J Am Acad Audiol 8: 383-390 (1997)

Anatomy and Orientation of the Human

External Ear
Lynn S . Alvord*
Brenda L. Farmer'

Abstract
A knowledge of the external ear and tympanic membrane is essential to practicing audiolo-
gists . This article provides an introduction to the anatomy of this area including dimensions,
orientation, vasculature, innervation, and relations to other structures . Traditional diagrams
are often inadequate in describing these structures . For example, typical frontal and sagit-
tal views of the external auditory meatus do not adequately describe its anteroposterior
course . Axial (transverse) views provide easier visualization of these areas. A nomenclature
is also provided for areas and angles of the external auditory meatus .

Key Words: Anatomy, external auditory meatus, external ear, nomenclature, orientation,
tympanic membrane

Abbreviations : TM = tympanic membrane

thorough knowledge of the external ear AURICLE

and tympanic membrane (TM) is essen-
A tial to those involved in the diagnosis or he auricle consists of a network of yellow
rehabilitation of auditory disorders. Audiolo- T elastic fibrocartilage covered by a very thin
gists are increasingly involved in making impres- layer of skin, which tightly adheres directly to
sions of deep portions of the external auditory the perichondrium. Since the auricle does not
canal as well as the fitting of hearing instru- contain the usual subcutaneous layer of fat, sus-
ments near the TM. Such procedures should be ceptibility to frostbite is greatly increased.
preceded by a thorough examination of these Major portions of the auricle are shown in
areas in order to ensure that variations may be Figure 1. These include an outer ridge, the helix;
taken into account or appropriate referrals made . an inner ridge, the antihelix, with its two
This paper provides an introduction to the branches or crura; a lobe inferiorly, which con-
anatomy of the external ear, including the TM . sists mainly of fatty tissue ; and the tragus ante-
In addition, new labels for various angles and riorly, which is opposed by the antitragus .
cross-sectional areas of the external auditory Several spaces have also been named including
canal are provided . the concha, which consists of an upper and lower
portion termed the cymba and cavum, respec-
EXTERNAL EAR tively, separated by the crus of the helix. Other

T
HELIX
he external ear consists of the auricle (Latin,
pertaining to hearing), also called the pinna
(Latin, meaning wing), and the external audi-
tory meatus (earcanal) . The external ear is closed
medially by the TM .

*Department of Communication Disorders, Univer-

sity of Utah, Salt Lake City, Utah ; 'Department of Bioengi-
neering, University of Utah, Salt Lake City, Utah
Reprint requests : Lynn S . Alvord, Department of Com-
munication Disorders, University of Utah, 1201 Behavioral
Sciences Building, Salt Lake City, UT 84112 Figure 1 Anatomical subdivisions of the pinna .

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Journal of the American Academy of Audiology/Volume 8, Number 6, December

