Tympanic membrane

It is important to understand what a normal tympanic membrane looks like before commenting on ones with pathology. There are several key anatomical landmarks which are seen on the ear drum.
Begin by focusing on the handle of the malleus. This is one of the three ossicles and useful structure to locate. It will almost appear to protrude out of the tympanic membrane. Above this will be the pars flaccida and anteriorly inferiorly on the tympanic membrane is the light reflex. As the light reflex will always be in the same place it can be used to determine which ear we are looking at. It does not determine the presence or absence of pathology.
Other important things to comment on and notice are;
  • Is the tympanic membrane smooth or sucked in (retracted) ?
  • Are there any holes?
  • Are there any deep pockets in the tympanic membrane
Imagine you are looking through the tympanic membrane. It provides an insight into what is happening in the middle ear. Is there air of fluid behind it?
If you do notice any pathology in the ear canal, tympanic membrane or middle ear this typically indicates a conductive hearing loss and should be reflected in your clinical hearing tests. The absence of such pathology in the canal and tympanic membrane may, but not always, point towards a sensorineural loss.
It is common to get a picture of an ear drum in an OSCE station. You could be asked to label it, state whether it is a right or left ear, and comment on any abnormalities seen.


Image of a normal tympanic membrane.

Note the position of the light reflex (anteriorly-inferior) which makes this a right ear


The videos below are taken using a high definition camera designed for looking at the tymapanic membrane by an ENT specialist. This level of detail cannot be achieved by looking through an otoscope but after having viewed these videos it should give you an idea of important landmarks to look for and common presentations:

Ear canal and tympanic membrane:


Ear Wax:

Having wax in your ears is perfectly normal. Wax is produced by the ceruminous glands in the outer ear, and is sometimes called cerumen. Remember that the ears are self-cleansing. Often people mistakenly attempt to clean their ears using cotton wool buds. This is not necessary and actually causes impaction of the wax.

Ear wax removal and narrowed ear canal: