Eye anatomy

Author: Jana Vasković • Reviewer: Nicola McLaren MSc • Last reviewed: June 11, 2020 

Orbit (anterior view)

The eyes are essential for our daily experience, since about 70% of information we gather
is by seeing. They are placed within the orbits, two cavities in the upper face, in the
anterior surface of the head.
Besides the eyes, the orbits host several structures that support the eyeballs, including
muscles, vessels, nerves and a gland. The orbits are specifically designed to allow these
neurovascular structures to pass through its walls, from the cranium on their way to the
face.

This page will discuss the anatomy of the eye and orbit.

Key facts about the orbit and eyes

Orbit definition Bony cavity within the skull that houses the eye and its associated structures (muscles of the
eye, eyelid, periorbital fat, lacrimal apparatus)

Bones of the orbit Maxilla, zygomatic bone, frontal bone, ethmoid bone, lacrimal bone, sphenoid bone and palatine
bone

Structure of the eye Cornea, anterior chamber, lens, vitreous chamber and retina

Muscles of the eye Extrinsic: Superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior
oblique, levator palpebrae superioris
Intrinsic: Sphincter pupillae, dilator pupillae, ciliaris
 Innervation of the eye Vision: Optic nerve (CN II)
Muscles: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Blood supply of the Ophthalmic artery, vorticose veins

eye

Contents

1. Bones of the orbit

2. Eyelid anatomy
3. Lacrimal gland
4. Eye muscles
5. Eyeball
1. Blood supply of the eye
2. Nerves of the eye

+ Show all

Bones of the orbit

The bony orbit is made out of seven bones, which include the maxilla, zygomatic

bone, frontal bone, ethmoid bone, lacrimal bone, sphenoid bone and palatine bone. The
orbit appears as a pyramid, with its base opening anteriorly onto the face, while the
apex is pointed posteromedially. The orbit hosts the eyeballs, extraocular muscles, optic
nerve, lacrimal apparatus, fat tissue, fascia and vessels that supply these structures.

The walls of the orbit contain several fissures, openings and fossae which are important
for housing the orbital structures, and for neurovascular communication of the orbital
content with the central nervous system. Some of the most important openings are
the superior orbital fissure and its downstairs neighbour, the inferior orbital fissure. More
about them and all the other landmarks of the orbital bones can be found in the
following article and quizzes.

Bones of the orbitExplore study unit

 Superior and inferior orbital fissuresExplore study unit

Eyelid anatomy

The eyelids are soft tissue structures that cover and protect the anterior surface of the
eyeball. The anatomy of the eyelid may seem complex, but if we dissolve its multi-
layered structure it is actually quite simple: 

 Skin
 Subcutaneous tissue
 Muscle - orbital part of the orbicularis oculi muscle
 Orbital septum - extensions of the periosteum from the orbital margin, that extends
through both eyelids and supports them; 
 Tarsus - plates of the dense connective tissue present in both eyelids. Superior tarsus is
associated with muscles that raise the upper eyelid.
 Conjunctiva - thin membrane that covers the posterior surface of the eyelid and reflects
onto the anterior surface of the eyeball. 

Eyelids and tunica conjunctivaExplore study unit

Lacrimal gland

The lacrimal gland is a part of the lacrimal apparatus, which besides the gland consists
of its numerous ducts, the lacrimal canaliculi, lacrimal sac and nasolacrimal duct.
Everyone who has cried at least once, especially because of sleep deprivation that
medical college brings, probably thinks that the lacrimal gland is placed in the medial
part of the orbit since the tears run from there. But actually, the gland is placed in
the lacrimal fossa at the upper part of the superior orbital wall, and its duct opens at the
medial part of the orbit causing the tears to run down our nose when we think about
how many anatomy pages we have left and it’s already 5 AM.
 So, the function of the lacrimal gland is the production of tears, and it is regulated by
the lacrimal nerve, a branch of the ophthalmic nerve (CN V1). Everything about the
anatomy of the lacrimal gland and lacrimal apparatus can be found in these learning
materials. We made them in a fun and approaching way, so we promise you won't cry: 

Lacrimal apparatusExplore study unit

Eye muscles

There are two groups of eye muscles:

 Extraocular muscles that move the eyeballs within the orbit

 Intrinsic ocular muscles which are within the eyeball itself and control how the
eyes accommodate
Six extraocular muscles move the eye: superior rectus, inferior rectus, medial
rectus, lateral rectus, superior oblique and inferior oblique muscles; and one
other, levator palpebrae superioris, opens the eyelid. 
 

