Comparison of fetal and adult tympanic membrane sizes: a cadaveric study.

OBJECTIVE: The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. METHODS: Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. RESULTS: The mean area, height and width of the TM in adults were found as 58.84 ± 22.01 mm2, 9.06 ± 1.33 mm, and 8.10 ± 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 ± 12.57 mm2, 8.22 ± 1.12 mm, and 7.25 ± 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20-32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. CONCLUSION: The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) × 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations.

Sexual dimorphism in external morphology of the American bullfrog Rana (Aquarana) catesbeiana and the possibility of sex determination based on tympanic membrane/eye size ratio.

The American bullfrog Rana (Aquarana) catesbeiana has been reported to show significant sexual dimorphism based on the size ratio between the tympanic membrane and the eye. In males the tympanic membrane is much larger than the eye, but not in females. The ratio has been used as a convenient criterion to discriminate sexes (sexing) in the American bullfrog, though its reliability is unknown. In this study, we examined 86 adult American bullfrogs to clarify whether the tympanic membrane long diameter/eye long diameter (Dtm/De) ratio is a reliable index to discriminate sexes in this species. In addition, we examined the growth of this sexually dimorphic trait. Results indicated that there is a significant difference but there is a small overlap in this ratio Dtm/De between sexes. The allometric comparisons showed the sexual dimorphism of the Dtm/De ratio was increased during growth and the dimorphism is attributable to the difference in the growth rate of the tympanic membrane (Dtm). Therefore, sex determination of American bullfrogs cannot be wholly reliably achieved by the Dtm/De ratio alone; other external morphological features are required in addition.

Laser-induced tissue remodeling within the tympanic membrane.

The tympanic membrane (TM) separates the outer ear from the tympanic cavity. Repeated pathologies can permanently decrease its tension, inducing conductive hearing loss and adhesive processes up to cholesteatoma. The current main therapy is its surgical reconstruction. Even though lasers have been proposed to tighten atrophic TMs, details of this effect, specifically histological analyses, are missing. We therefore used laser pulses to induce TM collagen remodeling in an animal model to compare the histological and electrophysiological effects of different applied laser intensities before entering clinical studies. We irradiated Fuchsin-stained areas of the TM in anesthetized mice with 532-nm laser-pulses of 10 mW for 30 s (0.3 J), 25 mW for 30 s (0.75 J) or 50 mW for 30 s (1.5 J) monitoring hearing with auditory brainstem responses (ABRs). The mice were sacrificed after 2 to 8 weeks and histologically analyzed. An increase in the TM thickness within the defined, stained, and irradiated areas could be observed after 4 weeks. Polarized light microscopy and transmission electron microscopy demonstrated the tissue volume increase majorly due to new collagen-fibrils. Directly after irradiation, ABR thresholds did not increase. We herein demonstrate a controlled laser-induced collagen remodeling within defined areas of the TM. This method might be the prophylactic solution for chronic inflammatory ear pathologies related to decreased TM tension.

Mechanical properties of the Papio anubis tympanic membrane: Change significantly from infancy to adulthood.

Mechanical properties of the tympanic membrane (TM) are important for studying the transfer function of the auditory system. However, nearly all reported human data are limited to adults because of the unavailability of temporal bones from children. In this study, we used the baboon (Papio anubis), a genetically close human relative, as a model to address the occurrence of age-dependent changes of the human TM. Forty-five baboon TMs were characterized in five age groups: <1 year, 1 to <2 years, 2 to <3 years, 3 to <5, and >5 years of age, comparable to human ages ranging from newborn to adult. The elastic properties of the baboon TMs were characterized by a micro-fringe projection technique. Volume displacement of the TM under quasi-static pressure was first determined from its micro-fringe pattern. Subsequently, these displacement values were used in a finite element model to derive mechanical properties. The Young's modulus of the baboon TM exhibited a modest decrease from 29.1 MPa to 26.0 MPa over the age groups. The average Young's modulus was ∼1.4 times higher than that of the adult human TM. This is the first time that age-related TM mechanical properties of high primate are reported. These new findings may help to explore the potential value of the baboon as a new primate model for future age-related hearing research on the normal and diseased ear.

