In theanatomy of humans and various othertetrapods, theeardrum, also called thetympanic membrane ormyringa, is a thin, cone-shapedmembrane that separates theexternal ear from themiddle ear. Its function is to transmit changes inpressure ofsound from the air to theossicles inside the middle ear, and thence to theoval window in the fluid-filledcochlea. The ear thereby converts and amplifies vibration in the air to vibration in cochlear fluid.[1] Themalleus bone bridges the gap between the eardrum and the other ossicles.[2]
The tympanic membrane is oriented obliquely in theanteroposterior, mediolateral, and superoinferior planes. Consequently, its superoposterior end lies lateral to its anteroinferior end.[citation needed]
The eardrum is divided into two general regions: thepars flaccida and thepars tensa.[3] The relatively fragile pars flaccida lies above the lateralprocess of themalleus between theNotch of Rivinus and the anterior and posterior malleal folds. Consisting of two layers and appearing slightly pinkish in hue, it is associated with[vague]Eustachian tube dysfunction andcholesteatomas.[4]
The larger pars tensa consists of three layers:skin,fibrous tissue, andmucosa. Its thick periphery forms afibrocartilaginous ring called theannulus tympanicus or Gerlach's ligament.[5] 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.[6]
The manubrium (Latin for "handle") of themalleus is firmly attached to the medial surface of the membrane as far as its center, drawing it toward thetympanic cavity. The lateral surface of the membrane is thus concave. The most depressed aspect of this concavity is termed the umbo (Latin for "shield boss").[7]
When the eardrum is illuminated during amedical examination, acone of light radiates from the tip of the malleus to the periphery in the anteroinferior quadrant, this is what is known clinically as 5 o'clock.[citation needed]
Patients with 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.[13][14][15] The prognosis becomes more guarded as the force of injury increases.[15]
Surgical puncture for treatment of middle ear infections
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 out of the middle ear. If this does not occur naturally, amyringotomy (tympanotomy, tympanostomy) can be performed. A myringotomy is asurgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drainpus from themiddle ear. The fluid or pus comes from a middle ear infection (otitis media), which is a common problem in children. Atympanostomy 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.[16]
Those requiring myringotomy usually have an obstructed or dysfunctionalEustachian 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.[16]
TheBajau people of thePacific intentionally rupture their eardrums at an early age to facilitate diving and hunting at sea. Many older Bajau therefore have difficulties hearing.[17]
^Kristensen S (December 1992). "Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience".J Laryngol Otol.106 (12):1037–50.doi:10.1017/s0022215100121723.PMID1487657.S2CID21899785.
^Lindeman P, Edström S, Granström G, Jacobsson S, von Sydow C, Westin T, Aberg B (December 1987). "Acute traumatic tympanic membrane perforations. Cover or observe?".Arch Otolaryngol Head Neck Surg.113 (12):1285–7.doi:10.1001/archotol.1987.01860120031002.PMID3675893.
^abSmith N, Greinwald JR (2011). "To tube or not to tube: indications for myringotomy with tube placement".Current Opinion in Otolaryngology & Head and Neck Surgery.19 (5):363–366.doi:10.1097/MOO.0b013e3283499fa8.PMID21804383.S2CID3027628.
