1d. 2. The Middle Ear or Tympanic Cavity

(Cavum Tympani; Drum; Tympanum)

The middle ear or tympanic cavity is an irregular, laterally compressed space within the temporal bone. It is filled with air, which is conveyed to it from the nasal part of the pharynx through the auditory tube. It contains a chain of movable bones, which connect its lateral to its medial wall, and serve to convey the vibrations communicated to the tympanic membrane across the cavity to the internal ear. 1 The tympanic cavity consists of two parts: the tympanic cavity proper, opposite the tympanic membrane, and the attic or epitympanic recess, above the level of the membrane; the latter contains the upper half of the malleus and the greater part of the incus. Including the attic, the vertical and antero-posterior diameters of the cavity are each about 15 mm. The transverse diameter measures about 6 mm. above and 4 mm. below; opposite the center of the tympanic membrane it is only about 2 mm. The tympanic cavity is bounded laterally by the tympanic membrane; medially, by the lateral wall of the internal ear; it communicates, behind, with the tympanic antrum and through it with the mastoid air cells, and in front with the auditory tube (Fig. 907). 2 The Tegmental Wall or Roof (paries tegmentalis) is formed by a thin plate of bone, the tegmen tympani, which separates the cranial and tympanic cavities. It is situated on the anterior surface of the petrous portion of the temporal bone close to its angle of junction with the squama temporalis; it is prolonged backward so as to roof in the tympanic antrum, and forward to cover in the semicanal for the Tensor tympani muscle. Its lateral edge corresponds with the remains of the petrosquamous suture. 3 The Jugular Wall or Floor (paries jugularis) is narrow, and consists of a thin plate of bone (fundus tympani) which separates the tympanic cavity from the jugular fossa. It presents, near the labyrinthic wall, a small aperture for the passage of the tympanic branch of the glossopharyngeal nerve. 4

FIG. 909– Right tympanic membrane as seen through a speculum. (See enlarged image) The Membranous or Lateral Wall (paries membranacea; outer wall) is formed mainly by the tympanic membrane, partly by the ring of bone into which this membrane is inserted. This ring of bone is incomplete at its upper part, forming a notch (notch of Rivinus), close to which are three small apertures: the iter chordæ posterius, the petrotympanic fissure, and the iter chordæ anterius. 5 The iter chordæ posterius (apertura tympanica canaliculi chordæ) is situated in the angle of junction between the mastoid and membranous wall of the tympanic cavity immediately behind the tympanic membrane and on a level with the upper end of the manubrium of the malleus; it leads into a minute canal, which descends in front of the canal for the facial nerve, and ends in that canal near the stylo-mastoid foramen. Through it the chorda tympani nerve enters the tympanic cavity. 6 The petrotympanic fissure (fissura petrotympanica; Glaserian fissure) opens just above and in front of the ring of bone into which the tympanic membrane is inserted; in this situation it is a mere slit about 2 mm. in length. It lodges the anterior process and anterior ligament of the malleus, and gives passage to the anterior tympanic branch of the internal maxillary artery. 7 The iter chordæ anterius (canal of Huguier) is placed at the medial end of the petrotympanic fissure; through it the chorda tympani nerve leaves the tympanic cavity. 8 The Tympanic Membrane (membrana tympani) (Figs. 909, 910) separates the tympanic cavity from the bottom of the external acoustic meatus. It is a thin, semitransparent membrane, nearly oval in form, somewhat broader above than below, and directed very obliquely downward and inward so as to form an angle of about fifty-five degrees with the floor of the meatus. Its longest diameter is downward and forward, and measures from 9 to 10 mm.; its shortest diameter measures from 8 to 9 mm. The greater part of its circumference is thickened, and forms a fibrocartilaginous ring which is fixed in the tympanic sulcus at the inner end of the meatus. This sulcus is deficient superiorly at the notch of Rivinus, and from the ends of this notch two bands, the anterior and posterior malleolar folds, are prolonged to the lateral process of the malleus. The small, somewhat triangular part of the membrane situated above these folds is lax and thin, and is named the pars flaccida; in it a small orifice is sometimes seen. 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 umbo. 9

