ANATOMY 

OF  MIDDLE  EAR

AND  PHSIOLOGY  OF HEARING

DR. APURVA PALATKAR

EMBRYOLOGY OF MIDDLE EAR
 MIDDLE EAR ANATOMY

•The middle ear cleft consists of 

 Tympanic cavity 

 Eustachian tube 

 Middle ear mucosa

 Mastoid air cell system

 Auditory ossicles and the

tendons.

 Segment of the facial nerve 

 The tympanic cavity is shaped like a biconcave disc . 

 It lies in between the tympanic membrane laterally and the osseous

labyrinth medially. 

 Divided into 3  compartments- 

 Epitympanum( attic)- above level of malleolar folds.

 Mesotympanum 
 Hypotympanum- below tympanic inferior part of tympanic sulcus.
 Protympanum- anterior to promontory.

 The tympanic cavity has 6 walls. 

 CONTENTS OF MIDDLE EAR
• Ossicles
• Stapedius muscle
• Tensor tympani muscle
• Chorda tympani nerve
• Tympanic plexus
• Eustachian tube
• Mucosa of tympanic cavity

Is essentially mucus secreting mucosa

bearing cilia on its surface.
• Covers tendon of 2 muscles
• Mucosal fold separates middle ear space into
compartments.
OSSICLES :
MALLEUS-
lateral and the largest ossicle-
measures 8mm in length.
resembles a hammer .
INCUS-resembles an anvil
STAPES- resembles stirrup ,
smallest ossicle- 3.5 mm in length
MUSCLES OF MIDDLE EAR:
Tensor tympani-
Muscle for malleus, arises from the walls of the
auditory tube.
inserted into the medial side of the upper part
of the handle of malleus.
Supplied- mandibular nerve
It pulls the handle inward making the TM more
tense and thus dampens the excess vibrations.
Stapedius-
Muscle for stapes, arises from the interior of the
hollow pyramid.
inserted into the back of stapes.
Supplied by the facial nerve.
It tilts the footplate laterally and opposes the
action of tensor.
EUSTACHIAN TUBE
Dynamic channel that links the middle ear with the nasopharynx,
36mm in length in adults.

Lined- ciliated respiratory epithelium with mucous secreting

glands and goblet cells.

The wider medial end protrudes into the nasopharynx, lying

directly under the mucosa to form the torus tubaris.

 tube opens 1-1.25 cm behind and below the inferior turbinate

into nasopharynx.
ANTERIOR WALL   The lower 1/3rd consists of a thin
plate of bone covering the carotid
artery.

 The middle 1/3rd - tympanic

orifice of the Eustachian tube,5 x 2
mm in size.
 Just above - canal containing the
tensor tympani muscle.

 The upper 1/3rd is usually

pneumatized and may house the
supratubal recess, a small niche
that can be separated from
anterior epitympanic space by the
tensor fold.
LATERAL WALL
Formed by :

• Superiorly-Bony lateral wall of the epitympanum

• Centrally--Tympanic membrane

• Inferiorly- Bony lateral wall of the hypotympanum

The lateral epitympanic wall is wedge-shaped in section

and its sharp inferior portion is also called the outer
attic wall or scutum.

It is thin and easily eroded by cholesteatoma, leaving a

telltale sign on a high resolution coronal CT scan.
 Three holes are present in bone of medial surface of lateral wall of the tympanic cavity:

 The petrotympanic fissure is 2 mm long which opens anteriorly just above the attachment
of the tympanic membrane.

The chorda tympani nerve enters the medial surface of the fissure through a separate
anterior canaliculus (canal of Huguier).

Runs posteriorly between the fibrous and mucosal layers of the tympanic membrane

then continues within the membrane, but below the level of the posterior malleolar fold.

nerve reaches the posterior bony canal wall just medial to the tympanic sulcus, enters the
posterior canaliculus.

runs obliquely downwards and medially through the posterior wall of the tympanic cavity
until it reaches the facial nerve (at the level of the inferior third of the facial canal on its
anterior wall).
 POSTERIOR WALL

 The posterior wall is wider above than below.

 Upper part a large irregular opening - the

aditus and antrum,

 Below the aditus is a small depression, the

fossa incudis,

 Below the fossa incudis and medial to the

opening of the chorda tympani nerve is the
pyramid, a small hollow conical projection with
its apex pointing anteriorly.
 Stapedius muscle.

 The facial recess is a groove which lies between

the pyramid with facial nerve, and the annulus
of the tympanic membrane.
•Surgically facial recess is
important as direct accsess
can be made through this into
the middle ear without
disturbing posterior canal
wall( intact canal wall
technique).
 MEDIAL WALL
 It seperates the tympanic cavity from
the middle ear.

