When we speak about the ear we refer to it as statoacoustic organ,

what are we mean?

because it has manly 2 functions: OStato from static (balance); when
we stand up (equilibrium).O and it has an acoustic function: auditory
(hearing).

-The ear is divided into 3 mean parts:
The Statoacoustic Organ
The Ear

External Ear, Middle Ear and Inner Ear.
-The Middle Ear and Inner Ear located within the petrous part of
temporal bone inside the skull.
-The external ear; is made of the Auricle outside which we see it and
the canal that conduct the sound waves from the external ear from the
auricle all the way to tympanic membrane this canal we refer to it as
external auditory meatus.
-The middle ear; the chamber that containing the ear ossicles (
) which are: malleus, incus, stapes.this area we refer to it as
tympanic cavity.
-The Tympanic Cavity; its a little bit confusing because of the openings
and orientation in it, so thats why we refer to it as tympanic from maze
(tympanic is a Greek word that means maze).
So; external ear which is auricle and external auditory meatus until
tympanic membrane, the tympanic membrane is the part that separate
the external ear from the middle ear, the middle ear is a small chamber
that containing the ear ossicles, after that there is the inner ear or the
labyrinth (the part that containing hearing and the balance organs-
Cochlea and the Vestibule-).
-The cochlea; that part to hearing, the vestibule is the part related to
equilibrium.
-When we speak about the external ear: the first part of it is the
auricle; when we look to a real auricle in any view we will see that each
auricle is made by the way of elastic cartilage covered by skin except in
the lower part which we referred to it as a lobule, the elastic cartilage is
replaced by a pad of fat.
-So most of the auricle is elastic cartilage it collects the sound waves-
function of it-, its made of several structures, elevations and
depressions and they called just named them:
Othe helix: which is the most big elevations at the periphery-outer
side- of the auricle.
Oanti helix: is the elevations opposite to the helix.
Othe scapha(the scaphoid fossa): the groove between the helix and
anti helix.
Otragus(lingual): it is a structure in scapha from anterior like the
tongue and the other elevation opposite to it called as antitragus.
the concha(the concha fossa): the deepest depression in the auricle
that leads to external auditory meatus.

External auditory meatus: when we want to define the meatus -by
meatus we mean a canal- the meatus is an Osteocartilaginous tube
(osteo means bone cartilaginous means cartilage) this indicate that
the outer third of it is made by cartilage, those cartilages are
contributing to the auricle and also contributing to the lateral third of
the meatus so the outer third is cartilage but the inner 2/3 is bone,,,
which bone? Temporal bone; because this within the petrous part of
temporal bone.
-so the inner 2/3 is bone and it extends from the auricle outside all the
way to the tympanic membrane (2-3 cm in length), within it its covered
by skin and the skin until the tympanic membrane where it reflected to
go back again, so even the outer side of the tympanic membrane is also
covered with the skin but the skin in the meatus here it has specific
glands -special kinds of glands- in addition to the sebaceous gland we
refer to them as ceruminous gland, ceruminous gland is the gland
that secret the serumen-the earwax.
-tympanic membrane: when we look to any tympanic membrane with
an otoscope (its a laminating light within the ear to see the tympanic
membrane), we will see that is a thin, oval shape, semitransparent
membrane and of ~ 1 cm in diameter.
The tympanic membrane is separating the external ear from middle ear
and it slid from outside skin but from inside within the middle fossa,
the middle ear with Mucous membrane.
So it has a concave outside and its convex inside towards the middle
ear, because it being tense through a muscle that called tensor
tempany muscle because it tenses the tympanic membrane, this
tensing is very important to keep the membrane tense for the
vibration; when the sound waves start to hit the membrane, the
membrane starts to vibrate producing change in the sound waves into
vibrations and this vibrations in the inner ear will later be change into
nerve signals.
-Wthe nerve supply to tympanic membrane: it depends in what the
nerve supply of the outer and the middle ear which is trigeminal nerve.
-From outside the sensation to the skin that covering the tympanic
membrane is the auriculotemporal nerve but from inside to the
mucous membrane covering the tympanic membrane is
glossopharyngeal nerve; which is the nerve that it responsible for
sensations in the middle ear(cranial nerve #9).
When we look to the membrane from otoscope we will see it compose
from 4 main regions :