FIG. 910– The tympanic membrane viewed from within. (Testut.) The malleus has been resected immediately beyond its lateral process, in order to show the tympanomalleolar folds and the membrana flaccida. 1. Tympanic membrane. 2. Umbo. 3. Handle of the malleus. 4. Lateral process. 5. Anterior tympanomalleolar fold. 6. Posterior tympanomalleolar fold. 7. Pars flaccida. 8. Anterior pouch of Tröltsch. 9. Posterior pouch of Tröltsch. 10. Fibrocartilaginous ring. 11. Petrotympanic fissure. 12. Auditory tube. 13. Iter chordæ posterius. 14. Iter chordæ anterius. 15. Fossa incudis for short crus of the incus. 16. Prominentia styloidea. (See enlarged image)

FIG. 911– View of the inner wall of the tympanum (enlarged.) (See enlarged image) Structure.—The tympanic membrane is composed of three strata: a lateral (cutaneous), an intermediate (fibrous), and a medial (mucous). The cutaneous stratum is derived from the integument lining the meatus. The fibrous stratum consists of two layers: a radiate stratum, the fibers of which diverge from the manubrium of the malleus, and a circular stratum, the fibers of which are plentiful around the circumference but sparse and scattered near the center of the membrane. Branched or dendritic fibers, as pointed out by Grüber, are also present especially in the posterior half of the membrane. 10

Vessels and Nerves.—The arteries of the tympanic membrane are derived from the deep auricular branch of the internal maxillary, which ramifies beneath the cutaneous stratum; and from the stylomastoid branch of the posterior auricular, and tympanic branch of the internal maxillary, which are distributed on the mucous surface. The superficial veins open into the external jugular; those on the deep surface drain partly into the transverse sinus and veins of the dura mater, and partly into a plexus on the auditory tube. The membrane receives its chief nerve supply from the auriculotemporal branch of the mandibular; the auricular branch of the vagus, and the tympanic branch of the glossopharyngeal also supply it. 150 11

FIG. 912– The right membrana tympani with the hammer and the chorda tympani, viewed from within, from behind, and from above. (Spalteholz.) (See enlarged image) The Labyrinthic or Medial Wall (paries labyrinthica; inner wall) (Fig. 913) is vertical in direction, and presents for examination the fenestræ vestibuli and cochleæ, the promontory, and the prominence of the facial canal. 12 The fenestra vestibuli (fenestra ovalis) is a reniform opening leading from the tympanic cavity into the vestibule of the internal ear; its long diameter is horizontal, and its convex border is upward. In the recent state it is occupied by the base of the stapes, the circumference of which is fixed by the annular ligament to the margin of the foramen. 13 The fenestra cochleæ (fenestra rotunda) is situated below and a little behind the fenestra vestibuli, from which it is separated by a rounded elevation, the promontory. It is placed at the bottom of a funnel-shaped depression and, in the macerated bone, leads into the cochlea of the internal ear; in the fresh state it is closed by a membrane, the secondary tympanic membrane, which is concave toward the tympanic cavity, convex toward the cochlea. This membrane consists of three layers: an external, or mucous, derived from the mucous lining of the tympanic cavity; an internal, from the lining membrane of the cochlea; and an intermediate, or fibrous layer. 14

FIG. 913– Coronal section of right temporal bone. (See enlarged image)

