External auditory canal length 2.

4 cm
Cartilaginous part of the external auditory canal 1/3 EUC= 0.8 cm
Bony part of the EUC 2/3 EUC= 1.6 cm
EUC Ant-inf dimension 31mm
Euc sup-post 25mm
Isthmus 0.5 cm from tympanic membrane
A-P diameter 5.7mm
Vertically 8.2mm

Tympanic membrane
T.M diameter 9-10 mm vertical,8-9 mm horizontal
T.M thickness 0.1 mm
Surface area 85mm3
Effective vibrating area 55 mm3
T.M angle to the floor 55 degree

Dimensions of the middle ear cavity

Anterioposterior (width): 1.5 cm
Vertical (Ht) 1.5cm
Transverse (depth)
Epitympanum 6mm
Mesotympanum 2mm
Hypotympanum 4mm
In summary 1.5*1.5*.5cm in which 5cm represent the depth
Malleus 9mm
Average size of stapes footplates 1.41*2.99 mm
Distance from the central portion of the footplate & utricle 2.1mm
Distance from the central portion of the footplate & saccule 1.4mm
Surface area of the stapes footplate 3.2 mm3
Oval window 1.75*3.25 mm ( + 0.25mm difference)
Round Window membrane 2.3mm*1.9 mm
Tensor Tympani muscle 2 cm
mastoid antrum depth in releation to macewen's triangle 1.5cm
Cochlea length 35mm
Eustachian tube
At birth Eustachian tube length
Adult Eustachian tube length 35mm
Bony part of the ET 11mm
Cartilaginous part of ET 24mm
Infant Eustachian tube 18mm
Adult length is achieved at the age 7 yr
Diameter of tympanic ostium 2-5mm
Diameter of ET isthmus 0.5 mm
Diameter of the pharyngeal ostium 3*4mm
ET in the nasopharynx is way from inferior turbinate 1-1.25 cm
Internal auditory canal
Max. Internal auditory canal Diameter 0.8cm
Internal auditory canal length 1 cm
Facial nerve segments
Cp< segment 24mm
Meatal segment 8mm
Fallopian canal 30mm
Labrynthin segment 5mm ( shortest & longest s
Tympanic segment 10mm
Vertical segment 15mm
Labyrinthine part of the fallopian canal diameter at the meatal entrance 0.68 mm
% of ppl who has dehiscence in the tympanic/mastoid segment 50-55%
Most common site of dehisency of fallopian canal ( tympanic segment esp the oval area) 40-50%
The distance between the chordi tympani & stylomastoid foramen 4-7mm
Distance between the tympanomastoid fissure & extracranial facial trunk 6-8mm
Distance between the extracranial facial trunk from the post belly of digastic 1cm
Distance between the styloid foramen and pes anserinus 1.3cm
% of facial nerve injuries due to longitudinal temporal bone fractures occur in the 90%
perigengiulate area
The minimal Differences in the facial excitability that suggest facial depriviation 3.5mA

Embryology of the ear

The auricle reach the adult shape 20th week of gestation
Most of the ear congenital deformity occurs Around the 12th week or shortly there after
Incidence of microtonia 1/20.000
The auricle reach the adult location End of 2nd trimester
The auricle reach the adult size 9 years
Adult size of the ossicles At birth
Adult size of inner ear 4th fetal month
Antrum is well developed At birth
Adult volume of antrum 2 ml
Mastoid process development occurs between 1-3 yr
Facial nerve is fully developed 4 yr
Adult size maccule 14-16 weeks
Adult size saccule 23 week
Adult size corti 25 week
Adult size Inner ear 4th month

Comparison
External auditory canal length 24mm
ET 36mm
Fallopian canal 30mm
Internal auditory canal 8mm
 Nerve Number of fibers
Facial nerve 10,000( 70% myelinated +30% secretory & sensory)
Auditory nerve 30,000
Affrent vestibular 18,000
Efferent vestibular nerve 200
Incidence of epistaxis from the kiesselbach plexus 90%

Amount of nasal secretions 1L

Sinusitis 93% of pt has ethmoidal sinusitis
73% maxillary sinusitis
Adult size of Sinuses
Size of ethmoid sinus 2-3ml
Size of adult of frontal sinus 4-7ml
Nasal numbers
Sphenoid sinus .5ml-8ml
Maxillary sinus size 15ml
Frontal sinus dimensions 28*24*20 mm

Age of development onset

Maxillary sinus 12 wk
Ethmoid sinus
Frontal sinus Start to develop 4yr
Sphenoid sinus 4th intrauterine month

Age of achieving adult size (asf)