The first one: The most superficial area, is the upper third area
which we refer to it as Pars Flaccida, Flaccid mean it gives a red
color ,,,why?
Because its rich in blood supply, most of artery that supply the
tympanic membrane located in the superior third of it, so the
superior part of the tympanic membrane we refer to it as pars
Flaccida, we can also say flaccid part and we have to avoid this part
during any surgery through the tympanic membrane to avoid
hemorrhage.
and all remaining parts is the tense part of the tympanic membrane
and we see how it tense because we can see the direction of the
fibers radiating there, once we see the direction of all these fibers
this all part is refer to as the tense part called the pars tensa of
tympanic membrane
In the middle of the tympanic membrane (the peak of concavity) we
refer to it as umbo, the umbo of the tympanic membrane so pars
tensa, pars flaccida, umbo
-Now from the umbo why we speak about the umbo because
when we look to otoscope we will see that there is a radiation or a
reflection of light going from the umbo anterior to the inferior
always this reflection of light we refer to it as cone of light .
The cone of light is not real actually its a reflection of light; when
we insert the otoscope, and this is very important sign for a healthy
tympanic membrane so when we look to the tympanic membrane
through the meatus using the otoscope if you see the cone of light
that indicates everything is normal (the tensity of the membrane is
okay)
-However; if there is any problem in the light resulting in
inflammation infection and whatever the cone of light will change in
its angulations or in its presents.

So an indication about healthy tympanic membrane is to see
the cone of light radiating interior inferior from the umbo.



When we put the otoscope we have to put the auricle posterior
superior in the adult but in infant just posterior, so that to get the
meatus straight into the tympanic membrane after u get the auricle
there u get the otoscope and u can see the pars flaccida, the pars
tensa, the umbo and the cone of light.
That all thing about the tympanic membrane.



The middle ear

Is an ear field space within the petrous part of temporal bone, the air
reach to it from the Eustachian tube, that is find usually through the
mucous membrane varies type of epithelial in the mucous start from
anterior respiratory with auditory then become simple cuboidal to
mastoid simple squamous.
It divided into two main parts:
OThe tympanic cavity proper: the part that behind the tympanic
membrane itself we refer to it as main part, proper is this part.
Oepitympanic recess:, the top( the fundus, the dome shape) of
middle ear, epi means above and recess above tympanic cavity these
is also show the clinicians usually refer to it as the attic, a small space
usually superior to the tympanic membrane.
.






the middle ear -when we look to it in a sagittal section within the
middle ear- it communicate anteriorly with the nasopharynx
through Eustachian tube (pharyngio tympanic tube between the
so your mark is the roof of the
tympanic membrane all thing behind
the tympanic membrane is the main
part of tympanic cavity the remaining
space above the tympanic membrane
is the epitympanic recess
pharynx and tympanic cavity) but posteriorly it communicates with
mastoid air cells through the aditus to mastoid antrum.
- the entrance to this large cavity within the mastoid which we call it
the antrum since all the mastoid air cells communicate there we call
it the mastoid antrum and the entrance from the middle ear into this
antrum is the access of mastoid antrum which also they call it
aditus (access) aditus to mastoid antrum.
so anteriorly Eustachian tube to the nasopharynx posteriorly additus
to mastoid antrum which communicated to mastoid air cells.
the boundaries of the tympanic cavity:
anteriorly: the anterior wall we refer to it as carotid wall, (remember
the meddle located in the petrous part of temporal bone, anterior to
it there is carotid canal which pass through it the internal carotid
artery), so the anterior wall of the tympanic cavity we refer to it as
carotid wall because it separate the tympanic cavity from the
carotid canal so this is called the carotid wall however the wall is
superiorly open with 2 opening:
the first one is the Eustachian tube the other opening is the canal
where the tensor tympani muscle is situated or originated from, so
when we look to the tensor tympani it originate(ascend) from
superior wall then their tendon tern 90 degrees and go laterally to
insert in tympanic membrane
so: in the lateral wall we have the tympanic membrane, in the
medial wall we have the inner ear, and the anterior wall have is the
carotid wall where it contains the auditory tube opening and a canal
for tensor tympani muscle, the posterior wall which is separating the
middle ear from the mastoid air cells -for that they call it mastoid
wall- .
the mastoid wall it separates the middle ear from the mastoid air
cells, it contains another opening we call it aditus to mastoid
antrum.
so remember this: there is an opening communication between
the middle ear and the mastoid air cells thats why when we have
any infections in the middle ear it will affect the mastoid air cells
always, or any infections in the mastoid will goes to the middle ear
so thats why signs and symptoms of otitis media and mastoiditis
always the same.
Pyramidal eminence: also if we look to the posterior wall u will see
there is pyramidal shape of bone this is the cone of bone, its arising
from the posterior wall of the tympanic cavity, its a hollow(empty
from inside) bony cone( ( why its empty?
Because inside it there is muscle called the stapedius muscle, its
stapedius because its go and inserted in the stapes, so its function is
to stabilize the stapes prevent excessive movement of the stapes
reducing the oscillatory range so they call it the stapedius muscle
So when we look to the muscle here, u cannot see it because its
inside this cone of bone but from the tip of the cone u can see the
tendon of the muscle arising there all the way to be attach to the
neck of the stapes.
So u see that at the tip of the pyramid pyramidal eminence- since it
will be open then there tendon ascend and go all the way to attach
to the neck of the stapes.
-Stapedius muscle is the smallest skeletal muscle in your body that
stabilizes the smallest bone in your body stapes- .
So the pyramidal eminence inclosing the stapedius muscle.
when we look to the tympanic cavity we will see; From posterior
wall the pyramidal eminence this is the bony cone, from its tip we
can see the tendon of the stapedius going out from the tip of the
cone all the way into the stapes.
The medial wall which also called (labyrinthine) wall>>> why?
Because it opens in the labyrinth in the inner ear communicating or
separating the middle ear from the inner ear, on the medial wall you
can see a very large bulge area there, this bulge on the medial wall
which we refer to it as promontory.
Promontory is formed because of the base of the cochlea (the
hearing organ) in the inner ear is resting there so once it resting
there it form convex area towards the middle ear and this area we
refer to it as promontory, so the promontory is bony convexity
because of the base of the cochlea is resting there.
The glossopharyngeal nerve will gives a nerve towards the middle
ear for sensory innervations, the nerve to the middle ear from
glossopharyngeal we call it usually as tympanic nerve.
The tympanic nerve will get inside the middle ear and over the
promontory it start to divide forming a plexus this plexus usually see
it over the promontory we call it tympanic plexus formed by the
tympanic nerve from glossopharyngeal and its responsible for
sensation within middle ear.

