Clinical

Anatomy of
External
Ear and Its
Congenital
Anomalies
Dr Amit Jha
Associate Professor
Chitwan Medical College
Bharatpur-10
Chitwan
 Parts of Ear
• External Ear
• Middle Ear
• Inner Ear
 External Ear
• Pinna
• External Auditory
Canal
 Pinna
• Text
 Nerve Supply of Pinna
• Text or image • Greater Auricular
C2,3
• Lesser occipital C2
• Auriculotemporal V3
• Auricular branch of
CN X also known as
Arnold’s nerve
 External Auditory Canal
Length : 24mm
Two parts:
Outer/Lateral 1/3rd, Cartilagenous Part 8mm
Inner/Medial 2/3rd, Bony Part 16mm
Not straight. Hence, pull the pinna upwards,
backwards and outwards to straighten it.
 Cartilagenous Part
• Only the cartilagenous skin has hair
follicles, hence, susceptible for furuncles
• Cartilagenous fissure of Santorini:
Passage of
infection to and from parotid gland
• Skin covering the cartilaginous canal is
thick
• Contains ceruminous and pilosebaceous
glands that secrete wax
 Bony Part
• Skin lining is thin
• Continuous over tympanic membrane
• Devoid of hair and ceruminous glands
• Isthmus at 6mm
• Anterior recess
• Foramen of Huschke: upto 4 yrs and
sometimes in adult
Anterior Recess
 Relations of EAC
• Superiorly: Middle Cranial Fossa
• Posteriorly: Mastoid Air Cells and the
Facial Nerve
• Inferiorly: Parotid Gland
• Anteriorly: Temporomandibular joint
Congenital Anomalies of
External Ear
Congenital Anomalies of Pinna
 1. Anotia
• Complete absence of
pinna and lobule
• Usually forms the part
of the first arch
syndrome
 2. Microtia
• A major developmental anomaly
• Varying degree of microtia
• a/w anomalies of EAC, Middle Ear an
Inner Ear
• U/L or B/L
• Hearing Loss is frequent
– Eg Peanut Ear is a form of Microtia
Peanut Ear Grade 1 Microtia
Grade 2 Microtia Grade 3 Microtia
Grade 4 Microtia
 3. Macrotia
• Excessively large
pinna
 4. Bat Ear
(syn. Prominent Ear or Protuding Ear)
• An abnormally
protruding ear
• Large concha
• Poorly developed
antihelix and scapha
• Surgery after 6 yrs of
age
Surgical correction of Bat ears
 5. Cup Ear/Lop Ear
• Hypoplasia of the
upper third of the
auricle
• Upper portion of helix
is cupped
• Cockle-shell ear or
snail-shell ear are
greater
deformities of cup
ear
 Cryptotia
(syn. Pocket ear)
• Upper third of the
auricle embedded
under the scalp skin
• Corrected by
mobilizing pinna to
normal position and
covering the raw area
by a skin graft
 7. Coloboma
• Transverse cleft in the
pinna in the middle
 8. Other Minor Deformities
Absent Tragus Darwin’s Tubercle
Stahl’s Ear
• Helix which should
normally be folded is flat
and the upper crus of
antihelix is duplicated and
reaches rim of helix
• Can be corrected by a
mould in the first 6 weeks
of life
 9. Deformities of ear lobule
Absent Ear Lobule Large Lobule
Bifid Lobule Pixed (Attached) Lobule
10. Preauricular Tags/Appendages
• Skin covered tags
that appear on a line
drawn from the tragus
to the angle of mouth
• May contain small
pieces of cartilage
 11. Pre-auricular sinus
• Epithelium lined blind tract with opening at root of helix.
Caused by incomplete fusion of hillocks or tubercles of His
during development.
• May get infected & present with discharge or abscess
formation
• Treatment: Meticulous surgical excision of entire tract
along with a portion of auricular cartilage & skin
around the opening.
Congenital Disorders of EAC
 1. EAC Atresia
• May occur alone or in a/w microtia
• When it occurs alone, it is due to failure of
canalization of the ectodermal core that
fills the dorsal part of the first branchial
cleft
• Outer meatus is obliterated with fibrous
tissue or bone
• Deep meatus and TM are normal
• Atresia with microtia
more common
• May be a/w
abnormalities of
middle ear, inner ear
and other structures
 2. Collaural fistula
• An abnormality of the first branchial cleft
• Two openings of fistula: one in neck just
below and behind the angle of mandible
and the other in external canal or the
middle ear
• Track of fistula transverses through the
parotid in close relation to facial nerve
THANK YOU