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y equipment. You may view any picture and the accompanying text by clicking the image. Figure 1 - The normal tympanic membrane Figure 2 - Wax Figure 3 - Acute otitis media with effusion (A) Figure 4 - Acute otitis media with effusion (B) Figure 5 - Acute otitis media with no recognisable landmarks Figure 6 - Serous (secretory) otitis media (A) Figure 7 - Fluid behind the eardrum Figure 8 - Resolution of middle ear infection Figure 9 - Serous otitis media (B) Figure 10 - Tympanosclerosis Figure 11 - Central perforation of the ear drum Figure 12 - Grommet - Tympanostomy tube
1. The
The normal tympanic membrane The normal tympanic membrane is thin and semi-transparent. When viewed through an otoscope it has a pearly-grey appearance and often some structures within the middle ear, such as the long process of the incus and the opening of the eustachian tube, can be seen if it is sufficiently transparent. Where the outer margin of the drum is attached to the external canal it is thickened and called the annulus fibrosa. The upper fifth of the drum is slack and called the pars flaccida and the lower four-fifths called the pars tensa. The handle of the malleus, which extends downwards and backwards, is a reliable landmark. The short process of the malleus protrudes forwards into the external canal. The umbo is the central attachment of the tympanic membrane to the malleus. From the umbo a cone of light extends downwards and forwards. The blood supply of the tympanic membrane comes form the ear canal superiorly. Prominent blood vessels on the rim superiorly are within normal limits.
2. Wax
Wax, or cerumen, is a normal secretion in the cerumenous glands in the outer part of the meatus, and can obscure or partially obscure the drum. When it is first produced it is colourless and semi-liquid in consistency, but with time it changes from pale yellow, to golden yellow, to light brown and finally black. As the wax darkens it also hardens, and the darker the colour the denser the consistency.
10. Tympanosclerosis
Tympanosclerosis. In some cases of otitis media healing may not be completed and the inflammatory process leads to the formation of scar tissue. This can take the form of calcified plaques on the tympanic membrane.