Skip to main content
SpringerLink
Log in

Endoscopic Middle Ear Anatomy

  • Endoscopic Ear Surgery (D. Pothier, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

The anatomy of the middle ear is very complex. The otologist must have a good knowledge of the structures comprising the tympanic cavity; a clear view of all the subsites of this region is essential to ensure the complete removal of all pathology. The development of endoscopic techniques to access the middle ear has offered the possibility to “look around corners” and explore hidden recesses the microscope cannot reach. Moreover, by leading to a better understanding of the different ventilation pathways of the tympanic cavity, alterations of which may cause pathologies such as cholesteatoma, endoscopy represents a surgical approach aimed toward restoring normal physiology as well as eradicating disease. In this article, we discuss the state of the art of middle ear endoscopic anatomy, describing the different subsites of this small but challenging region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Thomassin JM, Korchia D, Doris JM. Endoscopic guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope. 1993;103:939–43.

    Article  CAS  PubMed  Google Scholar 

  2. •• Badr-El-Dine M. Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol. 2002;23:631–5. The importance of using the endoscope in conjunction with microscope during middle ear surgery is underlined. This concept can lead to a reduction of the residual cholesteatoma rate.

  3. •• Tarabichi M. Endoscopic management of acquired cholesteatoma. Am J Otol. 1997;18:544–9. One of the first case series that compares transcanal endoscopic middle ear surgery to postauricular procedures.

  4. Bottril ID, Poe DS. Endoscopic-assisted ear surgery. Am J Otol. 1995;16:158–63.

    Article  Google Scholar 

  5. Karhuketo TS, Puhakka HJ, Laippala PJ. Endoscopy of the middle ear structures. Acta Otolaryngol Suppl. 1997;529:34–9.

    Article  CAS  PubMed  Google Scholar 

  6. Marchioni D, Molteni G, Presutti L. Endoscopic anatomy of the middle ear. Indian J Otolaryngol Head Neck Surg. 2011;63(2):101–3.

    Article  PubMed Central  PubMed  Google Scholar 

  7. •• Marchioni D, Mattioli F, Alicandri-Ciufelli M, Molteni G, Masoni F, Presutti L. Endoscopic evaluation of middle ear ventilation route blockage. Am J Otolaryngol. 2010;31(6):453–66. The selective dysventilation syndrome is explained through the presence of anatomical blockages of the middle ear ventilation trajectories.

  8. • Marchioni D, Alicandri-Ciufelli M, Grammatica A, Mattioli F, Presutti L. Pyramidal eminence and subpyramidal space: an endoscopic anatomical study. Laryngoscope. 2010;120(3):557–64. The exploration of the middle ear through endoscopic instruments allows to better understand the anatomy of hidden areas like sub pyramidal space.

  9. • Marchioni D, Mattioli F, Alicandri-Ciufelli M, Presutti L. Transcanal endoscopic approach to the sinus tympani: a clinical report. Otol Neurotol. 2009;30(6):758–65. A classification of the ST based on radiological findings is proposed and the endoscopic approach to ST is discussed and compared to the posterior retrofacial approach.

  10. Ozturan O, Bauer CA, Miller CC, Jenkins HA. Dimensions of the sinus tympani and its surgical access via a retrofacial approach. Ann Otol Rhinol Laryngol. 1996;105:776–83.

    Article  CAS  PubMed  Google Scholar 

  11. Steinbrugge H. On sinus tympani. Arch Otolaryngol. 1889;8:53–7.

    Google Scholar 

  12. Donaldson JA, Anson BJ, Warpeha RL, Rensink MJ. The surgical anatomy of the sinus tympani. Arch Otolatyngol. 1970;91:219–27.

    Article  CAS  Google Scholar 

  13. Weiss MH, Parisier SC, Han JC, Edelstein DR. Surgery for recurrent and residual cholesteatoma. Laryngoscope. 1992;102:145–51.

