Endoscopic Anatomy of the Middle Ear

  • Daniele Marchioni
  • Gabriele MolteniEmail author
  • Livio Presutti
Original Article


Good knowledge of anatomy is fundamental for every surgeon. Middle ear anatomy is really complex and sometimes is challenging for otologists, who need to explore every single compartment for a radical removal of pathology. With introduction of the endoscope in middle ear surgery, anatomy of middle ear spaces has become wider and clearer due to a better magnification and to the possibility to look “behind the corner”. This article is a review of the state-of-art of endoscopic middle ear anatomy with description of every compartment, with particular attention to ventilation pathways and middle ear folds.


Middle-ear Anatomy Endoscope 


  1. 1.
    Prevedello DM, Doglietto F, Jane JA Jr et al (2007) History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg 107:206–213PubMedCrossRefGoogle Scholar
  2. 2.
    Mouton WG, Bessell JR, Maddern GJ (1998) Looking back to the advent of modern endoscopy: 150th birthday of Maximilian Nitze. World J Surg 22:1256–1258PubMedCrossRefGoogle Scholar
  3. 3.
    Reuter HJ (1988) Philipp Bozzini and endoscopy in the 19th Century. Max Nitze Museum, StuttgartGoogle Scholar
  4. 4.
    Baki FA, El Dine MB, El Said L et al (2002) Sinus tympani endoscopic anatomy. Otolaryngol Head Neck Surg 127:158–162PubMedCrossRefGoogle Scholar
  5. 5.
    Thomassin JM, Korchia D, Doris JM (1993) Endoscopic guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope 103:939–943PubMedCrossRefGoogle Scholar
  6. 6.
    Badr-El-Dine M (2002) Value of ear endoscopy in cholesteatoma surgery. Otol Neurotol 23:631–635PubMedCrossRefGoogle Scholar
  7. 7.
    Tarabichi M (1997) Endoscopic management of acquired cholesteatoma. Am J Otol 18:544–549Google Scholar
  8. 8.
    Tarabichi M (2004) Endoscopic management of limited attic cholesteatoma. Laryngoscope 114:1157–1162Google Scholar
  9. 9.
    Bowdler DA, Walsh RM (1995) Comparison of the otoendoscopic and microscopic anatomy of the middle ear cleft in canal wall-up and canal wall-down temporal bone dissections. Clin Otolaryngol Allied Sci 20:418–422Google Scholar
  10. 10.
    Bottril ID, Poe DS (1995) Endoscope-assisted ear surgery. Am J Otol 16:158–163Google Scholar
  11. 11.
    Karhuketo TS, Puhakka HJ, Laippala PJ (1997) Endoscopy of the middle ear structures. Acta Otolaryngol Suppl 529:34–39Google Scholar
  12. 12.
    Ozturan O, Bauer CA, Miller CC et al (1996) Dimensions of the sinus tympani and its surgical access via a retrofacial approach. Ann Otol Rhinol Laryngol 105:776–783PubMedGoogle Scholar
  13. 13.
    Steinbrugge H (1889) On sinus tympani. Arch Otolaryngol 8:53–57Google Scholar
  14. 14.
    Weiss MH, Parisier SC, Han JC et al (1992) Surgery for recurrent and residual cholesteatoma. Laryngoscope 102:145–151PubMedGoogle Scholar
  15. 15.
    Pulec JL (1996) Sinus tympani: retrofacial approach for the removal of cholesteatomas. Ear Nose Throat J 75:77–88PubMedGoogle Scholar
  16. 16.
    Jeng FC, Tsai MH, Brown CJ (2003) Relationship of preoperative findings and ossicular discontinuity in chronic otitis media. Otol Neurotol 24:29–32PubMedCrossRefGoogle Scholar
  17. 17.
    Richards S, Kilby D (1971) Mastoidectomy using otoplastic flap. J Laryngol Otol 85:1007–1112Google Scholar
  18. 18.
    Pickett BP, Cail WS, Lambert PR (1995) Sinus tympani: anatomic considerations, computed tomography, and a discussion of the retrofacial approach for removal of disease. Am J Otol 16:541–550Google Scholar
  19. 19.
    El-Meselaty K, Badr-El-Dine M, Mandour M et al (2003) Endoscope affects decision making in cholesteatoma surgery. Otolaryngol Head Neck Surg 129:490–496PubMedCrossRefGoogle Scholar
  20. 20.
    Holt JJ (2005) The ponticulus: an anatomic study. Otol Neurotol 26:1122–1124PubMedCrossRefGoogle Scholar
  21. 21.
    Presutti L, Marchioni D, Mattioli F, Villari D, Alicandri Ciufelli M (2008) Endoscopic management of acquired cholesteatoma: our experience. J Otolaryngol 4:1–7Google Scholar
  22. 22.
    Pratt LL (1984) Complications associated with the surgical treatment of cholesteatoma. Laryngoscope 93:289–291Google Scholar
  23. 23.
    Marchioni D, Mattioli F, Alicandri-Ciufelli M et al (2009) Transcanal endoscopic approach to the sinus tympani: a clinical report. Otol Neurotol 30(6):758–765PubMedCrossRefGoogle Scholar
  24. 24.
    Marchioni D, Alicandri-Ciufelli M, Grammatica A et al (2010) Pyramidal eminence and subpyramidal space: an endoscopic anatomical study. Laryngoscope 120(3):557–564Google Scholar
  25. 25.
    Palva T, Johnsson L (1995) Epitympanic compartment surgical considerations: reevaluation. Am J Otol 16(4):505–513PubMedGoogle Scholar
  26. 26.
    Palva T, Ramsay H (1996) Incudal folds and epitympanic aeration. Am J Otol 17:700–708PubMedGoogle Scholar
  27. 27.
    Onal K, Van Haastert RM, Grote JJ (1997) Structural variations of supratubal recess: the anterior epitympanic space. Am J Otol 18:317–321PubMedGoogle Scholar
  28. 28.
    Farrior JB (1968) Tympanoplasty: the anterior attico-tympanotomy. Surgery of the posterior tympanic recess. Laryngoscope 78:768–779PubMedCrossRefGoogle Scholar
  29. 29.
    Donaldson JA, Anson BJ, Warphea RL et al (1970) The surgical anatomy of the sinus tympani. Arch Otolaryngol 91:219–227PubMedGoogle Scholar
  30. 30.
    Marchioni D, Mattioli F, Alicandri-Ciufelli M et al (2008) Endoscopic approach to tensor fold in patients with attic cholesteatoma. Acta Otolaryngol 25:1–9Google Scholar
  31. 31.
    Savic D, Djeric D (1985) Anatomical variations and relations in the medial wall of the bony portion of the eustachian tube. Acta Otolaryngol 99(5–6):551–556PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2011

Authors and Affiliations

  • Daniele Marchioni
    • 1
  • Gabriele Molteni
    • 1
    Email author
  • Livio Presutti
    • 1
  1. 1.Department of Otolaryngology-Head and Neck SurgeryUniversity of Modena and Reggio Emilia, Azienda Ospedaliero-UniversitariaModenaItaly

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