Anatomy of the Ear

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Questions and Answers

Which of the following structures is NOT located within the external ear?

  • Helix
  • Semicircular canals (correct)
  • Tragus
  • Concha

Where does the Auriculotemporal nerve provide cutaneous innervation?

  • Anterior aspect of the auricle (correct)
  • Upper cranial medial surface
  • Lobule of the auricle
  • Posterior part of the auricle

Which cranial nerve provides motor innervation to the extrinsic muscles of the ear?

  • CN X (Vagus)
  • CN VII (Facial) (correct)
  • CN VIII (Vestibulocochlear)
  • CN V (Trigeminal)

Which artery is NOT a primary source of arterial blood supply to the auricle?

<p>Middle meningeal artery (C)</p> Signup and view all the answers

Which of the following correctly describes the lymphatic drainage pattern of the auricle?

<p>The lateral surface of the superior half drains into the superficial parotid lymph nodes. (C)</p> Signup and view all the answers

A patient presents with a cauliflower ear. Which of the following is the MOST likely cause?

<p>Trauma leading to hematoma formation (D)</p> Signup and view all the answers

Which of the following structures is NOT found within the external acoustic meatus?

<p>The malleus (A)</p> Signup and view all the answers

What is the approximate length of the external acoustic meatus in adults?

<p>2-3 cm (D)</p> Signup and view all the answers

Which of the layers makes up the tympanic membrane?

<p>Skin (externally), fibrous (intermediate), and mucous membrane (internally) (C)</p> Signup and view all the answers

Which statement accurately describes the Pars flaccida

<p>The pars flaccida is a thin membrane lacking radial and circular fibers found near the lateral edge of the tympanic cavity (D)</p> Signup and view all the answers

Which nerve supplies sensory innervation to the external surface of the tympanic membrane?

<p>Auriculotemporal nerve (CN V3) (B)</p> Signup and view all the answers

Branches from which artery supply the external acoustic meatus and tympanic membrane?

<p>Maxillary artery (D)</p> Signup and view all the answers

Which nerve innervates the internal surface of the tympanic membrane?

<p>Glossopharyngeal nerve (CN IX) (B)</p> Signup and view all the answers

Which of the following structures is NOT located within the middle ear?

<p>Cochlea (C)</p> Signup and view all the answers

Which best describes the tympanic cavity proper?

<p>The space directly internal to the tympanic membrane lined with a mucous membrane (D)</p> Signup and view all the answers

What fluid type fills the tympanic cavity?

<p>Air (A)</p> Signup and view all the answers

Which of the following is the correct order of the auditory ossicles from the tympanic membrane to the oval window?

<p>Malleus, Incus, Stapes (D)</p> Signup and view all the answers

Which of the following structures is directly attached to the tympanic membrane?

<p>Malleus (B)</p> Signup and view all the answers

What lines the tympanic cavity instead of the periosteal layer

<p>Mucous Membrane (B)</p> Signup and view all the answers

Which of the following muscles is responsible for dampening down the vibrations of the malleus by tension of the tympanic membrane during loud noises?

<p>Tensor tympani (B)</p> Signup and view all the answers

Which cranial nerve innervates the tensor tympani muscle?

<p>CN V3 (Mandibular branch of Trigeminal) (C)</p> Signup and view all the answers

Which of the following is the primary function of the pharyngotympanic tube?

<p>Equalizing pressure in the middle ear (B)</p> Signup and view all the answers

The pharyngotympanic tube is composed of:

<p>Bony and cartilaginous parts (A)</p> Signup and view all the answers

Contraction of which muscles opens the pharyngotympanic tube?

<p>Tensor veli palatini and levator veli palatini (C)</p> Signup and view all the answers

If a patient has excessive acuteness of hearing (hyperacusis), which of the following muscles is MOST likely paralyzed?

<p>Stapedius (A)</p> Signup and view all the answers

Through which structure does the tympanic cavity connect to the mastoid cells?

<p>Aditus (C)</p> Signup and view all the answers

Damage to the chorda tympani nerve within the middle ear can result in:

<p>Altered taste sensation (A)</p> Signup and view all the answers

If the tegmental wall is damaged what structure could be at risk?

<p>Cranial Fossa (B)</p> Signup and view all the answers

A patient is diagnosed with mastoiditis. Which of the following is the MOST likely route of infection?

<p>Spread of infection from the middle ear (B)</p> Signup and view all the answers

The jugular wall of the tympanic cavity separates what structure?

<p>Jugular Bulb (B)</p> Signup and view all the answers

Which of the following structures is MOST at risk during surgery or invasive disease of the anterior (carotid) wall of the tympanic cavity?