Better late than never: effective air-borne hearing of toads delayed by late maturation of the tympanic middle ear structures.

Most vertebrates have evolved a tympanic middle ear that enables effective hearing of airborne sound on land. Although inner ears develop during the tadpole stages of toads, tympanic middle ear structures are not complete until months after metamorphosis, potentially limiting the sensitivity of post-metamorphic juveniles to sounds in their environment. We tested the hearing of five species of toads to determine how delayed ear development impairs airborne auditory sensitivity. We performed auditory brainstem recordings to test the hearing of the toads and used micro-computed tomography and histology to relate the development of ear structures to hearing ability. We found a large (14-27 dB) increase in hearing sensitivity from 900 to 2500 Hz over the course of ear development. Thickening of the tympanic annulus cartilage and full ossification of the middle ear bone are associated with increased hearing ability in the final stages of ear maturation. Thus, juvenile toads are at a hearing disadvantage, at least in the high-frequency range, throughout much of their development, because late-forming ear elements are critical to middle ear function at these frequencies. We discuss the potential fitness consequences of late hearing development, although research directly addressing selective pressures on hearing sensitivity across ontogeny is lacking. Given that most vertebrate sensory systems function very early in life, toad tympanic hearing may be a sensory development anomaly.

Association Between Tegmen Tympani Status and Superior Semicircular Canal Pattern.

OBJECTIVE: Detecting and quantifying the possible association between tegmen tympani (TT) status and superior semicircular canal (SSC) pattern. DESIGN: Observational study. SETTING: Study conducted in three tertiary Spanish hospitals. PATIENTS: Nonselected consecutive patients of all ages (607 temporal bones). INTERVENTIONS: Thin-section multidetector row computed axial tomography (CAT scan) of the temporal bones. MAIN OUTCOME MEASURE: Thickness of SSC bone coverture adjacent to the middle fossa, and TT status as a dichotomous variable: dehiscence (TTD) or integrity (TTI). RESULTS: The observed SSC patterns were dehiscence (3.79%), papyraceous or thin (11.20%), normal (76.77%), thick (4.94%), and pneumatized (3.29%). The observed TT statuses were TTD (10.87%) and TTI (89.13%). TTD was associated with SSCD and papyraceous patterns, and TTI percentages were higher in normal and thick patterns (χ2 = 11.102; p = 0.001). The TTD probability was estimated as a function of SSC pattern and age by a multivariate binary logistics regression model (χ2 = 45.939; p < 0.001). CONCLUSION: SSC pattern was significantly associated with TT status. Age influenced this association. The risk for TTD increased by 4.1% per each year of increasing age, did not differ significantly for normal and thick patterns, and increased 12 times and 20 times for papyraceous and SSCD patterns, respectively.

Morphology and ciliary motion of mucosa in the Eustachian tube of neonatal and adult gerbils.

The Eustachian tube is a small canal that connects the tympanic cavity with the nasal part of the pharynx. The epithelial lining of the Eustachian tube contains a ciliated columnar epithelium at the tympanic cavity and a pseudostratified, ciliated columnar epithelium with goblet cells near the pharynx. The tube serves to equalize air pressure across the eardrum and drains mucus away from the middle ear into the nasopharynx. Blockage of the Eustachian tube is the most common cause of all forms of otitis media, which is common in children. In the present study, we examined the epithelial lining of the Eustachian tube in neonatal and adult gerbils, with a focus on the morphological and functional development of ciliated cells in the mucosa. The length of the tube is ∼8.8 mm in adult gerbils. Scanning electron microscopy showed that the mucosal member near the pharyngeal side contains a higher density of ciliated cells and goblet cells than that near the tympanic side. The cilia beat frequency is 11 Hz. During development, the length of the Eustachian tube increased significantly between postnatal day 1 (P1) and P18. Scanning electron microscopy showed that the mucosa contained a high density of ciliated cells with a few goblet cells at P1. The density of ciliated cells decreased while the density of goblet cells increased during development. At P18, the mucosa appeared to be adult-like. Interestingly, the ciliary beat frequency measured from ciliated cells at P1 was not statistically different from that measured from adult animals. Our study suggests that the Eustachian tube undergoes significant anatomical and histological changes between P1 and P18. The tube is morphologically and functionally mature at P18, when the auditory function (sensitivity and frequency selectivity) is mature in this species.

