ENT course

Ear Anatomy and Pathology

By: Islam Assi
 Table of contents

01 02 03
Common diseases of
Anatomy of external ear Anatomy of middle ear
external ear
 The ear
• The ear is the organ of hearing and balance. The parts of the ear include:
1. External.
2. Middle.
3. Internal.

• How do you hear?

1. Hearing starts with the outer ear. When a sound is made outside
the outer ear, the sound waves, or vibrations, travel down the
external auditory canal and strike the eardrum (tympanic
membrane). The eardrum vibrates. The vibrations are then
passed to 3 tiny bones in the middle ear called the ossicles. The
ossicles amplify the sound. They send the sound waves to the
inner ear and into the fluid-filled hearing organ (cochlea).

2. Once the sound waves reach the inner ear, they are converted
into electrical impulses. The auditory nerve sends these impulses
to the brain. The brain then translates these electrical impulses as
sound.
 Anatomy of external ear
1. Auricle (pinna)
• Structure
 The only visible part of the ear
 Consists of elastic cartilage
• Function:
 Collects sound waves; important for directional hearing
2. External auditory meatus (auditory canal)
• Structure
 The outer third is formed by cartilage, the inner two thirds are formed by bone.
 Lined by thin keratinized stratified squamous epithelium along the entire canal; also covers the
external tympanic membrane.
 Epithelium contains ceruminous glands that produce cerumen (ear wax): yellow-brownish, waxy,
bactericidal secretion.
• Function: Transmission of sound waves to the tympanic membrane.
3. Tympanic membrane (eardrum)
• Structure:
 Thin, cone-shaped membrane
 Cutaneous outer, fibrous middle, and mucous inner
layer
 Umbo: the point where ossicles attach to the tympanic
membrane
 Cone of light: a cone-shaped light reflection of the
otoscope light in the anterior inferior quadrant, which
helps with orientation
• Function:
 Sound waves cause vibration of the tympanic
membrane, which in turn transmits these vibrations to
the ossicles of the middle ear (i.e., the malleus, incus,
and stapes).
 Vasculature
• The external ear is supplied by branches of the external carotid artery:
 Posterior auricular artery
 Superficial temporal artery
 Occipital artery
 Maxillary artery (deep auricular branch) – supplies the deep aspect of the external acoustic
meatus and tympanic membrane only.
• Venous drainage is via veins following the arteries listed above.
• Lymphatics drainage of the external ear is to the superficial parotid, mastoid, upper deep
cervical and superficial cervical nodes.
 Innervation
• The sensory innervation to the skin of the auricle comes from numerous nerves:
 Greater auricular nerve (branch of the cervical plexus) – innervates the skin of the auricle
 Lesser occipital nerve (branch of the cervical plexus) – innervates the skin of the auricle
 Auriculotemporal nerve (branch of the mandibular nerve) – innervates the skin of the auricle
and external auditory meatus.
 Branches of the facial and vagus nerves – innervates the deeper aspect of the auricle and
external auditory meatus
• Some individuals can complain of an involuntary cough when cleaning their ears – this is due
to stimulation of the auricular branch of the vagus nerve (the vagus nerve is also responsible
for the cough reflex).
 Common diseases of external ear
• Diseases of the auricle:
1. Hematoma
It usually arises from blunt traumas (sports-related injury), but it can be
induced by any minor trauma. Auricular hematoma presents as a painless
swelling of the auricle with fading of auricular features. The separation of
the cartilage from its blood supply in the perichondrium can lead to
Auricular hematoma
ischemia, then necrosis, and subsequently to cauliflower deformity.
2.Chondritis/Perichondritis
An inflammatory condition involves the perichondrium (Perichondritis) or the
auricular cartilage (chondritis), It can be secondary to infections, trauma, or as a
manifestation of rheumatologic disease as in relapsing polychondritis. The most
common pathogen is Pseudomonas aeruginosa. It presents as painful erythematous
swelling sparing the pinna.
Left auricular perichondritis
sparing ear lobule
3. Furunculosis and Carbunculosis
Furunculosis and carbunculosis arise from hair follicles infection of the lateral ear canal. The
pathogen is typically Staphylococcus aureus. It presents with localized form or fluctuant
painful mass and erythema of the lateral external auditory canal.