spaces include the scaphoid fossa, triangular the upward swelling of bone just medial to the
fossa, and intertragic incisure (intertragal notch) . osseo-cartilaginous junction . This upward bony
A recent article uses these labels to suggest a prominence sometimes results in a narrowing of
formal terminology for portions of the earmold the canal at this point called the "isthmus ."
(Alvord et al, 1997). Medial to this point, water or other debris may
The auricle, which extends from the skull at become easily trapped at the inferior angle of the
an angle of approximately 30 degrees (Glasscock canal and TM referred to as the sulcus .
and Shambaugh, 1990), is attached to the skull The cartilaginous portion of the canal is a
by way of three extrinsic muscles, the superior, continuous extension of the cartilage of the con-
anterior, and posterior auricular, which each cha while the bony section is formed from the
have corresponding ligaments of the same name. tympanic and squamous portions of the tempo-
More secure attachment, however, is provided ral bone (Austin, 1991). The earcanal, which is
by the cartilage of the concha bowl, which is rather straight early in life, assumes a definite
continuous with that of the external auditory "S" shape in adulthood that becomes more tor-
meatus . In addition to the three extrinsic mus- tuous and narrowed in later life . Its length is
cles, the auricle has six small intrinsic muscles approximately 2.5 cm superiorly and 3 .0 cm
of unknown purpose. inferiorly.
Figures 3, 4, and 5 are axial (transverse)
EXTERNAL AUDITORY MEATUS views seen from below a right earcanal . This view
is beneficial in visualizing the course of the
he external auditory meatus (earcanal) con- canal as it travels first anteriorly, then posteri-
T sists of an outer cartilaginous portion, com- orly, and finally anteriorly again. We have des-
prising one-third to one-half of its length, and ignated the following labels for areas and angles
an inner bony or osseous portion. The junction of the canal (Fig . 6) : the first and second bends
of these two sections is termed the osseo-carti- divide the canal conveniently into three sec-
laginous junction . Figure 2 is a typical view of tions, sections 1 and 2 constituting the carti-
the external auditory canal as seen in frontal sec- laginous portion and section 3 consisting of the
tion . With this view only, it is impossible to bony portion (see Fig. 6, top) . Distinct angles in
observe the first and second bends or the antero- the horizontal plane occur at the first and sec-
posterior direction changes of the canal. This ond bends of the canal. The angle at the first
view does allow for visualization of the upward-
downward course, which usually occurs due to

Figure 3 Axial CT scan of the RT external auditory

Figure 2 Frontal section of the external auditory canal. meatus of an 81-year-old male, viewed from below.

384
 Anatomy and Orientation/Alvord and Farmer

Figure 5 Simplified diagram of axial CT scan of the RT

Figure 4 Detailed drawing of axial view of the RT external auditory meatus of an 81-year-old male, viewed
external auditory meatus, viewed from below. (Adapted from below. Figure shows first bend (a) and flaring, which
from Huber GC . [1930] . Piersol's Human Anatomy. 9th occurs just medial to the second bend (b).
ed . Philadelphia: JB Lippincott, 1488 .)

bend has previously been designated as the cartilaginous portion of the canal relative to the
"concho-meatal angle (CM)" (Abel et al, 1990). bony portion (see Fig. 7) . The flaring then occurs
An appropriate name for the angle formed at the at the opening to the bony portion as the canal
second bend is the "cartilaginous-bony angle resumes its original size (Polyak et al, 1946).
(CB)" (see Fig. 6, middle) . Abel also labeled the Oliveira (1995) and Polyak et al (1946) have
cross-sectional areas found at the first and sec- stressed the dynamic nature of the canal, indi-
ond bends with the arbitrary designators (OA) cating that the dimensions of the cartilaginous
and (IA), respectively (see Fig. 6, bottom). The portion change with jaw movement . In particu-
cross-sectional area is less at the second bend lar, the anteroposterior width increases when the
than at the first in most individuals. This jaw is opened . These dynamic properties are
notwithstanding, a flaring often occurs after particularly important to consider for "deep
the second bend as may be attested by many who canal" hearing instrument fittings .
have made deep impressions of the canal. Fig- The skin covering the earcanal has many
ure 7 shows how this flaring occurs . It is the nar- unusual properties that are significant to prac-
rowing of the canal in its middle section in the ticing audiologists . An understanding of these
anteroposterior dimension that results in its characteristics will aid in preventing injury to
flaring just beyond the second bend . Our obser- this area . The thinness of the skin and its adher-
vations from transparent "investments" (the ence directly to the perichondrium or perios-
negative of the impression used by hearing aid teum make it especially susceptible to bleeding
companies), as well as CT scans such as Figure when touched due to the lack of flexibility usu-
3, show that the narrowing prior to the second ally afforded by a subcutaneous layer of fat.
bend is due to the anterior displacement of the Bleeding occurs easily, due also to the profuse

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Journal of the American Academy of Audiology/Volume 8, Number 6, December 1997

Regions
2nd bend
i

ANTERIOR
ce
DISPLACEMENT
Cross-sectional Areas Figure 7 Axial view of a RT external auditory meatus,
viewed from below. Note that anterior displacement of car-
tilaginous canal results in flaring beyond the second
bend .

