Inspect the Tympanic Membrane

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As the speculum is introduced farther into the canal in a downward and forward direction, the tympanic membrane is visualized. The tympanic membrane should appear as an intact, ovoid, semitransparent, pearly gray membrane at the end of the canal. The lower four fifths of the tympanic membrane is called the pars tensa; the upper fifth, the pars flaccida. The handle of the malleus should be seen near the center of the pars tensa. From the lower end of the handle, there is frequently a bright triangular cone of light reflected from the pars tensa. This is called the light reflex, which is directed anteroinferiorly. The pars flaccida, the short process of the malleus, and the anterior and posterior folds should be identified. A normal tympanic membrane is pictured in Figure 11-17A, and the important landmarks are identified in Figure 11-17B.

Right Normal Tympanic Memb
Figure 11-17 Photograph (A) and labeled schematic (B) illustrating a normal right tympanic membrane.
Normal Tympanic Membrane Labeled

The presence or absence of the light reflex should not be considered indicative of either normality or disease. The sensitivity of the light reflex for indicating disease is low. There are as many normal tympanic membranes without a light reflex as there are abnormal membranes with a light reflex.

Describe the color, integrity, transparency, position, and landmarks of the tympanic membrane.

Healthy tympanic membranes are usually pearly gray. Diseased tympanic membranes may be dull and become red or yellow. Is the eardrum injected? Injection refers to the dilatation of blood vessels, making them more apparent. The blood vessels should be visible only around the perimeter of the membrane. Dense, white plaques on the tympanic membrane may be caused by tympanosclerosis, which is caused by deposition of hyaline material and calcification within the layers of the tympanic membrane. This condition is commonly (in 50% to 60% of cases) secondary to the insertion of ventilation tubes. The classic horseshoe shape of tympanoscle-rosis is seen in the tympanic membrane shown in Figure 11-18. Despite the size of these lesions, they usually do not impair hearing and are rarely of clinical importance. If the lesion extends into the middle ear, however, conductive deafness may result.

Is the tympanic membrane bulging or retracted? Bulging of the membrane may indicate fluid or pus in the middle ear. No bubbles or fluid should be seen behind the tympanic membrane in the middle ear. A tympanic membrane becomes retracted when intratympanic cavity pressures are reduced: for example, when the eustachian tube is obstructed. Figure 11-19 depicts a ''retraction pocket'' just above the lateral process of the malleus, a condition known as attic retraction. On occasion, the entire tympanic membrane may become retracted

Puss Pockets The Inner Ear

onto the ossicles of the middle ear. The ossicles may become eroded, with the development of a conductive hearing loss.

If the tympanic membrane is perforated, describe the characteristics. Perforation of the tympanic membrane can occur after trauma or infection.

The normal position of the tympanic membrane is oblique to the external canal. The superior margin is closer to the examiner's eye. This is frequently better seen in infants than in adults.

In the normal ear, the handle of the malleus attached to the tympanic membrane is the primary landmark. Frequently, the long process of the incus may be seen posterior to the malleus. The chorda tympani nerve, which supplies innervation to the anterior two thirds of the tongue and stimulates taste there, is frequently visible in the upper posterior quadrant;it passes horizontally across the middle ear behind the tympanic membrane between the long process of the incus and the handle of the malleus. Keratin patches appear as multiple, discrete white patches on the tympanic membrane of all normal membranes; if illumination is not sufficient, however, they may not be visualized. In the presence of a retracted tympanic membrane, the malleus is seen in sharp outline.

There are many differences in the color, shape, and contour of the tympanic membrane, which can be recognized only with experience.

After examining the right ear, examine the left ear by holding the otoscope in the left hand and straightening the canal with the right hand.

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  • jörg
    What is the contour of the tympanic membrane?
    4 years ago
  • nicole
    What is the integrity of tympanic membrane?
    3 years ago
  • veneranda pisani
    3 years ago
  • kidane
    How to judge light reflexes in pars tensa?
    2 years ago
  • Duncan Black
    How to describe tympanic membrane rupture on exam?
    2 years ago
  • gabriella russell
    Why tympanic membrane examined for luster.transparency.integrity.color?
    2 years ago
  • giuseppa
    How to describe tympanic membranes?
    2 years ago
  • margaret
    Is pearly white the only presentation of a healthy tympanic membrane?
    2 years ago
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    What does injected ear drum mean?
    2 years ago
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    How to describe the tympanic membrane on notes?
    2 years ago
  • daniela
    What is the normal location oshine f the light reflex at the tympanic membrane of the left ear?
    1 year ago
  • claudio
    How to describe the light reflex in the bulging tympanis membarne?
    1 year ago
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    How to describe tympanosclerosis assessment?
    1 year ago
  • regina
    What landmark is lost with bulging tympanic membrane?
    1 year ago
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    How to describe a healthy tympanic membrane?
    1 year ago
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    Is a dull TM retracted or injected?
    1 year ago
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    1 year ago
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    Is pink tympanic membranes normal?
    1 year ago
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    How to describe the Tympanic membrane on assessment?
    1 year ago
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    How to describe a perforated tympanic membrane?
    12 months ago
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    How should a healthy timpanic membrane look?
    11 months ago
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    How to describe tympanic membrane of elderly?
    10 months ago
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    How to describe tympanic membranes on exam?
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    What do white spots on tympanic membrane?
    10 months ago
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    What is the tympanic membrane made of'?
    10 months ago
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    What causes blood vessel on tympanic membrane?
    8 months ago
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    What is the characteristic of a normal healthy tempanic membrane?
    6 months ago
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    Does a normal tympanic membrane bulge when you plug your nose and blow?
    6 months ago
  • gringamor
    What does injected eardrum mean?
    5 months ago
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    4 months ago
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    Do you need a special tip for insufflating a tympanic membrane?
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    How to inspect the tympanic membrane?
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    What if the war drum is dark and pearly gray?
    2 months ago
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    How to visualize Tim panic membrane on an infant?
    2 months ago
  • candace
    Is an intact tympanic memebrane pearly white with a light reflex present?
    2 months ago
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    Are tympanic membranes visible in 2 month old child?
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    1 month ago
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    Why check the light reflex in the tempantic membrane?
    26 days ago
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    When is the tympanic membrane relaxed?
    16 days ago
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    13 days ago

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