Normal
Eardrum: Two normal eardrums are shown on the
right. Notice the light reflex on the anterior-inferior portion of
the eardrum.
Click
on Pictures to Enlarge
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Tympanosclerosis:
This is a condition where the eardrum has calcium plaques which form as
a result of old infections. It is of no significance unless the plaques
bind the
malleus
(the ear bone which attaches to the eardrum) with the ear canal, thus
preventing the drum from vibrating. The picture on the far left shows an ear with
an eardrum perforation and severe tympanosclerosis involving the
eardrum and
middle ear.
Click on
Pictures to Enlarge
Warning!!! ENT USA considers ear candles to be pure quackery and strongly advises that they not be used.
Serous Otitis Media:
(Go To Top)
Negative pressure builds up in the
middle ear
from
eustachian tube
dysfunction. (The tube that leads
from the ear to the back of the nose no longer lets enough air into the
middle ear.)
Even short term negative pressure can cause clear fluid to build up behind
the eardrum. The eardrum is often retracted or pulled into the
middle ear.
The patient usually has a hearing loss.
To the left is an ear
with serous (middle ear)
fluid and
a normal light
reflex.
Click on
Pictures to Enlarge
Retraction
of The Eardrum:
(Go To Top)
This is the first step in the formation of a
cholesteatoma. Negative pressure builds up in the
middle ear
from
eustachian tube
dysfunction. (The tube that leads from the ear to
the back of the nose no longer lets enough air into the
middle ear.)
Long term negative pressure will cause collapse of the eardrum and
eventually retraction pocket formation. (The pictures on the right show severely retracted eardrums)
Click on
Pictures to Enlarge
Severely Retracted Eardrums - Myringostapediopexy:
Chronic
negative pressure can also cause erosion of the
middle earbones or
ossicles.
Shown in photographs is erosion of the
incuswith the eardrum attaching to the
stapes
(Myringostapediopexy).
The
pictures on the right show eardrums which have eroded through the long
process of the the
incus.
The left hand and middle picture shows the
eardrum attached to the head of the
stapes. In the far right
picture, the eardrum is attached to the
top of the
stapes'
cura.
Warning!!! ENT USA considers ear candles to be pure quackery and strongly advises that they not be used.
Retraction
Pocket Formation:
(Go
To Top) Long term retraction of the eardrum will
cause erosion of the ear canal and forms a deep pocket. Eventually
the pocket may trap skin, forming a skin cyst or
cholesteatoma. Further
progression of retraction pockets can cause destruction of the eardrum. Many
of theses eardrums have
tympanosclerosis
or white plaques on the eardrum.
The picture on the far right shows a severely retracted eardrum
with attic retraction pocket formation. The eardrum is draped over
the
incus,
stapes
and
round window. The left hand picture shows a
very thin or atelectatic
eardrum (tympanic membrane)
which is draped over the promontory and
round window
nitch. It is also draped over the
stapes
and stapedial
tendon and forming a deep posterior-superior retraction Pocket.
Click on
Pictures to Enlarge
Ear
Tubes:
(Go To Top)
Treatment
of
eustachian tube
dysfunction
& eardrum retraction
pockets by placing an ear tube in the
eardrum. To the right is shown a pre-operative ear with
chronic serous otitis media
and retraction pocket
formation, the
"glue" which was
suctioned out of the ear and the post-operative result.
Complications
of Ear Tubes: Perforation: Sometimes when a tube comes
out of the eardrum a perforation is left. Shorter acting tubes
cause perforations in about 1% to 2% of patients. If a T-tube or
long-acting tube is used, up to 20% to 30% of eardrums will eventually
develop perforations.
Click on
Pictures to Enlarge
Granulation
tissue may also grow out of a blocked ear tube. This tissue will
usually go away with the use of steroid containing ear drops.
Monolayer: Sometimes when
the ear tube comes out, the eardrum heals in a very thin layer.