and deeper apocrine sweat glands . As shown in

Figure 8, ducts from these glands meet in the
Figure 6 Axial view of a RT external auditory meatus, channel of the hair follicle, or follicular canal,
viewed from below. Regions, angles, and cross-sectional
through which they are transported to the skin
areas are labeled.

blood supply to the area . The skin is approxi-

mately 0.2 mm thick in the osseous region but
somewhat thicker in the cartilaginous region
(0 .5 - 1.0 mm), where the epidermis is com-
posed of four layers (Lucente, 1995). Skin in
the earcanal is continuous with the outer layer
of the TM . Outward migration of skin occurs
actively at deep levels in the stratified epithe-
lium and more passively on the surface. This
migration allows for normal expulsion of ceru-
men if this process is not inhibited by the use of
cotton swabs, fingers, or ear inserts. Use of these
objects may also damage the natural proper-
ties of the skin by removal of natural oils that
keep the skin lubricated .
Cerumen, or "earwax," is a waxlike sub-
stance that lubricates the skin, preventing its
desiccation (Polyak et al, 1946); has antibacte-
rial properties (Stone and Fulghum, 1984); and
APOCRINE GLAND
may prevent intrusion of insects. Cerumen is pro-
duced only in the outer one-third of the canal by Figure 8 Small sebaceous and larger apocrine glands
a mixture of secretions of numerous sebaceous and their ducts leading to the channel of the hair follicles.

386
 Anatomy and Orientation/Alvord and Farmer

surface. Hairs in the external auditory meatus is a fibrocartilaginous ring or annulus (annular
are of two types. Large hairs found mainly in the ligament), which is imbedded in a groove in the
outer one-third of the cartilaginous portion, tympanic bone, the tympanic sulcus . The annu-
termed tragi, are a secondary sexual charac- lus is deficient superiorly at the notch of Rivi-
teristic and are found to a much greater extent nus (incisura tympanica) .
in males. These hairs occasionally require Common visible landmarks of a right TM are
removal as they may inhibit visualization of the seen in Figure 9. The most prominent landmark
TM, earmold impression, or natural expulsion is the manubrium of the malleus or malleolar
of wax. They may also occur on the tragus, anti- stria running in a superior-anterior direction
tragus, and, occasionally, the helix. In addition from the umbo . The upper portion of the
to the tragi, tiny, almost invisible vellus hairs manubrium is slanted to the right in a right
cover nearly all of the auricle and cartilaginous TM. At the upper edge of the malleolar stria, the
canal wall . In the osseous canal, small hairs malleolar prominence formed by the lateral
and glands occur only rarely and on the poste- process of the malleus may be seen . From this
rior and superior walls. A more detailed descrip- prominence, two ligamentous bands, the ante-
tion of the hairs and glands of the earcanal has rior and posterior malleolar folds, form a 'V' and
been provided by Lucente (1995) . run superiorly to the edge of the TM where they
insert at each end of the notch of Rivinus. These
TYMPANIC MEMBRANE folds, along with the lateral process of the
malleus, encompass the thin upper section of the