<p>Internal carotid artery (A)</p> Signup and view all the answers

Which nerve provides sensory innervation to the middle ear?

<p>Glossopharyngeal nerve (CN IX) (A)</p> Signup and view all the answers

Where does the pharyngotympanic not receive fibers from?

<p>Geniculate Ganglion (D)</p> Signup and view all the answers

The ascending pharyngeal artery gives blood supply to which of the following?

<p>The pharyngotympanic tube (D)</p> Signup and view all the answers

Where does the lymphatic system drain into from the pharyngotympanic tube?

<p>Retropharyngeal Nodes (B)</p> Signup and view all the answers

What are the two main parts of the inner ear?

<p>Bony Labyrinth and Membranous Labyrinth (A)</p> Signup and view all the answers

Which best describes what fluid type are the sacs and ducts within the bony labirynth?

<p>Endolymph (A)</p> Signup and view all the answers

Damage to the peripheral auditory system can result in which of the following?

<p>Hearing loss, vertigo, or tinnitus (C)</p> Signup and view all the answers

Which best describes the Scala tympani?

<p>The segment that leads to the round window to dissipate pressure waves (A)</p> Signup and view all the answers

Through which structure do the CN VII, CN VIII, and the labyrinthine artery transit?

<p>Internal acoustic meatus (B)</p> Signup and view all the answers

Which of the following is the MOST appropriate course of action if a patient develops lateral sinus thrombophlebitis in the temporal bone?

<p>All of the above (D)</p> Signup and view all the answers

Which nerve provides sensory innervation to the anterior aspect of the lateral surface of the auricle, including the rim of the concha and tragus?

<p>Auriculotemporal nerve (V3) (D)</p> Signup and view all the answers

Which of the following muscles is innervated by the temporal branch of CN VII?

<p>Auricularis anterior (A)</p> Signup and view all the answers

Through which structure does the chorda tympani nerve traverse the middle ear?

<p>Between the malleus and incus (C)</p> Signup and view all the answers

Which of the following structures supplies blood to the pharyngotympanic tube?

<p>Middle meningeal artery (B)</p> Signup and view all the answers

Which of the following muscles contracts to open the pharyngotympanic tube?

<p>Tensor veli palatini (D)</p> Signup and view all the answers

A patient presents with sensorineural hearing loss and vertigo after a chronic middle ear infection. Which of the following structures is MOST likely affected?

<p>Labyrinth (B)</p> Signup and view all the answers

A surgeon is performing a myringotomy and notes the chorda tympani’s path. Damage to which structure causes altered taste sensation (loss of sweet and salty) on the anterior two-thirds of the tongue?

<p>Facial nerve (CN VII) (A)</p> Signup and view all the answers

Following a severe blow to the head, a patient experiences a conductive hearing loss that is localized to the middle ear. Which of the following is the MOST likely cause?

<p>A perforated tympanic membrane (B)</p> Signup and view all the answers

A patient is diagnosed with mastoiditis. Which of the following pathways is MOST likely involved in the spread of infection from the middle ear?

<p>Aditus to mastoid antrum (A)</p> Signup and view all the answers

In a rare and complex case, a patient’s imaging reveals that an infection has eroded through the tegmen tympani, potentially leading to severe complications. Which anatomical space is now at immediate risk of being directly compromised?

<p>Cranial cavity (C)</p> Signup and view all the answers

Which of the following is the MOST accurate description of the auricle's composition?

<p>Elastic cartilage covered by dense connective tissue and thin skin. (B)</p> Signup and view all the answers

Which anatomical structure of the auricle is correctly paired with its location?

<p>Antitragus: Located at the base of the antihelix. (B)</p> Signup and view all the answers

The lobule of the auricle is characterized by which of the following?

<p>Consists of fibrous tissue, fat, and blood vessels. (A)</p> Signup and view all the answers

Which of the following describes the function of cerumen?

<p>Preventing moisture from macerating the epithelium. (B)</p> Signup and view all the answers

What is the primary characteristic of the bony part of the external acoustic meatus?

<p>Lined with thin skin, few hair, and glands. (C)</p> Signup and view all the answers

What is the clinical significance of the pars flaccida?

<p>It forms the lateral wall of the superior recess of the tympanic cavity. (C)</p> Signup and view all the answers

Which nerve provides sensory innervation to the internal surface of the tympanic membrane?

<p>Glossopharyngeal nerve (CN IX). (D)</p> Signup and view all the answers

The roof of the tympanic cavity is formed by which structure?

