Chapter 237

This chapter discusses common nontraumatic conditions affecting the external, middle, and inner ear. Selected traumatic conditions include auricular hematoma, burns, and frostbite. Management of lacerations to the ear is described in detail in Chapter 46, Lacerations to the Face and Scalp. Removal of foreign bodies in the ear is discussed in detail in Chapter 143A, Pediatric Procedures: Nasal and Otic Foreign Bodies in the Pediatrics section. Barotrauma to the middle ear, also called barotitis media, is discussed in Chapter 208, Dysbarism and Complications of Diving.

### External Ear

The auricle, or pinna, is the visible external portion of the ear, whose trumpet shape enables it to collect air vibrations. It consists of a thin plate of elastic cartilage with a tightly adherent covering of skin. The external auditory canal is an S-shaped skin-lined tube that extends from the auricle to the tympanic membrane (TM). The outer one third of the external auditory canal is composed of an incomplete cartilaginous tube. Its thick skin supports hair follicles plus apocrine and sebaceous glands. The inner two thirds of the canal is composed of bone covered by a thin layer of tightly adherent skin, which is easily torn by minimal trauma.

The blood supply to the external ear is derived from the posterior auricular, superficial temporal, and deep auricular arteries. Venous drainage of the external ear is into the superficial temporal and posterior auricular veins, which then drain into the external jugular vein. The posterior auricular vein frequently connects to the sigmoid sinus, providing a route for extension of infected material into the intracranial cavity.

### Middle Ear

The middle ear is an air-containing cavity in the petrous temporal bone. It contains the auditory ossicles, which transmit vibrations of the TM to the perilymph of the internal ear. It communicates with the nasopharynx anteriorly via the eustachian tube and with the mastoid air spaces posteriorly via the aditus ad antrum (Figure 237-1).

###### Figure 237-1.

Sagittal section of the middle ear and related structures.

The TM is a thin, pearly gray, fibrous membrane, that produces a cone-shaped light reflex anteroinferiorly when illuminated. Superiorly, the pars flaccida is the relatively slack portion of the membrane between the malleolar folds; the remainder of the membrane is tense and is called the pars tensa. The auditory ossicles are the malleus, incus, and stapes. Both the incus and the handle and lateral processes of the malleus are typically visible through the TM (Figure 237-2). Figure 237-1 shows the relationships of the facial nerve, sigmoid sinus, and internal carotid artery to the middle ear.

###### Figure 237-2.

Right tympanic membrane as seen through the otoscope.

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