T he TM or eardrum (Fig. 9) is a smooth,

translucent, pearl-gray membrane having
an average thickness of 0.074 mm (Donaldson
TM, the pars flaccida or Shrapnell's membrane .
All regions of the TM below these folds are con-
sidered the somewhat thicker pars tensa. The
and Duckert, 1991). It is elliptical in shape and TM may be conveniently divided into four equal
approximately 10 mm high and 8 mm wide quadrants, namely, anterior-superior, anterior-
(Duckert, 1993). Its mass is approximately 14 mg inferior, posterior-superior, and posterior-inferior.
(Zemlin, 1988). The TM is slanted so that its An important diagnostic landmark, the cone of
upper section is closer to the examiner than the light or light reflex, is a reflection of the exam-
lower section. This slanting forms an acute angle iner's light running anteroinferiorly that indi-
of approximately 40 degrees with the floor of the cates normal shape and displacement of the
external auditory canal . This angle is much TM .
smaller at birth, however, when the TM is nearly Other landmarks are sometimes visible
horizontal . The TM is concave, being inwardly behind more transparent eardrums . These
displaced by about 2 mm, except for at its cen- include the long process of the incus, which runs
ter or umbo (apex), where there is an outward posteriorly and parallel to the upper part of the
jutting caused by the inferior tip of the manu- manubrium of the malleus ; the head of the
brium of the malleus . The outer edge of the TM stapes, seen as a round whitish spot just below
the incus; the recess of the round window ; the
opening of the eustachian tube ; and the chorda
PS f AS tympani nerve, which dangles freely in the mid-
Pars flaccida
I (Shrapnell's membrane) dle ear space.
The TM is thickest anterosuperiorly and
near the annulus inferiorly (0 .09 mm) and
Lateral process
of malleus
thinnest in the middle of the posterosuperior
(short process) quadrant (0 .055 mm) (Donaldson and Duckert,
1991). Considering its thinness, the TM is sur-
prisingly tough and resilient (Zemlin, 1988).
These qualities are due to the TM's layered
architecture . The major layers consist of an
outer cutaneous layer, which is continuous with
the lining of the external auditory canal; a mid-
dle fibrous layer or lamina propria; and an inter-
nal layer or serous (mucous) membrane, which
Figure 9 Right tympanic membrane . Four quadrants
are designated with initials : PS = posterior-superior, AS is continuous with the lining of the middle ear.
= anterior-superior, PI = posterior-inferior, AI = anterior- The cutaneous layer may be subdivided into
inferior. an outer layer of squamous epithelium and a

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Journal of the American Academy of Audiology/Volume 8, Number 6, December 1997

deeper layer of cuboidal epithelium . Migration

of the outer epithelial layer begins at the umbo
and continues outward through the external
auditory canal carrying debris out of the ear. The
rate of this centrifugal migration at the eardrum
has been shown to be approximately 0.05 mm per Auriculotemporal
branch of ------- Ow
day (Litton, 1963). trigeminal nerve

The middle fibrous layer maybe subdivided

into an outer (lateral) layer of radial fibers
resembling the spokes of a wheel and an inner
layer of circular (circumferential) fibers . The
radial fibers are responsible for giving the TM
its tent-like shape. The circular fibers, which are
most dense near the center or outer edge, lend
flexibility. In addition to these two main fibrous
layers, there are some intertwining fibers run-
ning transversely and parabolically connecting
the main layers (Duckert, 1993). Although it Figure 11 Sensory nerves of the external ear: lateral
was originally believed that the TM lacked the (anterior) surface. (Adapted from Goycoolea MV, Papar-
middle fibrous layer in the pars flaccida region, ella MM, Nissen RL . [1989] . Atlas of Otologic Surgery.
Duckert (1993) maintains that all layers are Philadelphia : WB Saunders, 9.)

present throughout the TM .