Extraocular Muscles

Superior rectus Origin - superior part of common tendinous ring (anulus of Zinn)

Insertion - anterior half of eyeball superiorly
Innervation - oculomotor nerve (CN III)
Function - elevation, adduction, internal rotation of eyeball

Inferior rectus Origin - inferior part of common tendinous ring (anulus of Zinn)

Insertion - anterior half of eyeball inferiorly
Innervation - oculomotor nerve (CN III)
Function - depression, adduction, external rotation of eyeball

Medial rectus Origin - medial part of common tendinous ring (anulus of Zinn)

Insertion - anterior half of eyeball medially
Innervation - oculomotor nerve (CN III)
Function - adduction of eyeball

Lateral rectus Origin - lateral part of common tendinous ring (anulus of Zinn)

Insertion - anterior half of eyeball laterally
Innervation - abducens nerve (CN VI)
 Function - abduction of eyeball

Superior oblique Origin - body of sphenoid bone

Insertion - superolateral aspect of eyeball (deep to rectus superior, via trochlea orbitae)
Innervation - trochlear nerve (CN IV)
Function - depression, abduction, internal rotation of eyeball

Inferior oblique Origin - orbital surface of maxilla

Insertion - inferolateral aspect of eyeball (deep to lateral rectus muscle)
Innervation - oculomotor nerve (CN III)
Function - elevation, abduction, external rotation of eyeball

Levator palpebrae Origin - lesser wing of sphenoid bone

superioris Insertion - anterior surface of tarsus, skin of upper eyelid
Innervation - oculomotor nerve (CN III)
Function - elevation of upper eyelid

Don’t understand how all these muscles work? You can find out everything about them
in the following learning materials.

Muscles of the orbitExplore study unit

Eyeball

The eyeball is the main structure within the orbit because it enables us to see. Its
importance reflects on its size, making it the largest structure in the orbit. It is something
like a little camera inside our head, with all the necessary parts for capturing an image.
It is round with an anteriorly convex bulge. The most superficial layer of the convexity is
the cornea, which refracts and focuses the details of the image. Posterior to the cornea
are the anterior chamber, lens, vitreous chamber and the retina.

You have probably noticed that there is something in the eye called ‘the lens’, which is
also present inside our digital cameras. It has the same function as a digital lens, but in
the eyeballs it helps in focusing the light onto the retina.

The wall of the eyeball is three-layered; with the sclera as the outer layer (continuous
with the cornea), choroid as the middle vascular layer (continuous with the ciliary body
and iris), and the retina as the innermost layer. You can study the anatomy of the
eyeball in detail through these study units.
 EyeballExplore study unit

Lens and corpus ciliare: Posterior viewExplore study unit

Blood supply of the eye

The eye is supplied by branches of the ophthalmic artery: these are the short posterior
ciliary, long posterior ciliary, anterior ciliary and the central retinal arteries. Venous blood
is conveyed by the four vorticose veins that drain into the ophthalmic vein.

Read this article about the blood vessels and nerves of the eye and immerse yourself
with our learning materials to learn this topic in a more fun way.

Blood vessels of the eyeballExplore study unit

Nerves of the eye

The main function of the eye is sight, and the nerve that enables sight is the optic
nerve (CN II). Nerves that innervate the extraocular muscles are called bulbomotors and
they are the oculomotor (CN III), trochlear  (CN IV) and abducens (CN VI) nerves. The
oculomotor nerve also innervates the intrinsic ocular muscles and thus regulates
accommodation. The lower eyelid is innervated by the infraorbital nerve, a branch of
the maxillary nerve (V3), that passes through the infraorbital foramen. The upper eyelid
is supplied by the oculomotor nerve.

Take a look at this video tutorial in order to enhance your knowledge about the nerves
of the orbit.

Recommended video: Nerves of the orbit

Nerves found on the region of the orbit.
 Become a master of the eye anatomy with this specially designed quiz which covers
bones and muscles of the orbit and eye anatomy (including neurovasculature)!

Ear
Author: Jana Vasković • Reviewer: Dimitrios Mytilinaios MD, PhD • Last reviewed: June 09, 2020 

External acoustic meatus (Meatus acusticus externus)

The ear is a complex part of an even more complex sensory system. It is situated
bilaterally on the human skull, at the same level as the nose. The main functions of the
ear are, of course, hearing, as well as constantly maintaining balance. The ear is
anatomically divided into three portions:

 External ear
 Middle ear
 Internal ear

Key facts about the ear

Function Hearing and maintaining balance

External ear Parts: auricle, external acoustic meatus, tympanic membrane

Function: capture and conduction of sound

Middle ear Parts: tympanic cavity, auditory ossicles, muscles of the ossicles
Function: transforming a high-amplitude low-force sound wave into a low-amplitude high-force
vibration and transmitting it to the internal ear

Internal ear Parts: bony labyrinth (vestibule, semicircular canals, cochlea) and membranous labyrinth (utricle,
saccule, semicircular ducts, cochlear duct)
Function: 
- Bony labyrinth supports its membranous counterparts 
- Utricle and saccule provide information about the position of the head
- Semicircular ducts provide information about movements of the head
- Cochlear duct provides hearing information

Clinical relations Auricular hematoma, otitis (externa, media, interna), blockage of the pharyngotympanic
(Eustachian) tube, high tone deafness

This mixture of bones, nerves, vessels, membranes, and muscles that make up the ear
will be described in this article.