This condition is called a monolayer and can mimic a perforation of the
eardrum. It is usually of no pathological significance and does
not need treatment. The
eardrum shown on the right is shown in two views, as seen using a
handheld otoscope and a close up using the operating microscope.
Notice a thin protion of eardrum, mimicking a perforation, in
the close up photograph.
Other eardrums with a monolayer are shown below: Click on
Pictures to Enlarge
A
tube may heal into the
middle ear
instead of healing outward. This
is a rare complication. It usually occurs after a severe
infection. If the
middle ear
is aerated and the eardrum is not retracted,
treatment is usually not needed, .
Cholesteatoma:
(Go
To Top)
A skin cyst caused by a long standing retraction pocket of the eardrum into the
middle ear.
This is a serious condition. The cyst slowly erodes bone and can cause
facial paralysis, hearing loss, dizziness and, if left untreated, can slowly
erode into the brain cavity. Cholesteatomas are surgically
removed with a mastoidectomy operation.
The picture on the far right shows a large attic cholesteatoma extending behind
the eardrum into the mesotympanium. The left hand picture shows a large
attic cholesteatoma with exposure of the head of the malleus. Note the
eardrum retraction in the posterior inferior quadrant.
Search PubMed for CholesteatomaClick on
Pictures to Enlarge
A
cholesteatoma
can also form from a perforation. In this picture,
squamous epitheliumis growing around the top of a 100% eardrum
perforation. (Left Picture)
Sometimes a
cholesteatoma
can
exist in the upper part of the eardrum, with the remainder of the eardrum
being normal. (Right Picture)
Click on
Pictures to Enlarge
In
the picture on the left, a
cholesteatoma
can be seen behind the eardrum with
granulation tissue
in the region of the
attic
(Left Picture - Top of the
Eardrum).
In
the picture on the right, a
cholesteatoma
is hidden behind
granulation tissue
covering
the attic or superior portion of the eardrum. Note the large skin
sac which is behind the eardrum and filling the mesotympanium. (Right Picture)
Click on
Pictures to Enlarge
Although
cholesteatomas
are treated with surgery, there can be exceptions. The picture on
the right shows a large
cholesteatoma
with a very large and open
attic
retraction pocket, and a central perforation of the eardrum. The
patient was elderly and had very poor hearing in this ear. However,
this ear was also
the patient's only hearing ear and there was not a
history of pain or drainage. Thus, it was elected to follow the
cholesteatoma
very carefully and for now delay performing surgery.
Mural
Cholesteatoma:
The picture on the right shows
a small skin cyst on the eardrum (tympanic membrane) and a second one on the anterior canal
wall. These cysts can be congenital but also can form from trauma.
Click on
Pictures to Enlarge
Eardrum
Perforation:
(Go To Top)
Eardrums can also develop holes or
perforations in them. The picture on the far right shows an eardrum with three holes
& destruction of the
middle ear
bones
(ossicles). Repair of eardrum
holes can be accomplished with an operation called a
"tympanoplasty".
Click on
Pictures to Enlarge
This picture shows a dry central perforation
though which the tympanic nerve can be seen. The tympanic nerve is
part of a nerve plexus which transmits impulses that controls salivary
secretion. Click on
Pictures to Enlarge
This
picture shows a marginal perforation of the eardrum. Squamous
epithelium (the skin on the outside of the body) has grown into the
middle ear
through the perforation. This is a rare
cause of a
cholesteatoma.
Click on
Pictures to Enlarge
Chronic
Otitis Media:
This picture shows an eardrum with a large perforation and a chronically
infected
middle ear.
The
manubrium(part
of the
malleus,
outermost
middle ear
bone, which is attached to the eardrum) is
attached to the promontory (the medial wall of the
middle ear)
of the
middle ear
and the mucosa (lining) of the
middle ear
is inflamed.
Click on
Pictures to Enlarge
Healing Perforation:
Shown on the right is a freshly healed perforation with a reparative
granulomaover the previous perforation site.
Click on
Pictures to Enlarge
Traumatic Perforation: Trauma is a common cause of an eardrum
perforation. It is important to note if the patient is dizzy.
