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Eardrum

eardrum, eardrum rupture
In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear Its function is to transmit sound from the air to the ossicles inside the middle ear, and then to the oval window in the fluid-filled cochlea Hence, it ultimately converts and amplifies vibration in air to vibration in fluid The malleus bone bridges the gap between the eardrum and the other ossicles1

Rupture or perforation of the eardrum can lead to conductive hearing loss Collapse or retraction of the eardrum can cause conductive hearing loss or cholesteatoma

Contents

  • 1 Placement inside the external acoustic canal
  • 2 Structure
    • 21 Nerve supply
    • 22 Relations
    • 23 Umbo
  • 3 Clinical significance
    • 31 Rupture
    • 32 Surgical puncture for treatment of middle ear infections
  • 4 Society and culture
  • 5 See also
  • 6 Additional images
  • 7 References
  • 8 External links

Placement inside the external acoustic canaledit

The oblique placement of the tympanic membrane both antero-posteriorly, medio-laterally and superoinferiorly causes it's superoposterior end to be more lateral to its anteroinferior end From this you also understand that the superior part of the TM is also it's posterior part maximum area is shared while it's anterior part is also it's inferior part again maximum area shared

Structureedit

There are two general regions of the eardrum: the pars flaccida in the upper region and the pars tensa The pars flaccida consists of two layers, is relatively fragile, and is associated with eustachian tube dysfunction and cholesteatomas The larger pars tensa region consists of three layers: skin, fibrous tissue, and mucosaMiddle fibrous layer, which encloses the handle of malleus and has three types of fibres-the radial, circular and parabolic It is comparatively robust and is the region most commonly associated with perforations2

The pars tensa forms most of the tympanic membrane Its periphery is thick and forms a fibrocartilaginous ring called the anulus tympanicus The central part of the pars tensa is tented inward at the level of the tip of malleus and is called the umbo When the eardrum is illuminated during an examination, a cone of light radiates from the tip of the malleus to the periphery in the antero-inferior quadrant The pars flaccida is above the lateral process of the malleus between the notch of Rivinus and the anterior and posterior malleal folds It appears slightly pinkish

Nerve supplyedit

Sensory innervation of the external surface of the tympanic membrane is mainly by the auriculotemporal nerve, a branch of the mandibular nerve V3 It also has contributions from the auricular branch of the vagus nerve X, the facial nerve VII and a possible contribution from the glossopharyngeal nerve IX Sensory innervation of the inner surface of the tympanic membrane is by the glossopharyngeal nerve IX3

Relationsedit

The tympanic membrane is superiorly related to middle cranial fossa, posteriorly to the ear ossicles and the facial nerve, inferiorly to the parotid gland and anteriorly to the temporomandibular joint

Umboedit

The umbo is the most depressed part of the tympanic membrane The manubrium of the malleus is firmly attached to the medial surface of the membrane as far as its center, which it draws toward the tympanic cavity; the lateral surface of the membrane is thus concave, and the most depressed part of this concavity is named the umbo4

Clinical significanceedit

Ruptureedit

An unintentional perforated eardrum rupture has been described in blast injuries during conflict5 and air travel, usually when the congestion of an upper respiratory infection has prevented equalization of pressure in the middle ear6 It happens in sport and recreation, such as swimming, diving with a poor entry into the water, scuba diving,7 and martial arts8 In the published literature, 80% to 95% have recovered completely without intervention in two to four weeks91011

These injuries, even in a recreational or athletic setting, are blast injuries Many will experience some short-lived hearing loss and ringing in the ear tinnitus but can be reassured that it, in all likelihood, will pass A very few will experience temporary disequilibrium vertigo There may be some bleeding from the ear canal if the eardrum has been ruptured Naturally, the foregoing reassurances become more guarded as the force of injury increases, as in military or combat situations11

