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This is a patient who clinically had microtia,

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that is a small outer ear on the left side and they

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were doing the evaluation for extraordinary

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canal stenosis or atresia.

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So if we look initially at the soft tissues outside

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the external canal of the pinna of the ear and we

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look at the conformation of the ear and compare

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it to the normal helix of the ear,

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we see that the cartilaginous external ear is

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abnormal and thickened here and doesn't have

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a normal shape to the pinna of the ear.

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So this is also a small ear and so this is microtia

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with the abnormality of the pinna of the ear.

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So we start to see portion of the cartilaginous

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portion of this external auditory canal but it never

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communicates with the bony portion as opposed to the

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contralateral side where you see the bony external

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auditory canal communicating with

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the cartilaginous portion.

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This one sort of has a blind ending right here and

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a poorly developed external auditory canal.

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Now, this big cavity here may be that

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they tried to go in surgically.

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I'm not sure exactly what the history was,

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but let's proceed to the middle ear cavity.

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So we don't have a normal tympanic membrane to

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separate the external canal

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from the middle ear cavity.

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But we do see something that looks

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like the ossicles here.

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And let's look on the normal side with the ice cream

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ice cream cone configuration

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and the two parallel lines.

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Let's go to the abnormal side and we do see

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something that looks like the ice cream and the ice

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cream cone, but these parallel lines are fused.

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So one of these should be the neck of the malleus

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and the other should be the

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long process of the incus,

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the more posterior one being the long process of

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the incus. So you can actually see the incudostapedial

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joint right here with the stapes coming

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into the oval window and vestibule region.

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So this is a patient who has fusion of the neck

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of the malleus and long process of the incus.

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When you look at the normal side and you

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have the incudostapedial joint here,

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the long process of the incus going to the capitulum

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of the stapes and the normal incudostapedial joint,

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you see that it's not as dense as what we're seeing

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right here with this kind of bony fusion of the long

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process of the incus and the incudostapedial joint.

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And that's likely secondary to congenital anomaly.

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This case is an example of the type of abnormality

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that you see in the middle ear ossicles when one has

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a patient with external auditory canal atresia.

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So middle ear ossicular anomalies, particularly

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involving the malleus and incus, are fairly common in

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patients who have external auditory

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canal atresia.