Anatomy of the external ear

Prepared by:Chiman Abdulrahman Omer

1st year trainee of KBMS Otolaryngology
Head & Neck Surgery
Supervised by: Mouwafak Al Rawi, MD,FACS
External ear
Auricle (pinna)

Extrenal auditoary canal

Tympanic membrane
Auricle (pinna):
The auricle (or pinna) projects at a variable angle from
the side of the head and has some function in collecting
sound.
Fibroelastic cartilage.
The lateral surface of the auricle has characteristic
prominences and depressions
The skin is adherent to the perichondrium on its lateral
surface while it is comparatively loose on the medial
surface.
Sebaceous glands and hair follicles are found in the
subcutaneous tissue.
 Connected to the temporal bone by anterior &posterior ligaments.
Three extrinsic muscles &six intrinsic muscles.
Incisura Terminalis: This area is devoid of cartilage and lies
between the tragus and crus of the helix.
Importance:
Endaural incision

Grafts in rhinoplasty.

Grafts in tympanoplasty.
 Function of pinna :
Pinna serves following functions because of its shape and location.
It increases sound pressure by 6 dB .

Collection: Gather sound arriving from an arc of 135.

Localization: Determine the origin of sound .

Concentration: Horn-shaped concha acts like a megaphone

and concentrate the sound at the entrance of EAC.
 Nerve supply of auricle:
Nerve Derived from Region Supplied

Greater Auricular Cervical Plexus C2 Medial surface and

C3 posterior part of lateral
surface of pinna
Lesser occipital Cervical plexus C2 Superior portion of
medial surface

Auricular Vagus Concha and Antihelix

Auriculotemporal Mandibular division Tragus, Crus of the

of trigeminal nerve helix and adjacent
helix
Facial Supplies root of
concha
Blood supply of auricle:
Blood supply of auricle:
Posterior auricular artery supply medial surface(except
lobule) the concha, the middle and lower portions of the
helix and the lower part of the antihelix.

Anterior auricular branches of the superficial temporal

artery supply the upper portions of the helix, antihelix,
triangular fossa,tragus and lobule.
Lymphatic drainage of auricle:

The lymphatic drainage from the posterior surface is to

lymph nodes at the mastoid tip.

from the tragus and from the upper part of the anterior
surface to the preauricular nodes related to parotid glan

From the rest of the auricle to the upper deep cervical

nodes.
Embryologic development of auricle:

Development of pinna (A) from six hillocks of

His (B) around the first branchial cleft

Preauricular sinus or cyst: It is commonly seen between the

tragus and crus of helix. It is the result of the faulty fusion
between the first and the second arch tubercles.
B

A
 external auditory canal:
The external auditory canal extends from the concha of the auricle
to the tympanic membrane and is approximately 2.4 cm long.

Its anterior wall is 6 mm longer than the posterior wall. EAC is

usually divided into 2 parts:cartilaginous and bony .
Cartilaginous EAC: It is a continuation of the cartilage that forms
the framework of the pinna.
The skin of the cartilaginous canal is thick and contains ceruminous
and pilosebaceous glands that secrete wax.

Fissures of Santorini.
 Bony EAC: It is mainly formed by the tympanic portion of
temporal bone but roof is formed by the squamous part of the
temporal bone . In the anterosuperior region,squamous part
articulates with tympanic bone (tympanosquamous suture).
Inferiorly and medially squamous part joins with the lateral
superior portion of the petrous bone(petrosquamous suture).

Skin of the bony EAC is thin and continuous over the tympanic
membrane ,skin is devoid of subcutaneous layer, hair follicles
and ceruminous glands.

Isthmus: Approximately 6 mm lateral to tympanic membrane,

bony EAC has a narrowing called the isthmus.
 Recess: Anteroinferior part of the deep bony meatus,medial
to the isthmus has a recess, which is called the anterior
recess.
The anterior recess of bony EAC acts as a cesspool for
discharge and debris.
Foramen of Huschke: In children and occasionally in adults,
anteroinferior bony EAC may have a deficiency that is called
foramen of Huschke.

Foramen of Huschke permits spread of infections to and from

EAC and parotid gland.
 Hitzelbergers sign: The hypoesthesia of posterior meatal wall occurs due to
the pressure on facial nerve (sensoryfibers are affected early) in patients with
acoustic neuroma.

Vasovagal reflex.

Ramsay Hunt syndrome.

Relations of Bony EAC :
Relations of Bony EAC :

Superior: Middle cranial fossa

Inferior: Parotid gland
Posterior: Mastoid antrum and air cells and the facial
nerve
Anterior: Temporomandibular joint (TMJ)
Medial: Tympanic membrane
Lateral: Cartilaginous EAC
 Nerve supply of external auditory canal:

Auriculotemporal nerve (CN V3): It is a branch of mandibular

division of trigeminal nerve and supplies anterosuperior wall
of external auditory canal.

CN X (vagus nerve): Its auricular branch (Arnolds nerve)

supplies to inferoposterior external auditory canal.

CN VII (facial nerve): It innervates the skin of the mastoid

and posterior external auditory canal.
Blood supply of EAC:
Blood supply of external auditory canal:

The arterial supply is derived from branches of the external carotid.

The auricular branches of the superficial temporal artery supply the roof
and anterior portion of the canal.
The deep auricular branch of the first part of the maxillary artery arises
in the parotid gland behind the temporomandibular joint, pierces the
cartilage or bone of the external meatus and supplies the anterior meatal
wall skin and the epithelium of the outer surface of the tympanic
membrane.
auricular branches of the posterior auricular artery pierce the
cartilage of the auricle and supply the posterior portions of the canal.
The veins drain into the external jugular vein, the maxillary veins and the
pterygoid plexus.The lymphatic drainage follows that of the auricle.
Embryology of external auditory canal:
EAC derived from the first branchial cleft .

gets fully formed by the 28thweek. In the 16th embryonic week, cells
proliferate from the bottom of ectodermal cleft and form a meatal
plug.
Atresia of canal: The recanalization of meatal plug, which
begins from the deeper part near the tympanic membrane and
progresses outwards.
Collaural fistula.
Tympanic membrane:
Tympanic membrane :
The tympanic membrane lies at the medial end of the
external auditory meatus and forms the majority of the
lateral wall of the tympanic cavity.

Its slightly oval in shape ,forming an angle of about 55 with the floor
of the meatus.

Its dimensions are: 910 mm height and 89mm width

It is 0.1 mm thick.

Its posterosuperior part is more lateral than its anteroinferior

part.
 Tympanic membrane consists of two parts:
(1) pars tensa and (2) pars flaccida.
Pars tensa: It forms most of tympanic membrane (TM).
Annulus tympanicus: TM is thickened in the periphery and forms a
fibrocartilaginous ring called annulus tympanicus that fits in the tympanic
sulcus.
Umbo: The central part of TM near the tip of malleus is tended
inwards and is called the umbo.
Cone of light: A bright cone of light radiating from the tip of malleus to
the periphery in the anteroinferior quadrant is usually seen during
otoscopy.
Pars flaccida (Shrapnells membrane): It is situated above the lateral
process of malleus between the notch of Rivinus and the anterior and
posterior malleal folds. It is not as tense as pars tensa and may appear
little pinkish.
 Tympanic membrane consists of three layers

a. Outer epithelial layer: It is continuous with the EAC skin.

b. Middle fibrous layer: It encloses the handle of malleus and

consists of three types of fibers: radial, circular and parabolic. In
comparison to pars tensa, this layer is very thin in pars flaccida
and not organized into various fibers.

c. Inner mucosal layer: It is continuous with the middle ear

mucosa.
Blood supply of tympanic membrane:
Tympanic membrane innervation:
Auriculotemporal nerve (CN V3): It is a
branch of mandibular division of
trigeminal nerve and supplies anterior
half of lateral surface of TM.
CN X (vagus nerve): Its auricular branch
(Arnolds nerve) supplies to posterior
half of lateral surface of TM.
CN IX (glossopharyngeal nerve): Its
tympanic branch(Jacobsons nerve)
supplies to medial surface of tympanic
membrane.
Embryologic development of TM:
It develops from all the three germinal layers.
1. Ectoderm: Outer epithelial layer is formed by the
ectoderm.
2. Mesoderm: The middle fibrous layer develops from the
mesoderm.
3. Endoderm: Inner mucosal layer is formed by the
endoderm.