical tangent drawn
through the posterior margin of bony external meatus touching the first line
Mastoid air cell system Extensive system of interconnecting air filled
cavities arising from walls of mastoid antrum that extend throughout the mastoid
Lined with flattened non ciliated squamous epithelium Types
Cellular ( pneumatized) : Honeycomb appearance on plain X-Ray mastoid
Diploic : Air cells interspersed with marrow containing spaces
Acellular (sclerotic)
Five Recognized regions of mastoid pneumatisation (Allam -1969)
Middle ear: Epitympanum, Mesotympanum, Hypotympanum, Protympanum, posterior tympanum
Mastoid : Antrum, central mastoid, peripheral mastoid
Perilabyrinthine: Supralabyrinthine, infralabyrinthine
Petrous apex : Apical, peritubal
Accessory : Zygomatic, squamous, occipital, styloid
Inner ear
Lies in the petrous temporal bone
Divisions
Bony labyrinth
Membranous labyrinth
Bony labyrinth ( Vestibule, Semicircular canals , Bony cochlea)
Vestibule Central portion of bony labyrinth, ovoid in
shape
Oval window at the lateral wall, utricle and saccule in the medial
Openings of SCC (5) - lie on posterior, superior and inferior walls of bony vestibule
Semicircular canals (3)
Lie in planes at right angles to each other
Ampullated and non ampullated ends
Ampullated ends contain vestibular sensory epithelium and independently open into the vestibule
Bony cochlea Coiled tube like the shell of a snail,
contains 2 ½ to 2 ¾ turns
Height around 5mm,base around 9 mm in diameter
Coils turn around the modiolus - extends along the entire length of cochlea except for helicotrema ( small channel at the apex)
Three compartments
Scala vestibuli
Scala tympani
Scala media (membranous cochlea)
Within the modiolus lie spiral ganglion
Cochlear nerve lies within the bony modiolus throughout the entire length
Membranous labyrinth Membranous cochlea
Triangular in cross section
Bordered by Reisner’s membrane, Basilar membrane and stria vascularis
Utricle and saccule
Semicircular ducts
Endolymphatic ducts and sac
Organ of Corti Sense organ of hearing Situated on the basilar membrane Components
Tunnel of Corti Hair cells ( outer and inner) Supporting cells (Deiter's,
Hansen's) Tectorial membrane
Differences between inner and outer hair cells
Inner Hair Cells Outer Hair Cells
3500 12,000Single row Three or four rows
Flask-shaped CylindricalPrimarily afferent Primarily efferentTransmit auditory
stimuliModulate inner hair
cellResistant to
damageVulnerable to
damage