Contents
1. External ear
1. Auricle
2. External acoustic meatus
3. Tympanic membrane
4. Muscles of the external ear
5. Vasculature of the external ear
6. Innervation of the external ear
2. Middle ear
1. Tympanic cavity
2. Auditory ossicles
3. Muscles of the auditory ossicles
4. Vasculature of the middle ear
5. Innervation of the middle ear
6. Pharyngotympanic tube
3. Internal ear
1. Bony labyrinth
2. Membranous labyrinth
3. Vasculature of the internal ear
4. Innervation of the internal ear
4. Transmission of sound
5. Transmission of balance
6.
7. Clinical relations
1. Otoscopic examination
2. Auricular hematoma
3. Impacted cerumen
4. Inflammations 
5. Deafness 
6. Motion sickness
7. Vertigo

+ Show all

External ear

The external ear, like the middle ear, serves only to conduct sound to the inner ear. It
consists of the auricle and external acoustic meatus (or ear canal).

Key facts about the external ear

 Parts Auricle, external acoustic meatus

Blood supply Posterior auricular, anterior auricular, minor branches of the occipital, deep auricular,
stylomastoid, inferior tympanic arteries

Innervation Auriculotemporal branch of the mandibular nerve, lesser occipital, great auricular nerve,

auricular branch of the vagus nerve, branches of the facial nerve

Function Conducts sound to the inner ear

At the bottom of the ear canal is the tympanic membrane which establishes the border
between the external and middle ear.

Auricle

The auricle, also known as pinna, is a wrinkly musculocutaneous tissue that is attached
to the skull and it functions to capture sound. The auricle is mostly made up of cartilage
that is covered with skin. There are two aspects of the auricle: and medial (inner) and
lateral (outer). The medial aspect of the ear lobe is attached to the skull and has no
major practical significance.

The lateral aspect is concave and presents numerous grooves and ridges. The outer
rim of the auricle is called the helix, which then inferiorly ends as soft tissue known as
the lobule of auricle (or ear lobe). The helix has three parts: crus, spine, and tail. The
crus is the anterosuperior convex arch the helix, the spine the thick superior part of the
helix, while the tail is continuous with the lobule. Parallel to the helix is another convex
curvature referred to as the antihelix, which has two parts: the triangular fossa bound by
the crus of the helix and the antihelix; and the crura of the antihelix which is the
widening of the antihelix directed posteriorly toward the helix. 
Auricle (anterior view)

The center of the auricle has a fossa that is continuous with the external acoustic
meatus called the concha of the auricle. This concha is covered with a triangular
cartilaginous process called the tragus. The base of the tragus is attached to facial skin,
whereas its apex partially covers the entrance to the external acoustic meatus. Opposite
to the tragus, there is also a cartilaginous elevation above the lobule called antitragus. 

External acoustic meatus

External acoustic meatus (Meatus acusticus externus)

This is a bony-cartilaginous canal that projects from the auricle to the middle ear, from
which it is separated by the tympanic membrane (eardrum). The external acoustic
meatus consists of the lateral (outer) cartilaginous part, referred to as the cartilaginous
or membranous external acoustic meatus, and the medial (inner) bony part, called the
bony external acoustic meatus. 

Observed antero-posteriorly, this canal looks entirely like a broken line, meaning that it
doesn’t follow a straight course. The lateral part of the canal is directed posteriorly and
superiorly, whereas the medial part is directed anteriorly and inferiorly. This is important
to know while examining the ear, because the auricle must be pulled backwards,
upwards and slightly laterally in order for the lateral and medial portions to align, and so
that the tympanic membrane can then be seen and examined properly. 
 The membranous external acoustic meatus makes up the lateral one-third of this canal.
Its anterior and inferior walls are made of cartilage because it is a continuation of the
auricle. On the other hand the posterior and superior walls are actually fibrous
membranes. The bony external acoustic meatus makes up the the medial two-thirds of
the canal. Its anterior and inferior walls are built by the tympanic part of the temporal
bone, whereas its posterior and superior walls are built by the squamous part of the
temporal bone. Note that the posterior wall of the bony canal is anatomically related to
the mastoid cells of the mastoid process, while the anterior and inferior walls are related
to the temporomandibular joint.

Tympanic membrane

Eardrum (Membrana tympanica)

The tympanic membrane, or simply the eardrum, is found at the bottom of the bony
external acoustic meatus and it is the border between the external and middle ear. It is
attached with a fibrocartilaginous ring to the tympanic part of the temporal bone.

Based on its structure and tension, the tympanic membrane is divided into the two
following parts:

 Pars flaccida (flaccid part) also called Shrapnell’s membrane

 Pars tensa (tense part) 

It also has two sides: medial (inner) and lateral (outer). The medial side of the tympanic
membrane is covered with mucosa and is entirely convexed towards the middle ear. On
this side, around the border between the pars tensa and pars flaccida is the ridge of the
chorda tympani, below which the chorda tympani nerve (branch of the facial nerve (CN
VII)) passes. Also, the malleus bone is found on the medial side of the membrane and
makes impressions on it.

The lateral aspect of the tympanic membrane is divided into four quadrants:

anterosuperior, anteroinferior, posterosuperior, and posteroinferior. Behind the two
superior quadrants on the medial side are the auditory ossicles (stapes, malleus, and
incus) and the chorda tympani. The attachment of the lower end and the handle of the
malleus on the medial side of the tympanic membrane create the concavity on the
lateral side that is called the umbo of the tympanic membrane.