[Peculiarities of the development of antrum in the prematurely born infants].

The objective of the present study was to elucidate specific surgical anatomical features of the antrum in the children prematurely born at different gestational age. A total of 70 temporal bones from 35 newborn infants were available for the examination. The study revealed clinical and anatomical peculiarities in the antrum structure of the children prematurely born at different gestation age.

[Clinical and anatomical features of the middle ear in the premature infants at different gestational time].

The objective of the present study was to analyse anatomical features of the middle ear in the premature infants of different gestational age. Materials from 100 still-born and live-born babies (200 temporal bones) were available for the investigation. The study has revealed a number of distinctive clinical and morphological peculiarities in the structure of tympanic membranes in both the prematurely born infants depending on the gestational age and in the full-term babies. The fluid from the tympanic cavity was found to contain human beta-chorionic gonadotropin.

Comparison of cochlear implant relevant anatomy in children versus adults.

HYPOTHESIS: To test whether there are significant differences in pediatric and adult temporal bone anatomy as related to cochlear implant (CI) surgery. BACKGROUND: Surgeons rely upon anatomic landmarks including the round window (RW) and facial recess (FR) to place CI electrodes within the scala tympani. Anecdotally, clinicians report differences in orientation of such structures in children versus adults. METHODS: Institutional review board approval was obtained. High-resolution computed tomographic scans of 24 pediatric patients (46 ears) and 20 adult patients (40 ears) were evaluated using software consisting of a model-based segmentation algorithm that automatically localizes and segments temporal bone anatomy (e.g., facial nerve, chorda tympani, external auditory canal [EAC], and cochlea). On these scans, angles pertinent anatomy were manually delineated and measured blinded as to the age of the patient. RESULTS: The EAC and FR were more parallel to the basal turn (BT) of the cochlea in children versus adults ([symbol in text] EAC:BT 20.55 degrees versus 24.28 degrees, p = 0.003; [symbol in text] FR:BT 5.15 degrees versus 6.88 degrees, p = 0.009). The RW was more closely aligned with the FR in children versus adults ([symbol in text] FR:RW 30.43 degrees versus 36.67 degrees, p = 0.009). Comparing the lateral portion of the EAC (using LatEAC as a marker) to the most medial portion (using [symbol in text] TM as a marker), the measured angle was 136.57 degrees in children and 172.20 degrees in adults (p < 0.001). CONCLUSION: There are significant differences in the temporal bone anatomy of children versus adults pertinent to CI electrode insertion.

Maturation of the occlusion effect: a bone conduction auditory steady state response study in infants and adults with normal hearing.

OBJECTIVE: The aim of this study was to investigate the maturational time course of the occlusion effect in infants with normal hearing. The objectives were (i) to investigate the occlusion effect in a larger group of young infants, (ii) to determine whether the occlusion effect is seen in bone conduction auditory steady state responses (ASSRs) for older infants, and (iii) to investigate the mechanisms that underlie bone conduction hearing in unoccluded and occluded ears in infants by measuring sound pressure in the ear canal. DESIGN: Experiments 1A and 1B: The SPL in the ear canal to 500, 1000, and 2000 Hz bone-conducted pure tones were compared in 22 young infants (0-7 mo), 10 older infants (10-22 mo), and 34 adults, all with normal hearing, for unoccluded and occluded ears. Experiment 2: Bone conduction behavioral thresholds in 17 adults were compared for unoccluded and occluded ears at 500, 1000, 2000, and 4000 Hz. Experiment 3: Bone conduction ASSR thresholds and amplitudes were compared in 22 young infants, 10 older infants, and 20 adults for an unoccluded and occluded test ear. Stimuli were bone-conducted amplitude/frequency-modulated tones presented simultaneously at 500, 1000, 2000, and 4000 Hz. RESULTS: There were significant increases in sound pressure in the ear canal for stimuli presented at 40 dB HL when ears were occluded at 500 and 1000 Hz for all age groups. Infants showed the largest increases in SPL at 500 and 1000 Hz (5-8 dB > adults). Young infants showed no significant decreases in ASSR thresholds (2-6 dB) and amplitudes (0-10 nV) across frequency with occlusion; however, a significant number of infants had an occlusion effect at 500 Hz. Older infants showed a nonsignificant decrease in ASSR thresholds with occlusion (8 dB), a significant increase in ASSR amplitudes at 1000 Hz (6-21 nV), and a significant number of infants with an occlusion effect at 1000 Hz. Adult behavioral thresholds decreased significantly when ears were occluded at 500 and 1000 Hz; for ASSRs, thresholds also decreased (6-7 dB) and amplitudes increased (3-11 nV) at both 500 and 1000 Hz, but the mean trends and statistical findings were not in agreement in all cases. A significant number of adult subjects had an occlusion effect at 500 and 1000 Hz for both behavioral and ASSR thresholds. CONCLUSIONS: Our findings suggest that the occlusion effect for ASSR thresholds in young infants is small but emerging at 500 Hz but negligible at 1000 Hz and that the occlusion effect in older infants is emerging at both 500 and 1000 Hz. The clinical implications of these findings are that it is appropriate to conduct bone conduction testing on young infants without compensating for an occlusion effect; however, for older infants, it is prudent to remove insert earphones during bone conduction testing. For both young and older infants, occluding the ear canal increases the sound pressure near the tympanic membrane; however, this pathway appears to contribute less to bone conduction hearing when ears are occluded compared with adults as measured by ASSRs.

