≣ SIZE AND SHAPE

The middle ear is shaped like a block, compressed from side to side. In coronal section, it resembles
a biconcave disk, like a red blood cell.

≣ MEASUREMENTS

Vertical diameter: 15 mm.

Anteroposterior diameter: 15 mm.

Transverse diameters:

At roof: 6 mm.
In the centre: 2 mm.
At the floor: 4 mm.

≣ COMMUNICATION
The middle ear interacts:

Anteriorly with nasopharynx via pharyngotympanic tube.

Posteriorly with mastoid antrum and mastoid air cells via aditus to antrum termed
aditusadantrum.

Contents of the Middle Ear.

In the mucous lining:

Air

Outside the mucous lining:

3 small bones named ear ossicles: malleus, incus and stapes.

2 muscles: tensor tympani and stapedius.
2 nerves: chorda tympani and tympanic plexus.
Vessels supplying and emptying the middle ear.
Ligaments of the ear ossicles.

The mucous membrane lining of the middle ear invests all the structures inside it and creates
several folds, which project into the cavity supplying it a honey comb look. So strictly speaking, the
middle ear includes only air.

≣ SUBDIVISIONS OFTHE MIDDLE EAR

The tympanic cavity goes substantially past the limits of tympanic membrane, which creates its
lateral boundary. It’s split into 3 parts, viz.

Epitympanum (loft), a part above the tympanic membrane consisting of head of malleus, body
and brief process of incus.
Mesotympanum, a part opposite to tympanic membrane comprising handle of malleus, long
process of incus and stapes. It’s the narrowest part of the middle ear.
Hypotympanum, a part below the tympanic membrane.

≣ BOUNDS

The middle ear is likened to a 6 -sided box and therefore presents 6 walls, specifically,

Roof.
Floor.
Anterior wall.
Posterior wall.
Medial wall.
Lateral wall.

Roof: It’s created by a thin plate of bone referred to as tegmen tympani. It divides the tympanic
cavity from the middle cranial fossa
fossa. The tegmen tympani also go posteriorly to create the roof of
aditusadantrum.

Floor: The floor is also created by a thin plate of bone, which divides the tympanic cavity from the
jugular bulb. Occasionally it’s congenitally deficient and the jugular bulb subsequently projects into
the middle ear, being divided from cavity only by mucosa.

The tympanic branch of glossopharyngeal nerve pierces the floor between the jugular fossa
and lower opening of the carotid canal and enters the tympanic cavity to take part in the formation
of tympanic plexus.

Anterior wall: It’s created by a thin plate of bone. In the lower part it divides the cavity from internal
carotid artery
artery. The upper part of anterior wall presents 2 openings or ducts, the upper 1 for the
tensor tympani muscle and the lower 1 for the auditory tube.

The bony partition between both ducts goes backwards along the medial wall in the tympanic cavity
 as a curved lamina named processuscochleariformis.

Posterior wall: The posterior wall divides the tympanic cavity from mastoid antrum and mastoid air
cells and presents these features:

Aditusadantrum, an opening in the upper part via which tympanic cavity interacts with the
mastoid antrum.
Fossa incudis, a small depression close to the aditus, lodging the brief process of the incus.
Pyramid, a hollow conical bony projection below the aditus comprising stapedius muscle whose
tendon appears via its peak, enters forwards to be connected to the neck of the stapes.
Vertical part of facial canal runs in the posterior wall just behind the pyramid and descends up
to the stylomastoid foramen.
Posterior canaliculus for chorda tympani, a small aperture for development of the nerve.

Medial wall: It divides the tympanic cavity from the inter-nal ear; so it’s truly created by the bony
lateral wallof the internal ear. The medial wall presents the followingfeatures:

Promontory, a rounded bulge in the middle master-duced by first (basal) turn of the cochlea.
The tympanic branch of the glossopharyngeal nerve ramifies on it to create tympanic plexus.
Oval window (fenestra vestibuli), a reniform aperture situated above and behind the
promontory. It’s closed by the base of stapes and annular ligament.
Round window (fenestra cochleae), a small round opening below and behind the promontory
which in life, is closed by fibrous secondary tympanic membrane. The secondary tympanic
membrane divides the middle ear from the scala tympani.
Sinus tympani, a depression supporting the promontory between fenestra vestibuli and
fenestra cochleae, which signals the position of ampulla of the posterior semicircular canal.
Bulge of oblique part of the facial canal that goes backwards and downwards above the oval
window until it joins the vertical part of the facial canal in the posterior wall of the tympanic
cavity. Occasionally the bony covering of the facial nerve could be absent, hence exposing the
nerve for injuries and infection.
Bulge of lateral semicircular canal of the internal ear that is viewed as a small ridge high up in
the angle between the medial and posterior walls.

Lateral wall: the Majority of the lateral wall is composed by tympanic membrane, which divides the
tympanic cavity from the external auditory meatus
meatus.

The chorda tympani nerve, a branch of facial nerve enters across the tympanic membrane being
located lateral to the long process of the incus and medial to the handle of the malleus.
It enters the tympanic cavity via the posterior canaliculus in the posterior wall and leaves via the
anterior canaliculus medial to the petrotympanic fissure.