<p>Tegmental wall (tegmen tympani). (B)</p> Signup and view all the answers

What is the function of the pharyngotympanic tube?

<p>Balances air pressure on both sides of the tympanic membrane. (C)</p> Signup and view all the answers

Which of the following muscles is NOT involved in opening the pharyngotympanic tube during swallowing?

<p>Tensor tympani. (D)</p> Signup and view all the answers

The medial wall of the tympanic cavity contains which of the following structures?

<p>Fenestra vestibuli (oval window). (D)</p> Signup and view all the answers

Which artery is NOT a primary source of arterial blood supply to the middle ear?

<p>Occipital artery. (C)</p> Signup and view all the answers

The stapedius muscle has which primary function?

<p>Stabilizing the stapes and reducing its range of oscillation. (D)</p> Signup and view all the answers

Which nerve innervates the stapedius muscle?

<p>Facial nerve (CN VII). (D)</p> Signup and view all the answers

Unlike other bones of the body, the auditory ossicles lack periosteum, and are instead covered by:

<p>Mucous membrane. (D)</p> Signup and view all the answers

Through with structure does the tympanic cavity connect to the mastoid air cells?

<p>Aditus ad antrum (A)</p> Signup and view all the answers

What would be the MOST likely result of untreated otitis media?

<p>Impaired movement of auditory ossicles. (D)</p> Signup and view all the answers

A patient exhibits conductive hearing loss and is diagnosed with a middle ear effusion. Dysfunction of which structure is MOST likely the underlying cause?

<p>Pharyngotympanic tube. (C)</p> Signup and view all the answers

A surgeon mistakenly severs the chorda tympani nerve during a middle ear procedure. Which of the following deficits would be MOST likely to occur?

<p>Diminished taste sensation on the anterior two-thirds of the tongue. (A)</p> Signup and view all the answers

A patient presents with sensorineural hearing loss. Imaging reveals damage within the bony labyrinth of the inner ear that spares the cochlea. Which specific anatomical structure within the bony labyrinth is MOST likely affected, leading to this patient's symptoms?

<p>The vestibule. (D)</p> Signup and view all the answers

Flashcards

External Ear

The outermost part of the ear, collecting sound waves.

Auricle

Also known as the pinna, composed of elastic cartilage covered by thin skin.

External Acoustic Meatus

Lined with hairs and sebaceous glands, providing protection.

Extrinsic Muscles of the Ear

Developed from the 2nd pharyngeal arch; motor innervation is through CN VII.

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External Surface of Tympanic Membrane

Supplied by the auriculotemporal nerve, a branch of CN V3.

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Internal Surface of Tympanic Membrane

Supplied by the glossopharyngeal nerve (CN IX).

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Blood Supply to Tympanic Membrane

Branches from the maxillary artery supply this area.

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Lymphatic Drainage of Auricle

Drains into the mastoid and deep cervical nodes.

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Components of Middle Ear

Tympanic cavity proper & Epitympanic recess.

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Auditory Ossicles

Malleus, Incus, and Stapes.

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Pharyngotympanic Tube

Connects the tympanic cavity to the nasopharynx, equalizing pressure.

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Tensor Tympani Muscle

From cartilage of auditory tube & bony wall. Nerve: Medial Pterygoid (CN V3)

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Stapedius Muscle

Origin: Internal pyramid; Insertion: Neck of stapes; Nerve: CN VII.

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Tegmen Tympani

A thin plate separating cavity from middle cranial fossa.

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Medial Wall Injury Risk

This wall has risk of inner ear or nerve damage.

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Posterior Wall Risk

The facial nerve runs behind it, and infection may paralyze.

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Components of the Pharyngotympanic Tube

Boney (Posterolateral 1/3) & cartilaginous (2/3).

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Inner Ear

The organ for Equilibrium and hearing.

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Bony Labyrinth Components

These are Cochlea, Vestibule & semicircular canals.

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Membranous Labyrinth Components

Vestibular (equilibrium): Utricle, Saccule, Semicircular ducts;

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Peripheral Auditory System Injuries

Injuries leads to 1) hearing loss, 2) vertigo, or 3) tinnitus.

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Vestibulocochlear Nerve

CN VIII has two parts: the cochlear nerve (hearing) and the vestibular nerve (balance).

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Internal acoustic meatus

Transmits CN VII, CN VIII, and labyrinthine artery

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Anatomy: External ear

A collecting organ that receives sound waves.

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Anatomy: Helix

The large posterior free margin of the auricle.

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Anatomy: Tragus

Anterior prominence anterior to the concha that surrounds the external acoustic meatus.