Postnatal development of the middle ear in New Zealand White rabbits: ossicles and tympanic ring.

We studied the postnatal development of the middle ear (ME) in New Zealand White rabbits. Bullae were scanned using a desktop X-ray microtomograph and 3D models of the ME ossicles as well as the tympanic ring (TR) were prepared. In 0, 1, 2 days old rabbits the ossification process was incomplete. We can therefore present quantitative data obtained from older rabbits (ages: 4-180 days) and a qualitative description at the earlier ages. For a number of the measured parameters an exponential curve could be fitted to the data, and the time constant (at which 63% of the final value was obtained) was calculated. The length of the manubrium increased rapidly in a period of about 15 postnatal days, from 1.73 mm to 4.08 mm. The distance between the tip of the malleus and the TR increased rapidly until day 30, from nearly 0 to 1.40 mm. The increase of the surface area within the TR was small as compared to inter-specimen variance, but the ratio [tympanic membrane area]/[TR area] clearly increased (from 1.00 to 1.11), with a time constant of 8.3 days. The area of the stapes footplate (FP) increased rapidly in about 15 days (from 0.72 mm(2) to 1.49 mm(2), time constant 4.8 days). The TR was nearly developed at birth whereas the stapes footplate was quite underdeveloped. The distance between the tip of the malleus and the incudomallear rotation axis increased rapidly until day 20 and varied between 3.47 mm and 5.00 mm. The distance between the tip of the incus and the rotation axis increased until day 133, from 1.39 mm to 1.69 mm. Our study shows that in rabbits the ME is underdeveloped at birth and that the functional geometry develops over the same time course as the ability to hear. The conical shape of the tympanic membrane (TM) is formed by retraction and growth of the manubrium, mainly during the first 40 days after birth.

Suitability of formaldehyde-treated acellular dermis for tympanic membrane repair in chinchillas.