Superior to the umbo is a stripe called the malleolar stria which is the impression made
by the rest of the handle of the malleus. The superior end of the malleolar stria presents
with a ridge called the malleolar prominence. This impression is because of the lateral
process of the malleus. The lateral side of the tympanic membrane is covered with skin
and a thin layer of the cerumen. 
Muscles of the external ear

Auricularis anterior muscle (Musculus auricularis anterior)

All muscles of the external ear are associated with the auricle and are innervated by
posterior auricular branches of the facial nerve (CN VII). They are classified into two
groups, intrinsic and extrinsic. 

Intrinsic muscles contribute to defining the shape of the auricle by passing between its
cartilaginous parts. They are: helicis major, helicis minor, tragus, pyramidal muscle of
auricle, antitragus muscle, transverse muscle of auricle, and oblique muscle of auricle. 

Extrinsic muscles play a role in positioning the auricle, originating from the skull and
attaching within the auricle itself. They are: auricularis anterior, auricularis superior, and
auricularis posterior.

Key facts about the extrinsic muscles of the external ear

Auricularis anterior Origin: Temporal fascia/Epicranial aponeurosis

Insertion: Spine of helix
Innervation: Temporal branches of facial nerve
Function: Draws auricle anteriorly

Auricularis superior Origin: Epicranial aponeurosis

Insertion: Superior surface of auricle
Innervation: Temporal branches of facial nerve
Function: Draws auricle superiorly

Auricularis posterior Origin: Mastoid process, Tendon of sternocleidomastoid muscle

Insertion: Ponticulus of conchal eminence
Innervation: Posterior auricular nerve (branch of facial nerve)
Function: Draws auricle posteriorly

A fun fact about the extrinsic muscles is that they are remnants from earlier evolution,
and now we cannot consciously move them. To imagine how would it look like if we
could, think of of a rabbit moving its ears around towards a sound! 

Practicing what you've learned is essential! Luckily, we've prepared these blank ear
diagrams and quizzes just for you. 

Vasculature of the external ear

Posterior auricular artery (Arteria auricularis posterior)

 Three arteries participate in the supply of the auricle: the posterior auricular artery
(branch of the external carotid artery), anterior auricular arteries (branches of
the superficial temporal artery), and minor branches of the occipital artery. Veins that
drain the auricle mirror the arteries, while the lymph is drained into the superficial
parotid, mastoid, deep cervical, and superficial cervical lymph nodes.

The tympanic membrane is vascularized by the branches of the maxillary artery (deep

auricular, and anterior tympanic arteries), the stylomastoid artery (branch of
the posterior auricular artery), and inferior tympanic artery (branch of the ascending
pharyngeal artery). The lymph drains to the periauricular lymph nodes.

Innervation of the external ear

The sensory nerves that supply the auricle are numerous: 

Auriculotemporal nerve (Nervus auriculotemporalis)

 Anterior superior part is supplied by the auriculotemporal branch of the mandibular nerve (CN
V3) and the cervical plexus.
 Posterosuperior part is supplied by the lesser occipital nerve.
 Anterior and posteroinferior parts are supplied by the great auricular nerve.
 The deeper parts, closer to the external acoustic meatus, are supplied by the auricular branch of
the vagus nerve (CN X) and branches of the facial (CN VII) nerve.

Most of the sensory innervation of the external acoustic meatus is by: 

 The lateral branch of the auriculotemporal nerve (which is a branch of the mandibular nerve (CN
V3)); and also by 
 The auricular branches of the vagus and facial nerves. 

Because of vagus nerve innervation, any irritation of the external ear may cause a reflex
cough. The lateral side of the tympanic membrane is innervated by the anterior auricular
nerves (branches of the auriculotemporal nerve) and the auricular branch of the vagus
nerve. On the other hand the medial side has its sensory innervation by
the glossopharyngeal (IX) nerve.

Outer ear and auditory tubeExplore study unit

Middle ear
Tympanic cavity (Cavitas tympani)

The middle ear is a complex system of openings and canals placed mostly within
the temporal bone. Its function is to transfer vibrations of the tympanic membrane into
sound waves and pass them to the inner ear.

The middle ear is made up of the tympanic cavity and epitympanic recess.
The tympanic cavity is directly medial to the tympanic membrane, whereas
the epitympanic recess is the space superior to the membrane. 

Anterior to the tympanic cavity is the pharyngotympanic tube (Eustachian tube) which

extends to the pharynx, while posterior to the cavity are the mastoid cells of the mastoid
process of the temporal bone. Mastoid cells are covered with mucosa that has extended
from the nasopharynx through the pharyngotympanic tube and then through the
tympanic cavity.

Key facts about the middle ear

Parts Tympanic cavity, epitympanic recess

Blood supply Anterior tympanic, posterior tympanic, superior tympanic, inferior tympanic arteries, mastoid
branch of the occipital artery

Innervation Tympanic nerve, tensor tympani nerve, stapedius nerve,

Function Transfers vibrations of the tympanic membrane into sound waves and pass them to the inner ear

The anatomical communication between the pharynx, middle ear, and mastoid cells is a

possible path of spreading infections.

Tympanic cavity

This is a bony-membranous cavity. It is shaped like a biconcave lens, but from an

anatomical aspect it is usually described as a six-sided prism. Along with these six
walls, the auditory ossicles can also be described within the anatomy of the tympanic
cavity.