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Anatomy: Concha

A deep cavity in front of the antihelix.

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Anatomy: Lobule

Consists of fibrous tissue, fat, and blood vessels, no cartilage.

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External Acoustic Meatus function

Conducts sound to the tympanic membrane.

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Ceruminous glands

Modified apocrine sweat glands lining the external third of the meatus, producing ear wax.

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Tympanic Membrane Function

Divides the external acoustic meatus with the tympanic cavity of the middle ear.

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Anatomy: Umbo

A cone-like central depression of the TM; bright reflection of light.

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Anatomy: Pars flaccida

The small triangular portion between the malleolar folds.

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Auditory (Eustachian) tube

Connects tympanic cavity to the nasopharynx.

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Anatomy: Auditory ossicles

Three mobile bones that extend from the TM to the oval window.

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Malleus Function

Attaches to the tympanic membrane and functions as a lever.

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Stapedius muscle function

Stabilizes stapes and reduces the range of oscillation.

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Internal ear function

Vibrations are transduced to specific nerve impulses.

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Study Notes

The Ear

  • The external ear collects sound waves.

External Ear

  • The auricle, also known as the pinna, is composed of elastic cartilage covered by dense, irregular connective tissue
  • The Auricle's thin skin includes hair, exocrine glands, and sebaceous glands
  • The tragus is an anterior prominence that surrounds the entrance to the external acoustic meatus
  • The concha is its deepest depression

External Ear Sensory Innervation

  • Auriculotemporal nerve (V3), supplies skin of the anterior aspect of the auricle's lateral surface including the rim of the concha, crus of the helix, and tragus
  • The auricular branch of the Vagus nerve (CN X) supplies the skin of the concha
  • The Vagus nerve (CN X) and facial nerve (CN VII) supplies a minor contribution to the skin of the concha and its eminence

Lymphatic Drainage of the Auricle

  • Superficial parotid drains the lateral surface of the superior half of the auricle
  • Mastoid (retroauricular) & Deep cervical drains the medial surface of the superior half of the auricle
  • Superficial cervical drains the remainder of the auricle, including the lobule

External Acoustic (Auditory) Meatus

  • Ceruminous glands (modified apocrine sweat glands) and sebaceous glands produce cerumen ("ear wax"), which helps prevent moisture trapped in the canal from macerating the epithelium

The Tympanic Membrane (Eardrum)

  • The external surface of the tympanic membrane is supplied by the auriculotemporal nerve (from CN V3), with a small contribution from the auricular branch of the vagus nerve (CN X)
  • The internal surface of the tympanic membrane is supplied by the glossopharyngeal nerve (CN IX)

Ear Infections

  • Acute Otitis Externa:
    • Is the inflammation of the external acoustic meatus
    • Characterized by itching and pain in the external ear which increases when the auricle is pulled or pressure is applied to the tragus
    • Common in people that do not dry their meatus well, but it can also be due to a bacterial infection
  • Otitis Media:
    • Presents with an earache and red tympanic membrane (pus or fluid buildup)
    • Often secondary to upper respiratory infections
    • The Pharyngotympanic tube may be partially or completely blocked disrupting drainage
    • Symptoms: ear popping
    • May produce impaired hearing if untreated

Boundaries of the Tympanic Cavity

  • In the superior part of the posterior (mastoid) wall is an opening that connects the tympanic cavity to the mastoid cells (aditus to the mastoid antrum)
  • The canal for CN VII descends between the posterior wall and the antrum, medial to the aditus

Sensory Innervation to the Middle Ear

  • Tympanic plexus provides inneration via a branch of CN IX (glossopharyngeal nerve) and the caroticotympanic nerves from the internal carotid plexus
  • Pharyngotympanic tube fibers come from the tympanic plexus (CN IX), and from the pterygopalatine ganglion

Blood Supply to the Pharyngotympanic

  • Ascending pharyngeal artery and artery of the pterygoid canal are derived from the external carotid artery

Composition of the Internal Ear

  • Bony labyrinth is composed of cavities within the otic capsule of the petrous part of the temporal bone
    • Cochlea is a shell-shaped bony art
      • the Cochlear duct is concerned with hearing
    • Vestibule is a small oval chamber (~5mm long) which is continuous with the cochlea (anteriorly) and the semicircular canals (posteriorly).
      • features the oval window, and it is composed of the utricle, saccule and balancing apparatus.
    • Semicircular canals (anterior, lateral and posterior) have dilated ends called the ampullae which contain a sensory area called the ampullary crest
      • communicate with the vestibule of the bony labyrinth
  • Membranous labyrinth contains endolymph and perilymph

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