HYPOTHESIS: Formalin-fixed acellular dermis (AlloDerm; LifeCell Corporation, Branchberg, NJ, USA) is safe and efficacious for tympanoplasty in the chinchilla model as compared with the established technique of nonfixed acellular dermis tympanoplasty. BACKGROUND: Temporalis fascia autografts have been shown safe and effective in the treatment of near-total tympanic membrane (TM) perforations. The formalin-fixation technique first described by Perkins allows the autologous fascia graft to be shaped to more closely resemble the natural TM and has been successful but somewhat cumbersome. The use of acellular dermis as a fascia substitute has also been shown safe and effective in closing smaller perforations. We sought to determine whether formalin-fixed acellular dermis is as safe and useful as nonfixed acellular dermis for TM perforation repair by examining inflammation and tissue effects in a well-established animal model of perforation. METHODS: Fifteen adult chinchillas underwent creation of 2-mm central perforations created using a Coherent CO2 laser. Each chinchilla underwent an immediate formalin-fixed acellular dermis repair in one ear and an unfixed acellular dermis repair in the other ear as a control. The chinchillas were randomized with regard to the repair applied to each ear. After 6 weeks of observation, the animals were killed by using sodium pentobarbital (dose, 150 mg/kg). The TMs were otomicroscopically examined for tissue reaction and repair success by a blinded observer. An estimate of residual perforation, if any, was made at that time. The TMs were then harvested and examined histopathologically by a blinded veterinary pathologist. RESULTS: Thirteen chinchillas survived to the evaluation endpoint. There were no significant differences in inflammation, fibrosis, and cellular ingrowth between the 2 groups, although there was a trend toward less inflammation in the formalin-fixed ears. Effusions were present in 15% of non-formalin-fixed ears. Adhesions were present in 15% of non-formalin-fixed ears and 8% of the formalin-fixed ears. A TM cholesteatoma was observed in one non-formalin-fixed ear. The TMs were completely healed in 11 (85%) of 13 TMs in each group. CONCLUSION: Formalin-fixed acellular dermis was as safe and efficacious as nonfixed acellular dermis in the repair of TM perforations in a chinchilla model. No adverse tissue effects related to formalin treatment were observed.

Prolonged maturation of cochlear function in the barn owl after hatching.

Cochlear microphonics (CMs), which represent the electrical activity of hair cells, and compound action potentials (CAPs), which represent the activity of the auditory nerve, were recorded from the round window of the inner ear, in owlets aged between 5 and 97 days posthatching, i.e., from soon after hatching to beyond fledgling. At the earliest ages examined, animals showed very insensitive CM and virtually no CAP responses. Thus, hearing in barn owls develops entirely posthatching and the birds appear to be profoundly deaf well into the second week. Thresholds improved gradually after that and CMs reached their adult sensitivity at 5 weeks posthatching at all frequencies. Compound action potential responses appeared progressively later with increasing frequency. Adult neural sensitivity was achieved about 1 week later than for the CM responses at most frequencies, but took until 9-10 weeks posthatching at the highest frequencies (8-10 kHz). This indicates an apex-to-base maturation sequence of neural sensitivity within the cochlea, with a disproportionately long period to maturity for the most basal regions. Compound action potential amplitudes matured even later, at about 3 months posthatching, at all frequencies. This suggests a prolonged immaturity in the temporal synchrony of spiking in the auditory nerve.

The development of the middle ear in neonatal chinchillas II. Two weeks to adulthood.

Studies of auditory function in the human neonate indicate adult-like hearing sensitivity, mature cochlear function and well-developed responses in the auditory pathway. Paradoxically, measurements of middle ear function are characterized by responses that would be interpreted as abnormal in older subjects. Consequently, there is not an accepted clinical test for middle ear disease in the newborn population. Like human neonates, chinchillas have normal hearing sensitivity at birth, but middle ear function tested by multifrequency tympanometry is abnormal compared to the adult. A previous study from our laboratory indicated that the newborn chinchilla middle ear is free of mesenchyme and other debris. Over the first 2 weeks of life there were no significant changes in tympanic membrane thickness and diameter, tympanic membrane to promontory distance and stapes footplate length. There were small changes in mastoid bulla area and perimeter and in mastoid bulla bone thickness. The most striking difference between the newborn and adult temporal bone was in bone composition, the newborn bone having a less dense, spongy appearance. Impedance characteristics of the newborn chinchilla ear, measured by multifrequency tympanometry, were abnormal relative to adult animals and did not change over the first 2 weeks of life. This investigation is an extension of the previous study, designed to better understand the relationship between middle ear function, hearing sensitivity and the structural changes of the newborn chinchilla middle ear. Twenty animals, aged 2-8 weeks, were studied. Additional adult animals were used as controls. Middle ear function was assessed by a wideband reflectance impedance system. Hearing sensitivity was measured by auditory brainstem response in 2- and 8-week-old animals. Structural characteristics of the temporal bone were analyzed using histopathologic preparations. There was an orderly progression in middle ear impedance and reflectance characteristics as the chinchilla ear matured from 2 to 8 weeks of age. At 8 weeks of age, impedance and reflectance patterns approached, but did not match, those of the adult animal. Hearing sensitivity was unchanged throughout this maturational period. Finally, histological analysis demonstrated no age-related changes in distance from the tympanic membrane (TM) to the promontory and in stapes footplate length. There was a small significant decrease in the TM thickness from 2 weeks to adulthood. The most significant developmental changes were a reduction in mastoid bone thickness and concomitant increases in the perimeters and areas of the middle ear and posterior bulla.