 Promontory

 Behind and above the promontory –

lies the oval window(3.25x1.75mm).
Tympanic cavity- to -vestibule.

 Round window( fenestra cochlea)–

triangular- lies below and behind the
oval window – separated by
Subiculum.( posterior extension of
promontory forming a bony bridge.
 Another bony ridge above the subiculum is called the
Ponticulus that runs to the pyramid on the posterior wall.

Fallopian canal- runs above the promontory and oval

window. It is marked anteriorly by processus
cochelariformis, a curved projection of bone which houses
tendon of tensor tympaniand runs laterally to handle of
malleus.
ROOF OF MIDDLE EAR
• The roof of the epitympanum is
the tegmen tympani, a thin bony
plate that separates the middle ear
space from the middle cranial
fossa.

• Petrosquamous suture line.

• AA– Route of infection into
extradural space in children.

• There is a bony crest known as cog

which projects from the tegmen
tympani caudally to lie anterior to
the head of the malleus.
• Residual cholesteatoma.
FLOOR OF THE MIDDLE EAR
 The floor of the tympanic cavity separates
the hypotympanum from the dome of the
jugular bulb.

 Floor may be congenitally dehiscent-

jugular bulb projects into the middle ear,
may be injured while raising the inferior
portion of tympanomeatal flap during
surgery.

 At junction- is the inferior tympanic

canaliculus, for Jacobson’s nerve.
b/w Pars flaccida-neck of malleus, lateral
malleolar fold.
BLOOD SUPPLY
ARTERIAL SUPPLY-
2 main
 Anterior tympanic branch of the maxillary artery enters through the
 petrotympanic fissure. – supplies tympanic membrane.
 stylomastoid branch of the posterior auricular artery enters through the stylomastoid
foramen supplies– middle ear and mastoid air cells.

4 minor:-
 Superior tympanic branch from the middle meningeal artery enters through the tympanic
canaliculus.
 Tympanic branch of artery of pterygoid canal enters through the canal for auditory tube.
(ET)
 tympanic branch of the ICA.
 Petrosal branch rom the middle meningeal artery runs along greater petrosal nerve.
VENOUS DRAINAGE-
Drain into the superior petrosal sinus and pterygoid
plexus of veins.

LYMPHATIC DRAINAGE-
retropharyngeal lymph nodes.

NERVE SUPPLY-

By the tympanic plexus over the promontory Plexus is

formed by :-
Tympanic branch of the glossopharyngeal nerve
Superior and inferior caroticotympanic nerves from the
sympathetic plexus around the ICA
 THE MASTOID AND ITS AIR CELL SYSTEM
MASTOID ANTRUM- large air containing space in the upper part of mastoid. Air space in
the posterior part of the petrous temporal bone.

The mastoid antrum is well developed at birth and the pneumatization begins in the first
year and is complete by 4-6 years.
Aditus- connects the epitymanum with the mastoid antrum. Short process of incus is
seen its floor with lateral semircular canal in its medial wall.

3 types of mastoid:-
 Cellular (well-pneumatized) air cells-
mastoid air cells are well developed with intervening septa.
 Diploeic air cells-
small and less numerous air cells
 Acellular( sclerotic)-
Air cells are practically absent
Groups of Mastoid air cells:

Zygomatic cells.
Tegmen cells.
Retrofacial cells.
Perilabyrinth cells
Peritubal cells.
Perisinus.
Tip cells.
Marginal cells.
Squamous cells.
 Physiology of Hearing
• Conduction of sound.
• Transduction of mechanical sound energy to electrical impulse.
• Conduction of electrical impulses to brain

• Impedance matching mechanism/transformer action of middle ear.

• Conduction of Sound accomplished by:

1) Lever action of the ossicles
2) Hydraulic action of the tympanic membrane
3) Curved Membrane Effect

4) Phase differential
 Transducer Mechanism
Bending of hair cells( displacement of
stereocilia towards kinocilium)

K+ flow into hair cell

Depolarisation

Ca+ channels open

Fusion of transmitter vesicle with basal

part of cell membrane.

Release of neurotransmitter(AAG) in
synaptic cleft

Initiate action potential in auditory nerve

 Bekesy’s travelling wave theory
Sound stimulus produces a wave-like vibration of basilar
membrane starting from basal turn towards apex of cochlea . It
increases in amplitude as it moves until it reaches a maximum &
dies off. Sound frequency is determined by point of maximum
amplitude. High frequency sounds cause wave with maximum
amplitude near to basal turn of cochlea. Low frequency sound
waves have their maximum amplitude near cochlear apex.
 AUDITORY PATHWAY
 Eighth (Auditory) nerve
 Cochlear nucleus
 Olivary nucleus (superior)
 Lateral lemniscus
 Inferior colliculus
 Medial geniculate body
 Auditory cortex
Thank you