The tympanic nerve itself is 2 part :
_1) sensory part ( somatic )
_2)autonomic part ( parasympathetic )>>>>>> has nothing
related with middle ear , thy still with each other then leave from
plexus by anterior surface of the middle ear through middle
cranial fossa . So, they called lesser petrosal nerve which go
through foramen ovali down into the otic ganglion which
responsible for secretion of slsiva from parotid gland .
Also , in the medial wall posteriorly superiorly to the promontory
we can see small opening it is oval window because the stapes
resting over it but posteriorly inferiorly there are other window its
around window .

the window open the middle ear into inner ear . and as the doctor
tolled you there is vibration need for move the fluid into inner ear to
produce the nerve signals .
The stapes start to push in ( inside ) from oval window then it start to to
push out ( outside ) by round window.

lateral wall ( membranous ) :
formed by tympanic membrane and separate tympanic cavity from external
ear .


The roof ( tegmental wall ) :
its avery thin layer of bone ( petrus part of temporal bone ) called tegmen
tympani which separate middle ear from the floor of middle cranial fossa .


The floor ( jugular wall ) :
which separate middle ear from IJV it goes more anteriorlythen descends
down ..

contents of middle ear

Auditory ossicles :malleus , incus , stapes

muscles : stapedius , tensor tympani muscle
Nerve: choroda tympani ( small cord ) >>>>>>> small nerve passing
through tympanic cavity .
Tympanic plexus.

Note: middle ear >>> 3 bone , 2 muscle , 2 nerve
Malleus :
its the hammar and its handle between tympanic membrane outside ( soft
tissue ) and tensor tympani inside

Note : this muscle has tendon because its attach
between soft tissue ( tympanic membrane ) and
hard tissue (handle of malleus)


Action : when it contract it tense the handle of malleus inside so it tense
tympanic membrane .

Incus : (L, anvil )
Body :epitympanic recess articulates with the head of the malleus .
long limb : articulate with stapes .

Short limb : attached to the posterior wall to fix it in its place .

Stapes: ( l, stirrup )
Its oval shape .
base ( foot plate ) attached to oval window
it has anterior , posterior limbs , neck ( attached to stapes muscle) and
head ( articulates with the incus .

stspedius muscle :
origin : pyramidal eminence .
Insertion : stapes neck .
Innervation : nerve to stapedius from facial nerve .
Action: stabilize the stapes

tensor tympani muscle:
Origin : from canal in the anterior wall of tympanic cavity .
Insertion : handle of the malleus .
Innervation : nerve to medial pteregoid from mandibular nerve
Action : tense the tympanic membrane.
Otitis media :
infection of middle ear , it can go posteriorly to mastoid air cell .
Symptom( what is the patient complaining about ): *
Earache , and impaired hearing
*Signs (what is the doctor or physician discover during physical
examination :
Bulging red tympanic membrane due to pus in middle ear .

COMPLICATION:
blockage of pharyngotympanic tube .
perforation .
Mastoiditis : inflammation of air mastoid cell .
osteomyelitis ( bone infection ) of tegmen tympani ( weakest part )>>>
spread superiorly to middle cranial fossa can lead to meningitis

The end;
Done by: Asmaa almawas
Habah ramadneh