FIG. 914– The medial wall and part of the posterior and anterior walls of the right tympanic cavity, lateral view. (Spalteholz.) (See enlarged image) The promontory (promontorium) is a rounded hollow prominence, formed by the projection outward of the first turn of the cochlea; it is placed between the fenestræ, and is furrowed on its surface by small grooves, for the lodgement of branches of the tympanic plexus. A minute spicule of bone frequently connects the promontory to the pyramidal eminence. 15 The prominence of the facial canal (prominentia canalis facialis; prominence of aqueduct of Fallopius) indicates the position of the bony canal in which the facial nerve is contained; this canal traverses the labyrinthic wall of the tympanic cavity above the fenestra vestibuli, and behind that opening curves nearly vertically downward along the mastoid wall. 16 The mastoid or posterior wall (paries mastoidea) is wider above than below, and presents for examination the entrance to the tympanic antrum, the pyramidal eminence, and the fossa incudis. 17 The entrance to the antrum is a large irregular aperture, which leads backward from the epitympanic recess into a considerable air space, named the tympanic or mastoid antrum (see page 142). The antrum communicates behind and below with the mastoid air cells, which vary considerably in number, size, and form; the antrum and mastoid air cells are lined by mucous membrane, continuous with that lining the tympanic cavity. On the medial wall of the entrance to the antrum is a rounded eminence, situated above and behind the prominence of the facial canal; it corresponds with the position of the ampullated ends of the superior and lateral semicircular canals. 18 The pyramidal eminence (eminentia pyramidalis; pyramid) is situated immediately behind the fenestra vestibuli, and in front of the vertical portion of the facial canal; it is hollow, and contains the Stapedius muscle; its summit projects forward toward the fenestra vestibuli, and is pierced by a small aperture which transmits the tendon of the muscle. The cavity in the pyramidal eminence is prolonged downward and backward in front of the facial canal, and communicates with it by a minute aperture which transmits a twig from the facial nerve to the Stapedius muscle. 19 The fossa incudis is a small depression in the lower and back part of the epitympanic recess; it lodges the short crus of the incus. 20 The Carotid or Anterior Wall (paries carotica) is wider above than below; it corresponds with the carotid canal, from which it is separated by a thin plate of bone perforated by the tympanic branch of the internal carotid artery, and by the deep petrosal nerve which connects the sympathetic plexus on the internal carotid artery with the tympanic plexus on the promontory. At the upper part of the anterior wall are the orifice of the semicanal for the Tensor tympani muscle and the tympanic orifice of the auditory tube, separated from each other by a thin horizontal plate of bone, the septum canalis musculotubarii. These canals run from the tympanic cavity forward and downward to the retiring angle between the squama and the petrous portion of the temporal bone. 21 The semicanal for the Tensor tympani (semicanalis m. tensoris tympani) is the superior and the smaller of the two; it is cylindrical and lies beneath the tegmen tympani. It extends on to the labyrinthic wall of the tympanic cavity and ends immediately above the fenestra vestibuli. 22 The septum canalis musculotubarii (processus cochleariformis) passes backward below this semicanal, forming its lateral wall and floor; it expands above the anterior end of the fenestra vestibuli and terminates there by curving laterally so as to form a pulley over which the tendon of the muscle passes. 23 The auditory tube (tuba auditiva; Eustachian tube) is the channel through which the tympanic cavity communicates with the nasal part of the pharynx. Its length is about 36 mm., and its direction is downward, forward, and medialward, forming an angle of about 45 degrees with the sagittal plane and one of from 30 to 40 degrees with the horizontal plane. It is formed partly of bone, partly of cartilage and fibrous tissue (Figs. 819, 915). 24 The osseous portion (pars osseo tubæ auditivæ) is about 12 mm. in length. It begins in the carotid wall of the tympanic cavity, below the septum canalis musculotubarii, and, gradually narrowing, ends at the angle of junction of the squama and the petrous portion of the temporal bone, its extremity presenting a jagged margin which serves for the attachment of the cartilaginous portion. 25

FIG. 915– Auditory tube, laid open by a cut in its long axis. (Testut.) (See enlarged image) The cartilaginous portion (pars cartilaginea tubæ auditivæ), about 24 mm. in length, is formed of a triangular plate of elastic fibrocartilage, the apex of which is attached to the margin of the medial end of the osseous portion of the tube, while its base lies directly under the mucous membrane of the nasal part of the pharynx, where it forms an elevation, the torus tubarius or cushion, behind the pharyngeal orifice of the tube. The upper edge of the cartilage is curled upon itself, being bent laterally so as to present on transverse section the appearance of a hook; a groove or furrow is thus produced, which is open below and laterally, and this part of the canal is completed by fibrous membrane. The cartilage lies in a groove between the petrous part of the temporal and the great wing of the sphenoid; this groove ends opposite the middle of the medial pterygoid plate. The cartilaginous and bony portions of the tube are not in the same plane, the former inclining downward a little more than the latter. The diameter of the tube is not uniform throughout, being greatest at the pharyngeal orifice, least at the junction of the bony and cartilaginous portions, and again increased toward the tympanic cavity; the narrowest part of the tube is termed the isthmus. The position and relations of the pharyngeal orifice are described with the nasal part of the pharynx. The mucous membrane of the tube is continuous in front with that of the nasal part of the pharynx, and behind with that of the tympanic cavity; it is covered with ciliated epithelium and is thin in the osseous portion, while in the cartilaginous portion it contains many mucous glands and near the pharyngeal orifice a considerable amount of adenoid tissue, which has been named by Gerlach the tube tonsil. The tube is opened during deglutition by the Salpingopharyngeus and Dilatator tubæ. The latter arises from the hook of the cartilage and from the membranous part of the tube, and blends below with the Tensor veli palatini. 26

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