    CAS  PubMed  Google Scholar 

  14. Pulec JL. Sinus tympani: retrofacial approach for the removal of cholesteatomas. Ear Nose Throat J. 1996;75:77–88.

    CAS  PubMed  Google Scholar 

  15. Jeng FC, Tsai MH, Brown CJ. Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol. 2003;24:29–32.

    Article  PubMed  Google Scholar 

  16. • Marchioni D, Alicandri-Ciufelli M, Piccinini A, Genovese E, Presutti L. Inferior retrotympanum revisited: an endoscopic anatomical study. Laryngoscope. 2010;120(9):1880–6. The inferior retrotympanum is an anatomical middle ear region that can be exposed with endoscopic approach. This is an anatomical study that describes the structures and the subsites of this region.

  17. Garcia PJ, Tamega OJ, Soares JC, Piffer CR, Zorzetto NL. Contribution to the study of the styloid prominence in the posterior tympanic cavity. Anat Anz. 1982;151:247–54.

    CAS  PubMed  Google Scholar 

  18. Proctor B. Surgical anatomy of the posterior tympanum. Ann Otol Rhinol Laryngol. 1969;78:1026–40.

    Article  CAS  PubMed  Google Scholar 

  19. Proctor B, Bollobas B, Niparko JK. Anatomy of the round window niche. Ann Otol Rhinol Laryngol. 1986;95:444–6.

    Article  CAS  PubMed  Google Scholar 

  20. Savic D, Djeric D. Surgical anatomy of the hypotympanum. J Laryngol Otol. 1987;101:419–25.

    Article  CAS  PubMed  Google Scholar 

  21. Marchioni D, Alicandri-Ciufelli M, Piccinini A, Genovese E, Monzani D, Tarabichi M, Presutti L. Surgical anatomy of transcanal endoscopic approach to the tympanic facial nerve. Laryngoscope. 2011;121(7):1565–73.

    Article  PubMed  Google Scholar 

  22. Marchioni D, Alicandri-Ciufelli M, Grammatica A, Mattioli F, Genovese E, Presutti L. Lateral endoscopic approach to epitympanic diaphragm and Prussak’s space: a dissection study. Surg Radiol Anat. 2010;32:843–52.

    Article  PubMed  Google Scholar 

  23. Chatellier HP, Lemoine J. Le diaphragme interattico-tympanique du nouveau-ne. Ann Otolaryngol Chir Cervicofac. 1946;13:534–66.

    Google Scholar 

  24. Palva T, Johnsson L. Epitympanic compartment surgical considerations: reevaluation. Am J Otol. 1995;16:505–13.

    CAS  PubMed  Google Scholar 

  25. Palva T, Ramsay H. Incudal folds and epitympanic aeration. Am J Otol. 1996;17:700–8.

    CAS  PubMed  Google Scholar 

  26. Marchioni D, Alicandri-Ciufelli M, Molteni G, Artioli FL, Genovese E, Presutti L. Selective epitympanic dysventilation syndrome. Laryngoscope. 2010;120(5):1028–33.

    PubMed  Google Scholar 

  27. Marchioni D, Grammatica A, Alicandri-Ciufelli M, Aggazzotti-Cavazza E, Genovese E, Presutti L. The contribution of selective dysventilation to attical middle ear pathology. Med Hypotheses. 2011;77(1):116–20.

    Article  PubMed  Google Scholar 

  28. Onal K, Van Haastert RM, Grote JJ. Structural variations of supratubal recess: the anterior epitympanic space. Am J Otol. 1997;18:317–21.

    CAS  PubMed  Google Scholar 

  29. Marchioni D, Mattioli F, Alicandri-Ciufelli M, Presutti L. Endoscopic approach to tensor fold in patients with attic cholesteatoma. Acta Otolaryngol. 2008;25:1–9.

    Google Scholar 

  30. Savic D, Djeric D. Anatomical variations and relations of the medial wall of the bony portion of the Eustachian tube. Acta Otolaryngol. 1985;99:551–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ENT Department, University Hospital of Verona - Borgo Trento, Piazzale Stefani 1, 37126, Verona, Italy

    Daniele Marchioni

  2. Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy

    Marco Bonali & Livio Presutti

Authors
  1. Daniele Marchioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Bonali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Livio Presutti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Bonali.

Additional information

This article is part of the Topical Collection on Endoscopic Ear Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marchioni, D., Bonali, M. & Presutti, L. Endoscopic Middle Ear Anatomy. Curr Otorhinolaryngol Rep 3, 200–208 (2015). https://doi.org/10.1007/s40136-015-0099-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40136-015-0099-4

Keywords

Search

Navigation