Surgical puncture for treatment of middle ear infectionsedit

The pressure of fluid in an infected middle ear onto the eardrum may cause it to rupture Usually this consists of a small hole perforation, which allows fluid to drain out If this does not occur naturally, a myringotomy tympanotomy, tympanostomy can be performed A myringotomy is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear The fluid or pus comes from a middle ear infection otitis media, which is a common problem in children A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid Without the insertion of a tube, the incision usually heals spontaneously in two to three weeks Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure12

Those requiring myringotomy usually have an obstructed or dysfunctional eustachian tube that is unable to perform drainage or ventilation in its usual fashion Before the invention of antibiotics, myringotomy without tube placement was also used as a major treatment of severe acute otitis media12

In some cases the pressure of fluid in an infected middle ear is great enough to cause the eardrum to rupture naturally Usually this consists of a small hole perforation, from which fluid can drain

Society and cultureedit

The Bajau people of the Pacific intentionally rupture their eardrums at an early age to facilitate diving and hunting at sea Many older Bajau therefore have difficulties hearing13

See alsoedit

  • Middle ear
  • Valsalva maneuver to equalize pressure across the eardrum

Additional imagesedit

Referencesedit

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy 1918

  1. ^ Purves, D; Augustine, G; Fitzpatrick, D; Hall, W; LaMantia, A; White, L; et al, eds 2012 Neuroscience Sunderland: Sinauer ISBN 9780878936953 
  2. ^ Marchioni D, Molteni G, Presutti L February 2011 "Endoscopic Anatomy of the Middle Ear" Indian J Otolaryngol Head Neck Surg 63 2: 101–13 PMC 3102170  PMID 22468244 doi:101007/s12070-011-0159-0 
  3. ^ Drake, Richard L, A Wade Vogl, and Adam Mithcell Gray's Anatomy For Students 3rd ed Philadelphia: Churchill Livingstone, 2015 Print pg 969
  4. ^ Gray's Anatomy 1918
  5. ^ Ritenour AE, Wickley A, Retinue JS, Kriete BR, Blackbourne LH, Holcomb JB, Wade CE February 2008 "Tympanic membrane perforation and hearing loss from blast overpressure in Operation Enduring Freedom and Operation Iraqi Freedom wounded" J Trauma 64 2 Suppl: S174–8 doi:101097/ta0b013e318160773e 
  6. ^ Mirza S, Richardson H May 2005 "Otic barotrauma from air travel" J Laryngol Otol 119 5: 366–70 PMID 15949100 doi:101258/0022215053945723 
  7. ^ Green SM; Rothrock SG; Green EA= October 1993 "Tympanometric evaluation of middle ear barotrauma during recreational scuba diving" Int J Sports Med 14 7: 411–5 PMID 8244609 doi:101055/s-2007-1021201 
  8. ^ Fields JD, McKeag DB, Turner JL February 2008 "Traumatic tympanic membrane rupture in a mixed martial arts competition" Current Sports Med Rep 7 1: 10–11 PMID 18296937 doi:101097/01CSMR0000308672531823b 
  9. ^ Kristensen S December 1992 "Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience" J Laryngol Otol 106 12: 1037–50 PMID 1487657 doi:101017/s0022215100121723 
  10. ^ Lindeman P, Edström S, Granström G, Jacobsson S, von Sydow C, Westin T, Aberg B December 1987 "Acute traumatic tympanic membrane perforations Cover or observe" Arch Otolaryngol Head Neck Surg 113 12: 1285–7 PMID 3675893 doi:101001/archotol198701860120031002 
  11. ^ a b Garth RJ July 1995 "Blast injury of the ear: an overview and guide to management" Injury 26 6: 363–6 doi:101016/0020-13839500042-8 
  12. ^ a b Smith N, Greinwald JR 2011 "To tube or not to tube: indications for myringotomy with tube placement" Current Opinion in Otolaryngology & Head and Neck Surgery 19 5: 363–366 PMID 21804383 doi:101097/MOO0b013e3283499fa8 
  13. ^ Langenheim, Johnny 18 September 2010 "The last of the sea nomads" The Guardian Retrieved 15 February 2016 

External linksedit

  • Diagram at Georgia State University
  • drtbalu's otolaryngology online

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