If dizziness is present, then the
inner ear
may be damaged and
middle ear
exploration for a inner ear to
middle ear
fistula
should be considered. An
audiogram
should also be obtained, since this will help determine if there is damage
to the
inner ear
and
middle ear
bones. If due to a water
injury, i.e. falling during water skiing, the risk of infection is high
and antibiotic ear drops should be used. Over 90% of all traumatic
perforations will heal spontaneously.
Click on
Pictures to Enlarge
Acute
Otitis Media:
(Go To Top)
This is a very common and painful ear infection which
is usually found in children. Treatment usually consists of a ten day
course of antibiotics. After the acute infection, serous ear fluid may
persist for weeks. The picture to
the right shows an eardrum which is markedly inflamed and has pus in the
middle ear.
Several round structures can be seen through the eardrum. These are
areas of granulation tissues and can be the precursors to tympanosclerosis.
Click on
Pictures to Enlarge
Eardrum
Hemorrhagic Blister: This is a rare condition which may
be seen with trauma, severe bacterial infections and viral infections (
Herpes Zoster
). This patient did not respond to antibiotics and was placed on
antiviral agents.
Eardrum
Abrasion:
This picture is from a 14 year old child who
complained of a hearing loss in her left ear. Audiometric testing
revealed a 25 dB conductive hearing loss in this ear. On
examination, the eardrum had a circular abrasion in the posterior
superior quadrant, The middle ear was air containing. On
further questioning, she admitted to using Q-Tips and experiencing sever
pain after one recent use. A diagnosis of partial ossicular
discontinuity was suspected.
Click on
Pictures to Enlarge
Small
hemorrhage on eardrum from Q-Tip use. Never stick a Q-Tip in your
ears.
Click on
Pictures to Enlarge
Middle
Ear Foreign Body. The pictures on right are from a 90 year old
who was undergoing hearing fitting. Liquid casting material was
placed in the ear canal to form a cast. This cast
would then be used to form a hearing aid mold. However, this
patient had a small perforation of the eardrum and the depths of the ear
canal was not completely plugged before placement of the casting
material. The picture on the near right shows the casting material
going threw the perforation. Several weeks later the eardrum
healed and the casting material can be seen through the eardrum in the
middle ear
(arrow in far right picture). The patient was of poor health and
not a surgical candidate. She suffered no adverse effects from the
material.
Click on
Pictures to Enlarge
Slag
Injury: This picture is from a 73 year old patient who was welding
and a spark entered his ear. He complained of pain and slightly muffled
hearing. The picture to the right shows an eardrum one week after the
injury. The eardrum is still red and had a crust on it. A small metal
ball is seen at the bottom of the canal. This patient was lucky
since often the eardrum will develop a non-healing perforation.
Click on
Pictures to Enlarge
Lateralized
Eardrum: The picture on the right shows
a lateralized eardrum which is only attached to the lateral process of
the malleus. The patient had a 20 dB conductive hearing loss.
The cause of the lateralization is unknown.
Click on
Pictures to Enlarge
Glomus
Tympanicum, Paraganglioma Tumor: This is a rare tumor which is highly vascular and arises in
the
middle ear
or jugular vein. The photo to the right shows a
large mass behind the eardrum which can be seen pulsating with the
heart beats.
Click on
Pictures to Enlarge
Below are pictures from another
patient with a Glomus Tympanicum showing the appearance of the eardrum and
tumor's blood flow from the Posterior Auricular Artery demonstrated on
angiography. The picture on the left shows the tumor at the time of
operation.
Click on
Pictures to Enlarge
Acute
Otitis Media:
(Go To Top)
This is a very common and painful ear infection which
is usually found in children. Treatment usually consists of a ten day
course of antibiotics. After the acute infection, serous ear fluid may
persist for weeks. The picture to
the right shows an eardrum which is markedly inflamed and has pus in the
middle ear.
Several round structures can be seen through the eardrum. These are
areas of granulation tissues and can be the precursors to tympanosclerosis.
