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The Normal Eardrum & Its Variants

Cone of light is directed to the right for the right ear

and to the left for the left ear.

The handle of malleus is directed to the left for the right ear

and to the right for the left ear.


Pars flaccida less obvious.

Thinner eardrum with barely visible cone of light.

A generally thicker eardrum

with no obvious cone of light visible.

High definition endoscopic image of normal left tympanic membrane.




A bulging tympanic membrane in a patient undergoing general anaesthesia inclusive of inhalational nitrous oxide resulting in positive middle ear cleft pressure.

Quadrants of The Tympanic Membrane

1- anterosuperior, 2- anteroinferior, 3- posteroinferior, 4- posterosuperior


Watch video of normal eardrum @ YouTube

Vascular Patterns of The Eardrum and Osseous Canal

Superior vascular strip region tapering towards handle of malleus and umbo.

Similar vascular pattern seen as above.

The radial pattern of eardrum capillaries.  Middle ear effusion present.

Epithelial Migration

Figures show epithelial migration in centrifugal pattern from the umbo.

 Established and completed epithelial migration of a patient's ear canal.

"Ripples" of epithelial migration along the external auditory meatus.




Another evidence of epithelial migration showing breakup of topical antifungal powder attached on the tympanic membrane surface in radial centrifugal pattern.  The patient had an otomycosis which was treated 2 weeks earlier. 


(Epithelial migration figures are courtesy of Dr G Revadi)

An Atrophic Tympanic Membrane

Eardrum can be very thin and transparent.  However, one's should be able to differentiate an intact eardrum based on history and its otoscopic appearance.  Healed eardrum perforation lacks of middle fibrous layer.


Watch video of atrophic and atelectatic tympanic membrane @ YouTube

False Tympanic Membrane

This should not be mistaken as the actual eardrum.  In some patient,

a similar layer aliken to normal eardrum can occur.  There is an air-filled

space in between these structures.


This image shows a thin layer before the actual eardrum due to

dried secretion in the ear canal close to the tympanic membrane.



 False tympanic membrane as seen from           Close-up endoscopic view

             left tragal (T) distance.                       of false tympanic membrane.

Tympanic Annulus

Tympanic annulus (arrows) clearly seen at the periphery of the eardrum in a patient with previous history of keratosis obturans.  It is the thickened edges of the eardrum which forms a fibrocartilaginous ring and reside in tympanic sulcus.

Visible postero-superior segment of tympanic ring (arrows).  Otitis media with effusion present with mild retraction of pars flaccida.

Epithelial Pearl Behind Pars Flaccida


Small island of keratin collection adhered on medial surface of pars flaccida (arrow).

The Chorda Tympani Nerve

Chorda tympani nerve branches from the facial nerve and passes from posterior to anterior direction in the middle ear lying medial to the neck of malleus.  It passes through the petrotympanic fissure and exits into infratemporal fossa to join lingual nerve.  This nerve is secretomotor to the submandibular and sublingual glands as well as taste sensation to the anterior 2/3rd of the tongue. 

Attempts should be made to preserve this nerve during tympanoplasty. 

These figures show the course or the chorda tympani nerve along the

postero-superior aspect of the tympanic annulus (arrow).

Chorda tympani nerve blends with tympanic annulus posteriorly and appears white (top left) and more obviously seen beyond transparent atrophic membrane (top right).

Retracted pars tensa and atrophic pars flaccida with obvious ossicular chain seen. (1 - handle of malleus, 2 - long process of incus, 3 - body of incus, 4 - tympanic membrane, arrow - incudomalleolar joint)



 Chorda tympani nerve (arrow) relations between malleus and incus.  (TM - tympanic membrane, 1 - handle of malleus, 2 - malleus head, 3 - body of incus)




 Visible chorda tympanii nerve (arrow) in a patient with healed keratosis obturan lesion.


Watch video of chorda tympani nerve course in relation to the eardrum @ YouTube

Schwartze Sign

The 'pink' of Flamingo!