Furuncle in right EAC

• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Viral:
1. Herpes simple: fever and painless vesicle
2. Herpes zoster: “Chicken Box virus” painful vesicles
3. Ballous myrigitis: bulla filled with serous fluid or blood
Herpes zoster oticus “Ramsay-Hunt syndrome”
Its neurotropic virus, characterized by :
4. Otalgia
5. Vesicles
6. Facial paralysis (7th)
7. Vertigo (8th)
Treatment:
8. Analgesics for pain
9. Acyclovir: local and systemic
• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Fungal :
1. Aspergillus Niger (white + hallow black )
2. Candida albicans (white)
characterized by :
3. Itching in EAC.
4. Conductive hearing loss
Treatment:
5. Local cleaning of EAC
6. Antifungal ear drops as: Nystatin ear drops
• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Bacterial :
1. Localized O.E. (Furuncle)
2. Diffuse O.E.
3. Malignant O.E.
Localized O.E. (Furuncle): (staph aures)
Hair follicle infection of the lateral EAC, occur in diabetic and characterized by:
Symptoms
4. Pain (on mastication).
5. Discharge: Scanty, purulent, and cheesy.
6. Deafness (if EAC is obstructed)
Signs:-
7. Tenderness
8. Internal swelling
9. External swelling (lymphadenopathy)
Treatment:-
10. General: Antibiotics
11. Local: Local cleaning of EAC.
• 10% Glycerine icthyol ear drops.
• Packing EAC with cream: Antibiotic + Steroid.
3. Incision and drainage
• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Diffuse O.E. :
Predisposing factors: (5s)
1. Scratch of EAC.
2. Swimming( in infected swimming pool). Investigation:
3. Sweating if excessive. 1. Blood sugar for diabetic (if recurrent)
4. Seborrhea. 2. Culture and senstivity of discharge
5. Sugar (Diabetic).
Symptoms:
6. Pain (↑ on mastication).
7. Discharge: Scanty and purulent
8. Deafness(if EAC is obstructed)
Signs:-
9. Tenderness
10. Internal swelling
11. External swelling
Treatment:-
12. General: Antibiotics
13. Local: Local cleaning of EAC.
• 8% Aluminium acetate packing .
• Packing EAC with cream: Antibiotic + Steroid.
• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Malignant otitis externa (skull base osteomyelitis):
Cellulitis osteomyelitis
Occur usually in diabatic
Symptoms:
1. Sever Pain and prolong more than 2 weeks .
2. Discharge: Scanty and purulent
3. Deafness
Signs:-
4. Tenderness
5. Internal swelling with granulations in the floor of EAC at the bony-cartilaginous junctions
6. External swelling
Extensions: due to (osteomyelitisa)
a) Facial palsy (compressed at stylomastoid foramen).
b) Parotid swelling.
c) Lower 4 cranial nerves palsy (compressed at jugular foramen).
d) Trigeminal facial pain if it extend to petrous apex
• Acute otitis externa
It is an inflammatory condition of the EAC caused by a bacterial, viral and fungal.
Malignant otitis externa :
Investigations :
1. Culture and sensitivity → pseudomonas aureginosa.
2. Fasting blood sugar
3. CT Scan.
4. Biopsy from the granulations.
5. Gallium and Tecntium scan
Treatment:-
6. Hospitalization and control of diabetes.
7. Antibiotics: systemic Quinolones, as Ciprofloxacin (for pseudomonas).
8. Ear drops: Ciprofloxacin.
9. Surgical debridement: sometimes needed
 Anatomy of middle ear
1.Tympanic cavity
Air-filled space that is located within the petrous portion of the temporal bone, Contains
ossicles, muscles, and nerves (e.g., chorda tympani). Connected to the nasopharyngeal cavity
via the eustachian tube.
2.Ossicles
Three small bones (Malleus, Incus and Stapes) in the middle ear that form a chain of bones
connecting the tympanic membrane laterally to the oval window of the inner ear medially.
• Function: The ossicles receive the acoustic vibrations from the tympanic membrane and
amplify them. They then transmit the amplified acoustic vibrations to the fluid of the inner
ear via the oval window with minimal energy loss.
3.Eustachian tube (pharyngotympanic tube)
• Definition: connects the middle ear cavity with
the nasopharynx
• Function: Controls the pressure within the
middle ear and allows the pressure to be
equalized on both sides of the tympanic
membrane (e.g., important for altitude
compensation).
Usually closed but opens when chewing, swallowing,
or yawning (ear clearing).
4.Muscles
There are two muscles which serve a protective function in the middle ear
 The tensor tympani, originates from the auditory tube and attaches to the handle of malleus,
pulling it medially when contracting. It is innervated by the tensor tympani nerve, a branch of
the mandibular nerve.
 Stapedius, attaches to the stapes, and is innervated by the facial nerve.
They contract in response to loud noise, inhibiting the vibrations of the malleus, incus and
stapes, and reducing the transmission of sound to the inner ear. This action is known as the
acoustic reflex.
5. Mastoid process
Process of the temporal bone behind the ear. Becomes pneumatized (aerated) with age, with
mastoid air cells formation.
 Vasculature
•Arterial supply
1. Anterior tympanic artery from the maxillary artery.
2. Stylomastoid artery from the posterior auricular or occipital arteries.
3. Numerous small vessels from the external carotid artery.
•Venous drainage
Drainage to the pterygoid venous plexus and the superior petrosal sinus
•Lymphatic drainage
Lymphatic drainage is to the parotid, retropharyngeal and upper group of deep cervical nodes.
 Innervation
This is by the tympanic branch of the glossopharyngeal nerve (Jacobson nerve), which forms the
tympanic plexus by combining with sympathetic fibers from the internal carotid nerve.

Branches from the plexus supply sensory and vasomotor fibers to the mucous membrane of the
tympanic cavity, as well as to the tympanic membrane and external auditory meatus.
Thank You !
CREDITS: This presentation template was created by Slidesgo,
including icons by Flaticon, and infographics & images by
Freepik