Walls of the tympanic cavity

Tegmental wall (roof) Tegmen tympani - formed by both squamous and petrous parts of the temporal bone, and it
separates the tympanic cavity from the cranial cavity.
 Jugular wall (floor) Separates the cavity from the jugular fossa.

Carotid wall (anterior) Corresponds with internal carotid artery canal

Contains: petrotympanic fissure, orifice of the pharyngotympanic tube, orifice of the semicanal of
the tensor tympani muscle

Membranous wall Medial aspect of the tympanic membrane

(lateral)

Labyrinthine wall Contains: oval window, round window, promontory, prominence of the facial canal
(medial)

Mastoid wall Corresponds with the mastoid process and its pneumatic cavities
(posterior) Contains: aditus to the mastoid antrum (entrance to the mastoid antrum), the pyramidal
eminence (contains the stapedius muscle)

Let's discuss briefly the features of the labyrinthine wall.

 The oval window is covered with a membrane and connects the middle ear to the vestibule of
the internal ear. 
 The round window also leads to the internal ear and is sealed with the secondary tympanic
membrane. The vibrations of this membrane allow the fluid of the cochlea to move.
 The promontory is the projection of the first coil of the cochlea. The groove of the
promontorium is a groove on its surface through which the tympanic nerve passes.
 The prominence of the facial canal has one horizontal and one vertical portion. The facial
nerve (CN VII) passes through the horizontal part. This part runs superiorly to the promontory on the
labyrinthine wall and then goes backwards toward the aditus of the mastoid antrum. Near this entrance,
the canal deviates inferiorly and continues as its vertical portion that runs over the mastoid wall of the
tympanic cavity.

The projection of the facial canal here is important, since the wall can sometimes
contain openings and therefore infections of the middle ear can easily spread to the
facial nerve and cause paralysis of its innervated structures. 

Auditory ossicles

Malleus

These are the three smallest bones of the human body. Their main function is to
transmit sounds to the internal ear, precisely to the labyrinth within the internal ear.
They articulate with each other with synovial joints, and transmit vibrations by being
moved by the muscles of the middle ear. In order from the tympanic membrane to the
internal ear (lateral to medial), these bones are: 

 Malleus (hammer)
 Incus (anvil)
 Stapes (stirrup) 
 A fun fact about these bones is that they lack osteogenic periosteum.

Malleus
The malleus is laterally attached to the tympanic membrane and medially it articulates
with the incus through the incudomalleolar joint. From the tympanic membrane it
receives sound vibrations which it further transmits to the incus. It has several parts that
include: head, neck, anterior and lateral processes, and the handle of the malleus.
The head is placed within the epitympanic recess and it contains the articulation surface
for the incus. It is connected to the tegmental wall of the tympanic cavity by the superior
ligament of the malleus. Inferior to the head is the neck of the malleus, which contains
two processes: 

 The anterior process which is attached by the anterior ligament of the malleus to the anterior
wall of the middle ear, and 
 The lateral process which is attached to the medial surface of the tympanic membrane by the
lateral ligament of the malleus. 

The extension that runs inferior to the neck and attaches to the central part of the
tympanic membrane is the handle of the malleus. 

Malleus

Incus
The incus is the anatomical connection of the malleus and stapes. It consists of three
parts: the body and the long and short limbs. 

 The body is placed in the epitympanic recess and articulates with the head of the malleus via
the incudomalleolar joint. 
 The long limb is placed parallel to the handle of the malleus and at the end it medially projects
the lenticular process. This articulates with the stapes through the incudostapedial joint. 
 The short limb extends posteriorly and attaches to the posterior wall of the tympanic cavity
through the posterior ligament of the incus. 
Stapes

Stapes

The stapes articulates with the incus laterally through the incudostapedial joint, while
medially it is attached to the membrane of the oval window on the labyrinthine wall of
the tympanic cavity. The vibrations carried from the malleus through incus and to the
stapes then cause the membrane on the oval window to vibrate further transmitting
sound to the vestibule of the internal ear. The parts of the stapes are: 

 The head which articulates with the lenticular process of the long limb of the incus, 
 Anterior and posterior limbs that attach to the oval base, and 
 The base that fits into the oval window.
Muscles of the auditory ossicles
 Even though the muscles related to the auditory ossicles are small, they are very
important because their synergistic actions enable sound transmission. They also
protect the internal ear from stimuli that are too strong by controlling the movements of
the ossicles. These muscles are the tensor tympani muscle and the stapedius muscle.

Key facts about the muscles of the auditory ossicles

Tensor tympani Origin: the cartilaginous part of the pharyngotympanic tube (Eustachian tube), the greater wing
muscle of the sphenoid bone, the semicanal for tensor tympani 
Insertion: the superior part of the handle of malleus
Innervation: the mandibular branch of the trigeminal nerve (CN V3)
Function: pulls the handle of malleus medially thus tenses tympanic membrane

Stapedius muscle Origin: inside of the pyramidal eminence

Insertion: neck of stapes
Innervation: facial nerve (CN VII)
Function: pulls stapes posteriorly thus prevents excessive oscillation 

The tensor tympani muscle is attached to the walls of the semicanal for tensor tympani
on the medial side, and to the malleus on the lateral side. Its contraction pulls the
malleus medially and in this way it tenses the tympanic membrane and pushes the
stapes into the oval window.

