Illustrated Intro to middle ear anatomy as seen by otoscopy

A normal ear human body presentation by Dr. James Berbee, one of the inventors of the Wispr digital otoscope and founder of WiscMed. The presentation focus is on the features of an eardrum and middle ear that can be seen with digital otoscopy using the Wispr. The PowerPoint video is here and a written discussion is below. Receive Wispr Clinical Cases emails by subscribing to WiscMed electronic mail updates. The WiscMed Wispr digital otoscope is a cock that every provider can use to improve their ability to access and represent findings in the ear. The device can be purchased here. What parts of the ear can you see with an otoscope ?

1. Ear canal
2. Cerumen (ear wax)
3. Tympanic membrane (eardrum)
4. Pars Tensa and Pars Flaccida
5. Cone of light
6. Malleus bone
7. Incus bone
8. Chorda Tympani nerve
9. Tympanic cavity shadow (middle ear)

The PowerPoint can be downloaded by clicking hera. Normal Ear Anatomy Discussion  WiscMed recommends that you watch the video presentation above. This contains the same information with more description and context. The human auricle is an model of nature ’ mho amazing biotechnology. It translates heavy waves foremost into mechanical apparent motion and then into electric signals that are interpreted as legal by the brain. The otoscope can “ see ” the tympanic membrane ( eardrum ) which separates the external ear from the middle ear. Because the eardrum is thin and translucent, it is possible to see some of the structures of the middle ear. These structures include the bones of the middle auricle along with the tympanic cavity. Understanding what a normal eardrum looks like will allow you to appreciate when something is not normal. Orientation of the ear compartments In this article, we will show you the features of the normal ear that you can expect to see during otoscopy. All the images and videos shown are from the WiscMed Wispr digital otoscope. To see the features, you must be able to obtain a position of the tympanic membrane ( eardrum ). The eardrum is located about 1.5 cm inside the skull at the end of the external auditory canal. The canal is rigid ( surrounded by bone and cartilage ), but it is not neat. Features of the Wispr digital otoscope. The canal much has ear wax ( aesculapian term, cerumen ) that either partially or completely obstructs the view of the eardrum. The first challenge is to navigate through the external canal and past the ear wax. Below is a distinctive position that you might get with a traditional otoscope. merely a modest part of the eardrum is visible because the ear canal is partially occluded by ear wax. No definitive affirmation may be made about the eardrum because such a minor dowry is visible. distinctive analogue otoscopy has a limited view of the eardrum due to cerumen – ear wax To by rights see the entire eardrum, either the ear wax must be removed, or you need to use a digital otoscope like the WiscMed Wispr that allows you to guide a television camera around the wax. Removing ear wax for the inexperienced provider is challenging. This is because 1 ) the small canal limits visibility, 2 ) the duct is sensitive, and 3 ) there is risk of damaging the eardrum without dependable situational awareness. A better alternative is to have an otoscope that is able of maneuvering through a humble “ window ” in the wax. here is a video recording from the WiscMed Wispr digital otoscope that incorporates a distal television camera that is able to maneuver past wax ; Wispr digital otoscope maneuvering by wax once you obtain a view of the tympanic membrane, you can begin to appreciate the anatomy that is apparent. Normal Tympanic Membrane ( Eardrum ) Primary Features of the Eardrum Ear canal, eardrum, cone of light and malleus cram Let ’ s start with the features that are promptly discernible. The first thing you notice is the big circular area. This is the tympanic membrane ( eardrum ) and is often described as chopper grey. In an adult, the eardrum is about 1 cm in diameter. A healthy eardrum is concave inwards. The cone of light is seen on a healthy eardrum – it is from otoscope light reflected from the concave surface. The cone of light extends from the center of the eardrum to the periphery. The following obvious social organization is the malleus bone. This bone is attached to the eardrum and translates the campaign of the eardrum to the inner ear via the chain of bones malleus, incus, stapes. These bones are normally referred to as mallet, anvil and stirrup. There is fine vasculature present on the malleus. This is a normal discover. Besides being the first cram in the middle ear, the malleus besides “ tells ” you which ear you are looking at. The malleus always points towards the face. here are examples of left and right ears with the malleus indicating which is which. Using the malleus to determine “ which ear ” Parts of the Tympanic Membrane There are two distinct areas to the tympanic membrane ( eardrum ), the pars tensa and the pars flaccida.

