The tympanic membrane is oriented obliquely in the anteroposterior, mediolateral, and superoinferior planes. Consequently, its superoposterior end lies lateral to its anteroinferior end. Anatomically, it relates superiorly to the middle cranial fossa, posteriorly to the ossicles and facial nerve, inferiorly to the parotid gland, and anteriorly to the temporomandibular joint.
Regions
The eardrum is divided into two general regions: the pars flaccida and the pars tensa. The relatively fragile pars flaccida lies above the lateral process of the malleus between the notch of Rivinus and the anterior and posterior malleal folds. Consisting of two layers and appearing slightly pinkish in hue, it is associated with Eustachian tube dysfunction and cholesteatomas. The larger pars tensa consists of three layers: skin, fibrous tissue, and mucosa. Its thick periphery forms a fibrocartilaginous ring called the annulus tympanicus or Gerlach's ligament. while the central umbo tents inward at the level of the tip of malleus. The middle fibrous layer, containing radial, circular, and parabolic fibers, encloses the handle of malleus. Though comparatively robust, the pars tensa is the region more commonly associated with perforations.
Umbo
The manubrium of the malleus is firmly attached to the medial surface of the membrane as far as its center, drawing it toward the tympanic cavity. The lateral surface of the membrane is thus concave. The most depressed aspect of this concavity is termed the umbo.
When the eardrum is illuminated during a medical examination, a cone of light radiates from the tip of the malleus to the periphery in the anteroinferior quadrant, this is what is known clinically as 5 o'clock.
Rupture
Unintentional perforation has been described in blast injuries and air travel, typically in patients experiencing upper respiratorycongestion that prevents equalization of pressure in the middle ear. It is also known to occur in swimming, diving, and martial arts. Patients suffering from tympanic membrane rupture may experience bleeding, tinnitus, hearing loss, or disequilibrium. However, they rarely require medical intervention, as between 80 and 95 percent of ruptures recover completely within two to four weeks. The prognosis becomes more guarded as the force of injury increases.
The pressure of fluid in an infected middle ear onto the eardrum may cause it to rupture. Usually, this consists of a small hole, which allows fluid to drain out. If this does not occur naturally, a myringotomy can be performed. A myringotomy is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. The fluid or pus comes from a middle ear infection, which is a common problem in children. A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously in two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure. Those requiring myringotomy usually have an obstructed or dysfunctional eustachian tube that is unable to perform drainage or ventilation in its usual fashion. Before the invention of antibiotics, myringotomy without tube placement was also used as a major treatment of severe acute otitis media. In some cases, the pressure of fluid in an infected middle ear is great enough to cause the eardrum to rupture naturally. Usually, this consists of a small hole, from which fluid can drain.
Society and culture
The Bajau people of the Pacific intentionally rupture their eardrums at an early age to facilitate diving and hunting at sea. Many older Bajau therefore have difficulties hearing.
