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Eardrum and Middle Ear Pictuers (Photographs)
Eardrum & Middle Ear Pictures
Eardrum Pictures
  
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  • 1.  Normal Eardrums - Click on Picture To View Slideshow
  • 2. Eardrum Perforations - Click on Picture To View Slideshow
  • 3. Acute Otitis Media - Click on Picture To View Slideshow
  • 4. Serous Otits Media - Click on Picture To View Slideshow
  • 5. Ear (Myringotomy) Tubes - Click on Picture To View Slideshow
  • 6. Retraction Pockets - Click on Picture To View Slideshow
  • 7. Cholesteatoma - Click on Picture To View Slideshow
  • 8. Tympanosclerosis - Click on Picture To View Slideshow
 
 
Tympanosclerosis
 
Serious Otits Media
(Ear Fluid)

 
Acute Otitis Media
(Ear Infection)

 
Ear (Myringotomy)
Tubes

 
Retracted Eardrums
 
Retraction Pockets
 
Cholesteatoma
 
Eardrum Perforations
 
Other Pathology
  
      

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Normal Eardrum:  Two normal eardrums are shown on the right.  Notice the light reflex on the anterior-inferior portion of the drum.    

Click on Pictures to Enlarge 
 
Click on colored text for word definitions

        

Normal Eardrum  Normal Eardrum
    
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 near right-hand picture shows an ear with an eardrum perforation and severe tympanosclerosis involving the eardrum and middle ear.   Click on Pictures to Enlarge
   


    
Eardrum Perforation and Severe Tympanosclerosis Involving the Eardrum and Middle Ear  Severely Retracted Eardrum with a Myringostapediopexy
  
  

Retracted Tympanic Membrane with a Myringostapediopexy  Eardrum Tympanosclerosis

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

  

Serous Otitis Media  Serous Otitis Media
 

   


 

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


 


Retracted Eardrum - Myringostapediopexy  Retracted Eardrum - Myringoincudopexy

  
Retracted EardrumRetracted EardrumRetracted EardrumRetracted EardrumRetracted Eardrum

 
Severely Retracted Eardrums -
MyringostapediopexyChronic negative pressure can also cause erosion of the middle ear bones or ossicles.  Shown in photographs is erosion of the incus with the eardrum attaching to the stapes (Myringostapediopexy).  
 

Retracted Eardrum - MyringostapediopexyRetracted Eardrum - Myringostapediopexy


Retracted Eardrum - MyringoincudopexyRetracted Eardrum - MyringostapediopexyRetracted Eardrum - 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.
 


 
Severely Retracted Eardrum With Retraction Pocket Formation and Chronic Serous Otitis MediaSeverely Retracted Eardrum With Retraction Pocket Formation and Erosion of the Long Arm of the IncusRetraction 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.

Eardrum with Chronic Serous Otitis Media and an Attic Retraction Pocket   Middle Ear Fluid, Glue, Suctioned from Middle Ear   Ear Tube in an Eardrum with an Attic Retraction Pocket

           Click on Pictures to Enlarge

Search PubMed for Myringotomy Tubes 


Extruding Ear Tube and Eardrum PerforationExtruding Ear Tube and Eardrum PerforationComplications 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


Ear Tube GranulomaGranulation tissue may also grow out of a blocked ear tube.  This tissue will usually go away with the use of steroid containing ear drops.


Eardrum Monolayer and TympanosclerosisEardrum Monolayer and TympanosclerosisMonolayer:  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


Eardrum Monolayer and TympanosclerosisEardrum Monolayer and TympanosclerosisEardrum Monolayer and TympanosclerosisEardrum Monolayer and Tympanosclerosis


Ear Tube Heald into Middle EarA 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, .

Rarely, a myringotomy tube may cause a cholesteatoma from skin being trapped in the middle ear.

Click on Pictures to Enlarge


 
Cholesteatoma of Attic and MesotympaniumAttic Cholesteatoma with Exposure of the Head of the Malleus and Eardrum RetractionCholesteatoma: (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 Cholesteatoma            
Click on Pictures to Enlarge

    


Attic Cholesteoma with an Otherwise  Normal EardrumLarge Cholesteatoma with a Total Eardrum PerforationA cholesteatoma can also form from a perforation.  In this picture, squamous epithelium is 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


Attic Cholesteatoma Covered with Granulation TissueAttic Cholesteatoma Covered with Granulation TissueIn 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. 

Click on Pictures to Enlarge

 
Congenital Cholesteatomas of the Tympanic MembraneCongenital
Cholesteatoma
:  This picture shows an 11 month old who had multiple skin cysts on her eardrum
(tympanic membrane).  These cysts can also reside in the middle ear and posterior fossa (brain cavity).

Click on Pictures to Enlarge


Congenital Cholesteatoma of the Tympanic MembraneMural
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 with multiple perforations or holesEardrum 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



   
  


Eardrum Perforation Showing Tympanic NerveThis 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


Marginal Perforation with Squamous Debris Extending Into the Middle EarThis 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


Eardrum Perforation with Chronic Otitis MediaEardrum Perforation with Chronic Otitis MediaChronic 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 Eardrum PerforationHealing Perforation:  Shown on the right is a freshly healed perforation with a reparative granuloma over the previous perforation site.

Click on Pictures to Enlarge


Traumatic Eardrum PerforationTraumatic 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

 

   
Eardrum Hole From Trauma
 Eardrum Hole From Trauma Traumatic Eardrum Perforation Traumatic Eardrum Perforation
Eardrum Home from Trauma


  
Acute Otitis MediaAcute Otitis Media with Blebs on EardrumAcute 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

  


 
Other Diseases of the Middle Ear and Eardrum (tympanic membrane)   (Go To Top)


Blisters on Eardrum from Herpes Zoster - ShinglesEardrum 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. 

Click on Pictures to Enlarge


HemotympaniumHemotympaniumHemotympanium (Blood in the Middle Ear): These pictures are from a patient that had a severe nosebleed (epistaxis).  Blood has been blown up both eustachian tubes into the middle ear cavities.

Click on Pictures to Enlarge


Eardrum Abrasion From Q-TipsEardrum 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


Hearing Aid Mold Extending into the Middle Ear Through an Eardrum PerforationMiddle 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 through 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 InjurySlag 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 EardrumLateralized 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


Eardrum Appearance with a Glomus TympanicumGlomus 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

Appearance of a Glomus Tympanicum at the Time of Surgery MRA of a Glomus Tympanicum Eardrum Appearance with a Glomus Tympanicum
     


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