Ethmoid sinus reach adult size 12-15 yr
Sphenoid sinus 12-18 yr
Frontal sinus reach adult size 12-20 yr
Maxillary sinus reach adult size 17-18 yr
Note:

all sinuses are present at birth except the frontal

Ethmoid sinus The most well developed at birth
maxillary sinus 1st one to develop

Underdevelopment/overdevelopment of sinuses
Frontal sinus agenesis Unilateral 4%
Bilateral 5 %
Underdeveloped frontal sinus 5-10%
ant ethmoid is absent Unilateral:14%; Bilateral:2%
Unpneumonized ethmoidal bulla 8%
Agger Nasi Cell 90% of population
% ppl with haller cells 10%
% ppl with onodi cells 12%
% supereme concha 60%
Pneumnization pattern of the sphenoid sinus
Conchal 3%
Presellar 11%
Sellar 59%
Dimensions
Thickness of ethmoid roof 0.5mm
Thickness of the lateral lamina of cribriform plate 0.2mm
Thickness of ethmoid sulcus .05mm
Dimensions of the maxillary sinus A-P: 3.5cm
Transverse: 2.5cm
Height: 3.3 cm
The distance between the floor of the maxilla Average: 0.5cm
&floor of the nose(maxillar flow is lower) Max: 1.25cm
The ht of the highest point of inferior meatus 1.6mm from the floor
Location of the highest point of inf turbinate 1.9mm from the nostril
Cross sectional area of the nasal valve 90-30 mm3
Sphenoid sinus ostium 1cm above roof of post choana
1-2mm lateral to the septum
7cm from the ant nasal spine
Location of nasolacrimal duct 10-15mm from the nostril
3-6mm ant to maxillary sinus ostium
Location of the sphenoplatine foramen 18 mm from the horizontal plate of palatine bone
13 mm from the inferior turbinate

% uncinate type I ( uncinate is attached to the lamina papyracea 80%

Bony dehiscence of cavernous portion of the carotid canal 22%
Dehiscence of the bony canal of the ant ethmoid artery 20-40%
Incidence of squamous cell ca of paranasal sinuses 1/200.000
Incidence of CSF leak following head trauma 2%
% of accidental trauma as a cause of CSF leak 80%

Accessory ostium
Frontal ostium 10%
Maxillary ostium 10-30 %

Average amount of saliva 1-1.5 L

PH saliva 6.2-7.4
% of sore throat caused by groub a beta hemolytic sterptococcus 15-20 %
Incidence of GN post untreated streptococcus Tonsillitis 10-15 %
Incidence of rheumatic fever post untreated streptococcus tonsillitis 3%
Incidence of 1ry bleeding post tonsillectomy .5-.22%
 Incidence of 2ndary bleeding post tonsillectomy 3%
Incidence of death post tonsillectomy 1/17000

Pathological Widening of tissue shadow at level C2 >6mm

Pathological Widening of tissue shadow at level C6 under age of 5 >14 mm
Pathological Widening of tissue shadow at level C6 adult >22mm
Length of the pharynx 15 cm
Distance from incisors to cricopharyngeal sphincter 16cm
Distance from incisors to constriction made up by the aortic arch & left main bronchus 25cm
Distance from incisors to hiatus hernia pouch 34cm
Distance from incisors to cardia of stomach 38-40cm

Parotid gland
Starts to develop from 1st pouch ectoderm 5.5 wk
Parotid duct length 4-6cm
Parotid duct distance from zygomatic arch 1,5cm

Thyroid embryology
Thyroid diverticulum forms 4th wk
Thyroglossal duct starts to degenerates 4.5
Completely degenerates 6wk
Adult position 7th wk

Tongue embryology
Development of primitive tongue 4th wk
Migration of muscles + XII+ tonsillar tissue 7th wk
Circumvalate papillae 8-20th wk
Filiform+fungiform 11th wk

Larynx and trachea

Larynx Lies between C3-C6
Supraglottis arise from 4th brachial arch
Glottis & supglottic 6th brachial arch
Differences in larynx between male & female
Length of larynx Female 26mm Male 36mm
Length of glottis area Female 1.6cmm Male 2.5cm
Optimal sound frequency 225 hz 125 hz
Thyroid angle 120 90
Trachea lies between C6-T5
# of tracheal rings 16-20 ring

Lacrimal system
Lacrimal canaliculi length Vertical part 2mm
Horizontal part 8mm
Lacrimal sac 12mm
Lacrimal duct 17mm

Start End
3rd week Inner ear
4th week Lip + 1ry palate, tongue, larynx
6th week Pinna, parotid, submandibular Thyroglossal duct degenrate
7th week 2ry palate Lip, 1ry palate
8th week EAC, sublingual
9th week Hard palate
12th week Soft palate, uvula
20th week Tongue, full cochlea
25th week Inner ear