The middle fibrous layer, containing radial, circular, and parabolic fibers, encloses the handle of malleus. Though comparatively robust, the pars tensa is the region more commonly associated with [ vague ] perforations. The manubrium Latin : handle of the malleus is firmly attached to the medial surface of the membrane as far as its center, drawing it toward the tympanic cavity. The lateral surface of the membrane is thus concave. The most depressed aspect of this concavity is termed the umbo Latin : shield boss.
Sensory innervation of the external surface of the tympanic membrane is supplied mainly by the auriculotemporal nerve , a branch of the mandibular nerve cranial nerve V 3 , with contributions from the auricular branch of the vagus nerve cranial nerve X , the facial nerve cranial nerve VII , and possibly the glossopharyngeal nerve cranial nerve IX. The inner surface of the tympanic membrane is innervated by the glossopharyngeal nerve.
When the eardrum is illuminated during a medical examination , a cone of light radiates from the tip of the malleus to the periphery in the anteroinferior quadrant. Unintentional perforation rupture has been described in blast injuries  and air travel , typically in patients experiencing upper respiratory congestion that prevents equalization of pressure in the middle ear. Patients suffering from tympanic membrane rupture may experience bleeding, tinnitus , hearing loss , or disequilibrium vertigo.
However, they rarely require medical intervention, as between 80 and 95 percent of ruptures recover completely within two to four weeks. 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.
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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 procedure. 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 media.
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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. 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 hearing.
The right membrana tympani with the hammer and the chorda tympani, viewed from within, from behind, and from above. Chain of ossicles and their ligaments, seen from the front in a vertical, transverse section of the tympanum. A subtotal perforation of the right tympanic membrane resulting from a previous severe otitis media. From Wikipedia, the free encyclopedia. For other uses, see Eardrum disambiguation.
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Outer ear. Pinna Tragus. Middle ear. Tympanic membrane Ossicles Malleus Incus Stapes. Inner ear. Vestibules Utricle Saccule Cochlea Semicircular canals. Anatomy of the human ear. Brown is outer ear. Red is middle ear.
Otolaryngology Resources: Anatomy and Image Resources
Purple is inner ear. The oval perforation in this left tympanic membrane was the result of a slap on the ear. Sunderland: Sinauer. Pars tensa and tympanicomalleal joint: proposal for a new anatomic classification. European Archives of Oto-rhino-laryngology. Comprehensive and Clinical Anatomy of the Middle Ear. Wade Vogl, and Adam Mithcell. On the promontory it coalesces with sympathetic fibres from the carotid chain forming the tympanic plexus which has individual variability.
Functionally, as well as giving off parasympathetic fibres to the parotid gland via the lesser petrosal nerve, it is a useful anatomical landmark for cochlear implantation. The surgical importance of the tympanic nerve is not only restricted to middle ear surgery; it also extends to salivary gland disorders. The tympanic nerve remains clinically relevant to the modern otolaryngologist and as such a detailed understanding of its anatomy is crucial. Core tip: The tympanic nerve is the first branch arising from the inferior ganglion of the glossopharyngeal nerve.
Despite its modest size it has a multitude of functions which are not only limited to the middle ear. In this review we detail the clinical anatomy of the tympanic nerve and its surgical applications in Otolaryngology as they have evolved over the years.
We also provide a brief summary of the life and achievements of the indefatigable Ludwig Levin Jacobson, an anatomist and military surgeon, who is credited with the discovery of the tympanic nerve. This review describes the present evidence outlining the anatomy, function and surgical significance of the tympanic nerve.
The tympanic nerve arises from the inferior ganglion of the glossopharyngeal nerve traversing through the tympanic canaliculus into the middle ear. On the promontory it coalesces with sympathetic fibres from the carotid chain forming the tympanic plexus. Functionally, it provides somatic fibres to the middle ear as well as parasympathetic fibres to the parotid gland via the lesser petrosal nerve.
We have summarised the anatomy from its origin and traced its course through the relevant anatomical segments namely extra tympanic; hypotympanic; and intratympanic. We also elucidate its role in middle ear innervation and secretomotor supply to the parotid. The surgical relevance of the tympanic nerve and the relevant pathological processes are also covered in detail.
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Further, we have detailed, a historical perspective on the intriguing life of Ludwig Levin Jacobson who is credited with the discovery of the tympanic nerve. Results were limited to articles published in English. The abstracts were reviewed and most relevant selected for inclusion.
Citation links were hand searched to identify further articles of relevance.
Clinical Anatomy and Physiology of the Auditory and Vestibular Systems.
Ludwig Levin Jacobson was born in Copenhagen on 10 th January to a family of jewellers[ 1 ]. After attending a German school in Stockholm he returned to surgical training in Copenhagen[ 1 , 2 ]. His interests included human anatomy, zoology, chemistry and teaching.
He is credited with various anatomical discoveries in animals and most importantly in humans[ 1 , 2 ]. As early as he discovered a previously undetected vomeronasal organ found in the nasal cavities of mammals only fully understood over a hundred years after his death[ 2 ]. In he would first describe the tympanic nerve outlining its anatomical relations and physiological function[ 1 , 2 ].
The tympanic nerve is the first branch arising from the inferior ganglion petrous ganglion of the glossopharyngeal nerve as it exits the jugular foramen[ 3 - 5 ] Figure 1. Anatomical variations of its origin are rarely reported. Historically Arnold, cited by Donaldson, noted that the tympanic nerve may occasionally arise at a higher point than the inferior ganglion of the glossopharyngeal nerve and Cuvellier, also cited by Donaldson, suggested that it could arise from contributions from both cranial nerves IX and X[ 6 ].
These findings have not been supported by more recent studies. The anatomical study of the tympanic nerve by Tekdemir et al[ 7 ] using ninety-six cadaveric temporal bones states that it arises from the inferior ganglion which is located at a mean distance of It invariably angulates at 90 degrees inferior to the genu en route to the tympanic canaliculus[ 7 ]. The tympanic nerve and the inferior tympanic artery enter the inferior tympanic canaliculus, a bony septum that lies between the internal carotid foramen medially and the internal jugular foramen laterally[ 8 ] Figure 2.
The tympanic canaliculus is located medial to the styloid process and the stylomastoid foramen[ 9 ]. In the tympanic canaliculus, the tympanic nerve traverses superiorly on the medial wall of the middle ear onto the cochlea promontory[ 6 ]. The mean length of the tympanic canaliculus is 9. An aberrant course of the tympanic nerve where it coursed anteromedially within the bony septum before entering the middle ear anteriorly accompanied by the sympathetic branch from the internal carotid sympathetic plexus was reported in one of the specimens in the same study[ 6 ].
Another unusual finding was a unilateral duplication of the tympanic nerve[ 6 ]. The tympanic nerve emerges on the promontory of the middle ear, on its medial wall and anterior to the round window[ 3 ]. It exits through the internal aperture of the tympanic canaliculus which lies anterior to the inferior half of the round window[ 7 ].
The nerve divides on the promontory forming an anterior branch which courses up towards the Eustachian tube and a posterior branch that skirts the rim of the round window[ 11 , 12 ].