Endoscopic Anatomy and Ventilation of the Epitympanum

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Key points

  • The superior attic (upper unit) is in communication with the mesotympanum through the underlying tympanic isthmus and posteriorly it is open to the aditus ad antrum.

  • The inferior lateral attic and the Prussack space are lower than the epitympanic diaphragm, and it is ventilated by the mesotympanum.

  • An isthmus blockage associated with a complete tensor fold leads to inadequate ventilation of the mastoid cells and this scenario could be at the basis of the attic retraction pocket development.

  • During

Discussion of middle ear anatomy

Intraoperative evaluation of middle ear anatomy during endoscopic surgery for inflammatory disorders allows the visualization of anatomic blockages of the middle ear ventilation patterns.

Many other investigators have described the anatomy and development of tympanic compartments and folds because this knowledge is crucial in the understanding and treatment of middle ear disease.

More recently, tympanic isthmus and middle ear ventilation patterns have been described in several articles.

Palva and

Summary

The physiopathology of middle ear disease requires proper understanding, and endoscopic middle ear surgery may help provide this, allowing the surgeon to explore all ventilation pathways without radically changing middle ear anatomy. In this way, the surgical approach must be the focused. The restoration of an adequate ventilation route between the mesotympanum and epitympanum, and, in our experience, surgical treatment of attic retraction or cholesteatoma limited to the tympanic cavity, can be

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Disclosures: All of the authors have read and approved the manuscript. None of the authors have any financial relationships to disclose.

Conflict of interest: None.

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