CLINICAL SIGNIFICANCE

Infection of the middle ear (otitis media): It’s common particularly in babies and youngsters. Infective
agents reach the middle ear from the upper respiratory tract via pharyngotympanic tube. The
longstanding infection results in chronic suppurative otitis media (CSOM), which medically presents
as ear discharge and perforation of tympanic membrane. The spread of infection from the middle
ear may generate the following clinical circumstances:

Acute mastoiditis and mastoid abscess, when infection spreads into mastoid antrum and
mastoid air cells via aditusadantrum in the posterior wall.
Meningitis and temporal lobe abscess may happen, if infection propagates upwards via the thin
roof (tegmen tympani).
Lower motor neuron type of facial palsy, when infection erodes the papery thin bony wall of
facial canal.
Transverse and sigmoid sinus thrombosis, when infection spreads via the floor.
Labyrinthitis, when infection spreads deep into medial wall. The labyrinthitis causes vomiting
and vertigo.
Cerebellar abscess, when infection spreads too much posteromedially.

≣ EAR OSSICLES

The 3 ear ossicles (malleus, incus and stapes) inside the middle ear are joined to 1 another by
synovial joints and create a bony chain that stretch across the tympanic cavity from the tympanic
membrane to the oval window . They conduct sound vibrations from tympanic membrane to the
oval window and afterwards to the inner ear fluid.

MALLEUS

It resembles a hammer and, thus, called malleus. Its head, neck, manage (manubrium), a lateral
process and an anterior process. The head and neck be located in the epitympanum, while the
handle is embedded in the fibrous layer of tympanic membrane. The lateral process creates a knob-
like projection on the outer surface of the tympanic membrane and gives connection to the anterior
and posterior malleolar folds. The head of malleus articulates with the body of the incus creating the
incudomalleolar joint (saddle type of synovial joint).

INCUS

It resembles an anvil or a premolar tooth in shape. It is composed of a comparatively large body and
2 thin processes: a brief process and a long process. The body and brief process be located in the
loft, on the other hand its long process hangs vertically behind and parallel with all the handle of the
malleus. Its bulbous tip (lentiform nodule) is directed medially to articulate with the head of the
stapes, creating the incudostapedial joint (ball and socket type of synovial joint).

STAPES

It resembles a stirrup. It is composed of head, neck, anterior and posterior crura and footplate. The
footplate shuts the oval window and is connected to its margin by annular ligament.

FEATURES OF THE 3 EAR OSSICLES

≣ INTRATYMPANIC MUSCLES
There are just two intratympanic muscles: tensor tympani and stapedius.

Origin, insertion, Nerve Supply and activities of the intratympanic muscles.

Nerve
Muscle Origin Insertion Actions
supply

Tensor Cartilaginous part of the Medial aspect of Mandibular Tenses the

tympani auditory tube and sulcus the upper end of nerve (V3) tympanic
tubae handle of malleus membrane

Stapedius Interior of hollow pyramidal Posterior aspect Facial Draws the stapes
eminence on the posterior of the neck of nerve laterally thus tilting
wall of tympanic cavity stapes (CNVII) its footplate in the
oval window

CLINICAL SIGNIFICANCE

Hyperacusis: Both, tensor tympani and stapedius contract reflexly and simultaneously to dampen
quite loud sounds, consequently preventing sound trauma to the internal ear. The paralysis of
stapedius ends in hyperacusis (an abnormally increased power of hearing) where even whisper
appears as sound.

Otosclerosis
Otosclerosis: Abnormal ossification of annular ligament, which anchors the footplate of stapes
to the oval window is termed otosclerosis. This impedes the movements of stapes and causes
deafness. The otosclerosis is the most frequently encountered cause of conductive deafness in
adults.

≣ ARTERIAL SUPPLY
The middle ear is supplied by 6 arteries
arteries, viz.

Anterior tympanic branch of the maxillary artery.

Stylomastoid branch of the posterior auricular artery.
Petrosal branch of the middle meningeal artery, running along the greater petrosal nerve.
Superior tympanic branch of the middle meningeal artery, running along the canal for tensor
tympani.
Branch from the artery of pterygoid canal.
Tympanic branch of the internal carotid artery.

Out of the 6 arteries, first 2-anterior tympanicbranch of the maxillary and stylomastoid branch of
theposterior auricular artery are the principal source of the bloodsupply.

≣ VENOUS DRAINAGE
The veins from middle ear drain into:

Pterygoid venous plexus, via squamotympanic fissure.

Superior petrosal sinus, via subarcuate fossa.

≣ LYMPHATIC DRAINAGE
The lymphatics from middle ear drain into:

Retropharyngeal lymph nodes.

Parotid lymph nodes.
Upper deep cervical lymph nodes.

≣ NERVE SUPPLY

Tympanic branch of glossopharyngeal nerve: It enters the middle ear via a canaliculus in the floor of
the tympanic cavity and takes part in the formation of tympanic plexus.

It gives Sensory Supply to the liner of middle ear, antrum and auditory tube.

Its preganglionic parasympathetic fibres supply the secretomotorfibres to the parotid gland

Superior and inferior caroticotympanic nerves: They’re vasomotor and originated from sympathetic