The stapedius muscle is placed within the pyramidal eminence of the mastoid wall of
the tympanic cavity. It extends a very thin tendon that attaches to the incus. The
stapedius pulls the incus laterally and therefore it pulls the stapes out of the oval
window.

Vasculature of the middle ear

The arteries that supply the tympanic cavity are the following:

 Anterior tympanic artery (branch of the maxillary artery)

 Posterior tympanic artery (branch of the stylomastoid artery)
 Superior tympanic artery (branch of the middle meningeal artery)
 Inferior tympanic artery (branch of the ascending pharyngeal artery)
 Anterior, superior, and inferior tympanic arteries (branches of the internal carotid artery)
 Mastoid branch of the occipital artery

The tympanic veins drain deoxygenated blood into the superior petrosal sinus and

the pterygoid venous plexus. Lymph drains into the retroauricular cervical lymph nodes.

Innervation of the middle ear

Tympanic plexus (Plexus tympanicus)

When it comes to innervation, the mucosa that covers the walls of the middle ear is
supplied with the tympanic nerve (branch of the glossopharyngeal nerve (CN IX)),
whereas the muscles of the auditory ossicles are innervated by the tensor tympani
nerve (tensor tympani muscle) and stapedius nerve (stapedius muscle).

The tympanic nerve and caroticotympanic nerves of the internal carotid plexus form
the tympanic plexus in the mucous membrane that covers the promontory on the
labyrinthine wall. This plexus supplies the mucosa of the middle ear, pharyngotympanic
tube, and mastoid antrum. It also gives off the lesser petrosal nerve, which provides
parasympathetic innervation for the otic ganglion.

Pharyngotympanic tube

Auditory tube (Tuba auditiva)

The pharyngotympanic (auditory) tube, commonly known as the Eustachian tube,

connects the middle ear and the nasopharynx. The air pressure in the external ear and
the nasopharynx is equal to atmospheric (open air) pressure, so this communication
between the middle ear and the nasopharynx serves primarily to equalize pressure on
both sides of the tympanic membrane.

Equalization happens with the tube staying closed most of the time. The action of
yawning or swallowing opens the tube, which allows air to flow and pressure to
equalize. We’re sure that anytime you were driving up a mountain, you felt that change
of pressure as if someone put plugs into your ears. If it wasn’t for the pharyngotympanic
tube, the membrane would easily rupture very quickly under pressure. 

The opening of the pharyngotympanic tube is on the carotid (anterior) wall of the middle
ear, from which the tube extends forward, medially, and downward on its way to
nasopharynx. The one-third of the tube that is closer to the middle ear (posterolateral
third) is the bony part, whereas the rest of the tube is the cartilaginous part.

The tube is mostly vascularized by the ascending pharyngeal artery, which is a branch
of the external carotid artery. The middle meningeal artery and the artery of the
pterygoid canal (branches of the maxillary artery) also participate in blood supply of the
pharyngotympanic tube. Venous blood drains into the pterygoid venous plexus, while
lymph drains into the deep cervical lymph nodes.

Recommended video: Outer ear and auditory tube

Overview of the structures of the outer ear and auditory tube.

 The mucosa that covers the tube is innervated by the tympanic plexus which is actually
an indirect way for the tympanic nerve (a branch of the glossopharyngeal nerve (CN IX))
to supply the tube.

Internal ear

This is definitely the most complex part of the ear, so it’s not a coincidence that it is
called the labyrinth. It is placed in the petrous part of the temporal bone and is made up
of bony cavities in which specific membranous parts fit. For this reason, the internal ear
is analyzed as the bony labyrinth and the membranous labyrinth which fits within the
bony labyrinth.

Recommended video: Labyrinth

Overview of the bony and membranous structures of the labyrinth.

Note that the bony labyrinth is filled with the perilymph, whereas the membranous is
filled with endolymph. This means that the membranous labyrinth is suspended in the
perilymph of the bony labyrinth.

Bony labyrinth

The bony labyrinth is placed in the petrous part of the temporal bone, and is separated
from the middle ear by the labyrinthine (medial) wall of the tympanic cavity. Grossly, it is
located medially and slightly posteriorly to the tympanic cavity. It contains the
vestibulocochlear organ, presented with the spiral organ of Corti (the origin of the
cochlear nerve which serves for hearing), and the vestibular nerve which provides the
balance information. These two nerves are branches of the vestibulocochlear nerve (CN
VIII). 

Vestibule of the ear (Vestibulum auris)

From its medial to lateral portion, the bony labyrinth contains the following structures:

 Vestibule
 Cochlea
 Semicircular canals

All three of those are actually cavities that communicate with each other. Their main
function is to house corresponding parts of the membranous labyrinth. 

Vestibule

Vestibule of the ear (Vestibulum auris)

 The vestibule is a central bony cavity. It contains two sacs: the utricle and saccule of the
vestibular labyrinth (part of the membranous labyrinth). The vestibule communicates
with the tympanic membrane through the oval window on its lateral wall. Anteriorly it
communicates with the cochlea, and postero-superiorly with the semicircular canals.