ENNERVATION
11) is innervated primarily by the greater auric-
igures 10 and 11 show sensory innervation ular nerve but also receives fibers in the concha
F of the medial (posterior) and lateral (ante- area from the auricular branch of the vagus
rior) surfaces of the pinna. The "great auricular nerve, and in superior areas by the "auricu-
nerve," which is a branch of the third cervical lotemporal nerve," which comes from the
nerve, innervates most of the medial and lateral mandibular branch of cranial nerve V While
surfaces of the pinna (Duckert, 1993). To a lesser the above-mentioned nerves provide most of the
extent, the medial surface is also innervated pinna's innervation, some authors also attribute
inferiorly by the "auricular branch" of the vagus minor contributions by cranial nerve IX (glos-
nerve and superiorly by the "lesser occipital" sopharyngeal), as well as the first and second cer-
nerve. The lateral surface of the pinna (see Fig. vical nerves (English, 1976 ; Lucente, 1995).
The external auditory meatus and the TM's
lateral surface are innervated mainly by the
auricular branch of the vagus nerve (inferior
and posterior canal wall) and the auriculotem-
poral nerve (anterior and superior canal wall).
These two nerves continue on to the lateral sur-
face of the TM where they innervate its poste-
rior and anterior halves, respectively. A sensory
branch of cranial nerve VII also contributes in
a minor way to the innervation of the postero-
superior wall of the external auditory canal,
which explains the hyperesthesia experienced by
some patients with acoustic neuroma (Roeser,
1996) . Small branches of cranial nerves IX and
VII may also play a minor role in the innerva-
tion of the TM's lateral surface . The inner
(medial) surface of the TM is innervated by the
tympanic branch of cranial nerve IX.
Figure 10 Sensory nerves of the external ear: medial The only motor innervation to the external ear
(posterior) surface. (Adapted from Glasscock ME, Sham-
is to the minor extrinsic muscles of the auricle pro-
baugh GE . [1990] . Surgery of the Ear. 4th ed . Philadel-
phia : WB Saunders, 37 .) vided by the temporal and posterior auricular

388
 Anatomy and Orientation/Alvord and Farmer

branches of the facial nerve, which allows for through the bony wall of the osseous meatus .
movement of the pinna in some individuals . This vessel completely surrounds the TM, giv-
The large number of nerves involved in the ing off smaller branches that cover most of the
innervation of the external ear explains the pars tensa and area of the manubrium. The
"referred otalgia" experienced by many whose internal surface receives blood from the poste-
actual disorder is located in the mouth, nose, rior auricular artery's stylomastoid branch and
throat, neck, or viscera (Schulier and Schleun- also from the tympanic branch of the maxillary
ing, 1994). The presence of the vagus nerve at artery. Venous drainage from the TM is into the
the midpoint of the posterior wall explains the external jugular veins, transverse sinus, and
cough or syncope (fainting) reflex experienced by veins of the dura mater and, to a lesser extent,
many who are touched in this area such as when into veins of the eustachian tube .
a hearing aid impression is made .
RELATIONS
VESSELS AND LYMPHATICS

he external auditory meatus is related ante-

ig-ure 12 shows the major arteries that sup-
T riorly to the condyle of the mandible and the
F ply the pinna. These include subdivisions of
parotid gland. Swelling of the anterior lymph
the external carotid artery, namely, the posterior
node can sometimes be mistaken for a parotid
auricular and superior temporal arteries . These
gland mass . The close proximity of this large
two arteries also supply the external auditory
saliva gland sometimes allows infections or
canal with aid from the deep auricular artery,
tumors to spread into the earcanal or vice versa
a branch of the internal maxillary artery.
by way of the fissures of Santorini, which are ver-
Principal veins for both the pinna and exter-
tical slits in the cartilage of the anterior wall of
nal auditory meatus are branches of the tempo-
the canal. Under normal conditions, these slits
ral vein (the anterior auricular tributaries) and
allow flexibility of the auricle.
the posterior auricular vein (auricular branch-
The superior wall of the bony canal is sep-
es) (Anson, 1966). Lymphatic drainage is into
arated from the epitympanic recess of the mid-
lymph nodes located just anterior, posterior,
dle ear by a thin layer of bone . If middle ear
and inferior to the auricle.
infections invade this area, there may be a sag-
The external (lateral) and internal (medial)
ging of the roof of the canal. Similarly, the close
surfaces of the TM receive blood from separate
proximity of the mastoid air cells to the poste-
sources. The external surface receives blood
rior wall of the canal may result in a fistula
from the deep auricular artery, which enters
into the canal in acute mastoiditis (Roeser, 1996).

SUMMARY

A thorough knowledge of the anatomy of the

external ear is essential to those involved
in the diagnosis and treatment of hearing dis-
orders . The new nomenclature proposed for
areas and angles of the external auditory mea-
tus should prove useful for purposes of teaching
and communicating between professionals.

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