These two areas are outlined in the follow images : The pars tensa is the part of the tympanic membrane that is the largest. It ’ s what people tend to think of when they think of the “ eardrum. ” As the name suggests, it is “ taut, ” much like if you stretched plastic wrapping on crown of a bowl. You could besides imagine the pars tensa to be like to a barrel surface. It is the fortune of the eardrum responsible for translating good waves into mechanical movement. The pars flaccida, as the name suggests, is less “ taut ” and besides thick. It drapes across the superior share of the malleus. Although it does not have an active role in sound wave transcription, it is necessary to provide complete coverage of the middle ear space and allow for the proper functioning of the pars tensa. From a clinical perspective, the pars tensa gets most of our attention. This is the locate where we would expect to see perforations, effusions, and the characteristic bulge of acute accent otitis media. See our clinical Cases using the Wispr digital otoscope. The pars flaccida may be the first place that bulge of the tympanic membran e is seen due to increase pressure in the center ear space. The pars flaccida is where most eardrum drift would be appreciated if evaluating mobility of the eardrum via either pneumatic otoscopy or a Valsalva tactic. Bones of the Middle Ear Bones of the middle auricle merely like the person, every ear is different. In some ears it is potential to see extra structures that are in the middle ear ( the other side of the eardrum ). This is possible because the eardrum can be quite crystalline. We ’ ve already talked about the malleus cram which is about constantly visible. It is besides common to be able to see the incus bone. The incus is the second cram in the chain of bones that communicate campaign of the eardrum to the inside ear. The malleus bone and the incus bone are connected at the superior dowry of the middle ear. It is rare to see the stapes bone because it is sol deep to the eardrum. The malleus and incus bones as seen through the guileless eardrum Chorda Tympani Nerve The chorda kettle heart traverses medial to ( “ behind ” ) the malleus and lateral to ( “ in front of ” ) the incus. Often, the chorda kettle boldness is not visible as it is superior adequate to be hidden by the tympanic membrane anulus. When it is visible, it is striking. In this image the chorda kettle is visible behind a highly translucent tympanic membrane : Chorda Tympani steel surprisingly, the officiate of this steel has nothing to do with the ear, it simply traverses the middle ear space where on occasion it can be seen behind a guileless eardrum as in this case. The heart is a branch of the facial boldness and provides sense to the anterior two-thirds of the tongue. It besides provides parasympathetic fibers that provide drive innervation to the submandibular and sublingual glands. Tympanic cavity and Eustachian Tube – Pressure  Equalization Another feature of speech that is normally seen is the shadow of the tympanic cavity ; this is where the Eustachian tube is located. This is in the anterior-inferior helping of the eardrum. For the eardrum to vibrate by rights from sound waves, the pressure on both sides of the eardrum most be the same. This is accomplished by the eustachian pipe which connects the middle ear to the buttocks adenoidal pit. Eustachian pipe and pressure equalization Most of us have had the experience of “ popping ’ our ears when descending in an ear flat. This maneuver is opening the Eustachian tube and allowing the blackmail on both sides of the eardrum to equalize. The Eustachian tube can become inflame and ineffective to “ open. ” This causes ear pain from unequal blackmail that can besides be a common symptom of acuate otitis media. The shadow of the open to the Eustachian tube can frequently be seen on the tympanic membrane as shown below. here is an exemplar of a damaged tympanic membrane where the Eustachian opening is clearly visible. Tympanic cavity shadow behind the eardrum Summary of common findings on a normal eardrum Otoscopy findings of a normal eardrum

For more information about Normal Ear Anatomy as Seen by an Otoscope Video Presentation reach us. Check out the WiscMed Youtube Channel. Purchase the Wispr digital otoscope .

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