The vestibule communicates with the posterior cranial fossa through the vestibular
aqueduct. It is a membranous structure that leaves the vestibule, courses medially,
passes through the temporal bone and opens on the posterior surface of the petrous
part of the temporal bone. 

Semicircular canals

Anterior semicircular canal (Canalis semicircularis anterior)

These three canals are positioned postero-superiorly to the vestibule. The canals are
placed in three different plans, where each canal makes an angle of 90 degrees with the
other. Within the semicircular canal are the corresponding semicircular ducts of the
membranous labyrinth.

The anterior semicircular canal is positioned on the sagittal plane, the posterior is on the

frontal plane, and the the lateral canal is placed horizontally on the transverse plane.
Each canal ends in the form of a dilated ampulla, while the rest of the canal is narrow.
Note that the anterior and posterior semicircular canals unite and form the common
bony limb.

Cochlea
Cochlea is Greek for snail, and that’s exactly how this structure looks–a spiral and
hollow bone chamber in which sound waves propagate from the base (near the oval
window) to the apex.

After the base of the cochlea is a tube, called spiral canal of the cochlea, that twists
around a central bony column (called the modiolus) two and a half times. Inside the
spiral canal of the cochlea is the osseous spiral lamina that is attached to the outer wall
of modiolus and extends into the cochlear canal. In this way it follows the wrapping of
the spiral canal around the modiolus.

Since the spiral lamina is attached only to the modiolus, it incompletely divides the inner
space of the spiral canal into the two canals:

 The superior scala vestibuli

 The inferior scala tympani

Cochlea
 These portions communicate with each other at the apex of the cochlea through a
narrow slit called the helicotrema. Note that the scala vestibuli is continuous with the
vestibule, whereas the scala tympani is placed in front of the round window on the
labyrinthine (medial) wall of the middle ear–so it is separated from the middle ear by the
secondary tympanic membrane which seals the round window.

Similar to the vestibule, the cochlea communicates with the posterior cranial fossa
through its own cochlear aqueduct. This canal emerges near the round window, passes
through the temporal bone and opens on its posterior surface in the cranium.

Membranous labyrinth

The membranous labyrinth is a system of membranous cavities filled with endolymph

which are suspended in the perilymph of the bony labyrinth. 

Labyrinth (diagram)

The membranous structures found within the bony labyrinth are:

 Vestibular labyrinth – Comprises of two sacs, the utricle and saccule, and three membranous

semicircular ducts. They all comprise the vestibular apparatus that is the sensory organ of balance. The
utricle and saccule are within the vestibule of the bony labyrinth while the semicircular ducts are in the
bony semicircular canal. 
 Cochlear labyrinth – The bony cochlea contains the cochlear duct, that is the organ of hearing
Utricle
Utricle (Utriculus)

The utricle is a sac which fills the postero-superior portion of the vestibule. On its
superior and posterior walls it has openings that correspond to the openings of the
vestibule and which are the place of the emerging of the semicircular ducts. 

The inner surface of the utricle is covered with sensory tissue for balance called
the macula of the utricle. This tissue comprises of cells that are rich with cilia and
otholites. The macula responds to both centrifugal and linear acceleration, and the
nerve that conducts this information begins right at this spot and is called the utricular
nerve (a branch of the utriculo-ampullary nerve).

Saccule
The saccule is smaller than the utricle and it is placed in the antero-inferior part of the
vestibule. Through the ductus reuniens, the cochlea is connected to the saccule, and in
this way empties into the saccule.

On the inner surface of the saccule is the sensory tissue called macula of the
saccule that responds to linear acceleration. The information registered here transmits
further through the saccular nerve that begins in this macula. The saccule extends a
communicating duct with the utricle, called the utriculosaccular duct. From this duct the
endolymphatic duct extends–it enters the vestibular aqueduct, passes through the
temporal bone and ends as the endolymphatic sac at the posterior surface of the
petrous part of the temporal bone.

Semicircular ducts

Anterior semicircular duct (Ductus semicircularis anterior)

The membranous semicircular ducts are suspended in the bony semicircular canals.
The spatial relation here is important for the function, so let’s recall that the canals, as
well as the ducts, are placed on three different planes, where each duct makes an angle
of 90 degrees to the other.

The anterior semicircular duct is positioned on the sagittal plane,

the posterior semicircular duct is on the frontal plane, whereas the lateral semicircular
duct is placed transversely. Each duct then opens to the saccule via a dilated end called
the ampulla. Because of this arrangement, each duct responds to movements directed
within the plane with which they are aligned.

Cochlear labyrinth

Cochlear duct (Ductus cochlearis)

 The organ of hearing (spiral organ) is presented within the cochlear duct. This is a
triangular shaped membranous duct that wraps around the modiolus two and a half
times, following the quilling of both the spiral canal of the cochlea and the osseous
spiral lamina.

