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Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease.

Maniu A, Catana IV, Harabagiu O, Petri M, Cosgarea M - Clujul Med (2013)

Bottom Line: When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area.This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT

Aim: The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted.

Methods: Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope.

Results: Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.

Conclusions: The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

No MeSH data available.


Related in: MedlinePlus

The interattico-diaphragm: 1. Incus. 2. Malleus. 3. Lateral incudomalleal fold. 4. Lateral malleal ligamental fold. 5. Anterior malleal fold. 6. Tensor tympani fold Isthmus tympani (black arrow).
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f1-cm-86-352: The interattico-diaphragm: 1. Incus. 2. Malleus. 3. Lateral incudomalleal fold. 4. Lateral malleal ligamental fold. 5. Anterior malleal fold. 6. Tensor tympani fold Isthmus tympani (black arrow).

Mentions: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid mucosa in which the tympanic membrane is not intact (perforation or tympanostomy tube) and discharge (otorrhea) is present [1]. The pathogenesis of CSOM is multifactorial: environmental versus genetically determined factors as well as anatomical and functional characteristics of the Eustachian tube are involved [2]. The factors that allow acute infections within the middle ear and mastoid to develop into chronic infections are unclear [3]. One of the contributing factors refers to the presence of anatomic blockages of the middle ear ventilation trajectories [4]. Aeration of the middle ear, antrum, and mastoid depends on the free movement of gases from the Eustachian tube into the mastoid air cells. Early studies showed that the middle ear is separated from the antrum not only by the ossicles, but also by mucosal folds [5]. This arrangement creates an interattico-diaphragm with only one constant opening (Fig. 1). Edema and inflammation with granulation tissue may block these communicating openings, preventing drainage of the antrum and mastoid. Chronic obstruction of the attic and antrum with infection leads to “irreversible” inflammatory changes in the mucosa and bone of the middle ear cleft, with the appearance of CSOM [1]. There is a lot of controversy in literature regarding the origin of the middle ear folds and their contribution to the partition of the middle ear spaces [6].


Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease.

Maniu A, Catana IV, Harabagiu O, Petri M, Cosgarea M - Clujul Med (2013)

The interattico-diaphragm: 1. Incus. 2. Malleus. 3. Lateral incudomalleal fold. 4. Lateral malleal ligamental fold. 5. Anterior malleal fold. 6. Tensor tympani fold Isthmus tympani (black arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4462447&req=5

f1-cm-86-352: The interattico-diaphragm: 1. Incus. 2. Malleus. 3. Lateral incudomalleal fold. 4. Lateral malleal ligamental fold. 5. Anterior malleal fold. 6. Tensor tympani fold Isthmus tympani (black arrow).
Mentions: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid mucosa in which the tympanic membrane is not intact (perforation or tympanostomy tube) and discharge (otorrhea) is present [1]. The pathogenesis of CSOM is multifactorial: environmental versus genetically determined factors as well as anatomical and functional characteristics of the Eustachian tube are involved [2]. The factors that allow acute infections within the middle ear and mastoid to develop into chronic infections are unclear [3]. One of the contributing factors refers to the presence of anatomic blockages of the middle ear ventilation trajectories [4]. Aeration of the middle ear, antrum, and mastoid depends on the free movement of gases from the Eustachian tube into the mastoid air cells. Early studies showed that the middle ear is separated from the antrum not only by the ossicles, but also by mucosal folds [5]. This arrangement creates an interattico-diaphragm with only one constant opening (Fig. 1). Edema and inflammation with granulation tissue may block these communicating openings, preventing drainage of the antrum and mastoid. Chronic obstruction of the attic and antrum with infection leads to “irreversible” inflammatory changes in the mucosa and bone of the middle ear cleft, with the appearance of CSOM [1]. There is a lot of controversy in literature regarding the origin of the middle ear folds and their contribution to the partition of the middle ear spaces [6].

Bottom Line: When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area.This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

ABSTRACT

Aim: The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted.

Methods: Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope.

Results: Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum.

Conclusions: The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.

No MeSH data available.


Related in: MedlinePlus