Postnatal development of the tympanic cavity: a computer-aided reconstruction and measurement study.

A computer-aided 3-D reconstruction and measurement method was used to assess postnatal volume and height changes in the tympanic cavity. Materials used were 14 normal human temporal bones obtained from 6 infants (under 1 year of age) and 8 adults (over 18 years of age). After defining the boundaries of the tympanic cavity, its total volume and height and the volume and height of the epitympanum, mesotympanum and hypotympanum were measured. The relationship between the volume of the tympanic cavity and age, and the correlation between the volume of the tympanic cavity and the grade of pneumatization of the air cells were also studied. The average volume of the tympanic cavity in adults (640.1+/-69.1 mm3, n = 8) was about 1.5 times larger than the volume of the infant cavity (451.7+/-68.2 mm3, n = 6). The hypotympanum increased most postnatally and the mesotympanum least. The volume of the tympanic cavity increased in proportion to increasing pneumatization in bone surrounding the cavity. The postnatal increase in the height of the tympanic cavity appears to be the major contributor to the increase in volume of the cavity. Postnatal changes in the tympanic cavity have clinical implications.

Maturation of tympanic membrane layers and collagen in the embryonic and post-hatch chick (Gallus domesticus).

The surface area of the chick (Gallus domesticus) tympanic membrane (TM) increases by as much as 400% from hatching to 70 days of age (Cohen et al. [1992] J. Morphol. 212:187-193). The present study is concerned with the processes that contribute to this remarkable size increase. Middle-ear specimens were harvested in embryos aged between E10 and E18, and in post-hatch animals between days P1 and P57. Specimens were embedded in paraffin, cut in serial sections, stained for collagen fibers, and examined with light microscopy. Four locations were examined in each specimen: the anterior and posterior perimeter of the TM, the TM, over the extra-stapedius, and the TM at the tip of the extra-columella. The thickness of the epithelial, respiratory, and lamina propria layers was measured at each location. The radial collagen fibers in the lamina propria were also counted at each location, and fiber density per square micrometer was determined at each age. Thickness of the epithelial and respiratory layers remains relatively constant throughout development in all areas of the TM, whereas the lamina propria at the extra-columella and extra-stapedius continues to thicken with increasing age. Collagen density also increases during development, and this is attributed to an increase in fiber number and a reduction in the space between fibers. The results suggest that collagen may be synthesized first in the central regions of the TM and then later in more peripheral areas of the TM.

Postnatal change in angle between the tympanic annulus and surrounding structures. Computer-aided three-dimensional reconstruction study.

Postnatal developmental relationships in human ears were studied by a computer-aided three-dimensional reconstruction and measurement method. We measured the angle, in reference to the horizontal plane, between the tympanic annulus, the oval window, and the internal auditory canal (IAC) in 20 normal temporal bones obtained from individuals between 1 day old and 76 years old. The horizontal plane was defined as the plane sloped 30 degrees infero-anteriorly from the plane of the horizontal canal in each specimen. The plane of the tympanic annulus changed from a nearly horizontal orientation (34.2 degrees from the horizontal plane) in neonates to a more vertical orientation (63.3 degrees from the horizontal plane) in adults. The tympanic annulus and oval window planes remained at the same angle to each other (11.9 degrees +/- 5.1 degrees) throughout postnatal development, as did the plane of the tympanic annulus and the IAC (68.6 degrees +/- 5.3 degrees). These findings have implications for ear surgeons, especially those operating on young children.

Applied embryology and post-natal morphology of the human tympanic membrane.

This article deals with the morphological as well as histological changes of the tympanic membrane and bone from early embryological life until mature age. An overview of the continuous changes is given with reference to pertinent clinical implications.