The cochlear duct completely follows the anatomy of the bony labyrinth, meaning it is
also divided into two canals–scala vestibuli and scala tympani (previously described in
the Cochlea section). The cochlear duct has three walls:

 The spiral ligament (outer wall) leans onto the bony labyrinth and consists of thick periosteum.
Together with the basilar and vestibular membranes, it encloses the triangular shaped cochlear duct.
 The vestibular membrane (roof) separates the perilymph in the scala vestibuli from the
endolymph in the bony cochlea. It extends from the modiolus and attaches to the lateral wall of the
cochlear duct.
 The basilar membrane (floor) completely separates the perilymph of the scala tympani from
the endolymph in the bony cochlea. It connects the free end of the spiral lamina with the spiral ligament
of the lateral wall of the cochlear duct, thus completely separating the membranous scala vestibuli from
the scala tympani.

On the basilar membrane inside this duct is the spiral organ, which is the organ of
hearing. This structure contains mechanoreceptors called hair cells. The tips of the cells
project out of the spiral organ and into the endolymph of the cochlear duct. The hair
cells are covered with the tectorial membrane, which moves during oscillations of the
endolymph that happen each time a sound wave is transmitted. The movements of the
tectorial membrane stimulate the hair cells which then generate electrical impulses that
transmit through the cochlear nerve to the brain.

Vasculature of the internal ear

The bony labyrinth is vascularized by the anterior tympanic artery (a branch of the

maxillary artery), stylomastoid artery (a branch of the posterior auricular artery), and the
petrosal artery (a branch of the middle meningeal artery). On the other hand,
the membranous labyrinth is supplied by the labyrinthine artery (a branch of the basilar
artery). 

Venous blood is drained by the vestibular and cochlear veins. They merge and form the
labyrinthine vein, which empties into the sigmoid or the inferior petrosal sinus.
Lymphatic drainage is by the parotid, mastoid, and superficial cervical lymph nodes.

Innervation of the internal ear

Spiral ganglion (Ganglion spirale)

When it comes to innervation, the cochlear nerve carries sensory hearing information
after arising from the spiral ganglion. It passes through the modiolus and the base of the
cochlea.

The vestibular nerve arises from the sensory tissues of the semicircular ducts, utricle,
and saccule carries sensory balance information. It forms the vestibular ganglion which
provides superior and inferior branches, which again, split and provide the branches:
utriculo-ampullary nerve, saccular nerve, and posterior ampullary nerve. Then, the
utriculo-ampullary nerve splits again into the utricular, anterior ampullary, and lateral
ampullary nerve. 

The cochlear and vestibular nerves unite and form the vestibulocochlear nerve (CN
VIII), which exits through the internal acoustic meatus together with the facial nerve (CN
VII) and travels to the lateral surface of the brainstem.

Learn more about the anatomy of the inner ear in our comprehensive study units:

Inner earExplore study unit

EarExplore study unit

Vestibulocochlear nerveExplore study unit

Transmission of sound

At the external ear, sound waves captured by the auricle enter the external acoustic
meatus, and travel through it to the tympanic membrane. Under the strike of the wave,
the membrane moves medially, affecting the handle of the malleus attached to the
medial surface of the tympanic membrane.

In the middle ear, the handle of the malleus moves medially, so that its head moves
laterally. Since the head of the malleus articulates with the body of the incus, the incus
is also moved laterally, which pushes the long process of incus medially. Since the long
process articulates with the stapes, this will push the stapes medially, and cause its
base to hit the oval window which then moves medially as well.

This will cause a large amplitude wave of the low force to be transformed into a small
amplitude vibration of a high force in the internal ear. This then vibrates the fluid inside
the scala vestibuli of the cochlea.

The receptors then send the information via the cochlear part of the vestibulocochlear
nerve (CN VIII) to the brain, where they will be interpreted as a sound via the auditory
pathway.

Transmission of balance

The membranous semicircular ducts, utricle and saccule are responsible for maintaining
balance. Note that the semicircular ducts detect movement of the head, while the
saccule and utricle provide head position information when it is not moving.
 Course and branches of vestibulocochlear nerve (diagram)

The anterior semicircular duct is positioned on the sagittal plane, the posterior
semicircular duct is on the frontal plane, whereas the lateral semicircular duct is placed
transversely. Because of this arrangement, each duct responds to movements directed
within the plane with which they are aligned. The saccule detects accelerations and
head tilts in the vertical plane, and the utricle detects accelerations and head tilts in the
horizontal plane.

The semicircular ducts, utricle, and saccule are filled with endolymph and contain
motion receptors (hair cells). As the head rotates or tilts, the endolymph lags in the
opposite direction due to inertia. This stimulates the stereocilia of the hair cells which
generate an electric signal that is transmitted in the following way:

 Hair cells from the anterior duct transmit signals via the anterior ampullary nerve
 Hair cells from the posterior duct transmit signals via the posterior ampullary nerve
 Hair cells from the lateral duct transmit signals via the lateral ampullary nerve
 Hair cells from the utricle transmit signals via the utricular nerve
 Hair cells from the saccule transmit signals via the saccular nerve

The utricular, anterior ampullary, and lateral ampullary nerves form utriculo-ampullary
nerve. Then, the utriculo-ampullary nerve, saccular nerve and posterior ampullary nerve
synapse within the vestibular ganglion. The vestibular nerve emerges from the
vestibular ganglion, joins the cochlear nerve, and via the vestibulocochlear nerve carries
sensory balance information to the central nervous system. 

Ear anatomy will be a lot easier to absorb after you take this specially designed quiz
that covers all you need to know about the ear!