The middle ear cavity (tympanic cavity) is an air-filled space within the temporal bone between the tympanic membrane laterally and the medial wall (containing the oval and round windows and the cochlear promontory). It contains the ossicular chain (malleus, incus, stapes), the chorda tympani crossing it, the facial nerve in its tympanic segment above the oval window, and the tympanic plexus on the promontory. It communicates with the mastoid via the aditus ad antrum and with the nasopharynx via the Eustachian tube.
The middle ear cavity is the site of otitis media, cholesteatoma, glomus tympanicum, and conductive hearing loss from ossicular dysfunction. Acute otitis media in children arises from Eustachian tube dysfunction allowing nasopharyngeal bacteria to enter the middle ear. Chronic suppurative otitis media (CSOM) with or without cholesteatoma destroys the ossicles and adjacent structures. Middle ear anatomy guides surgical approaches: tympanotomy (posterior tympanotomy facial recess approach) provides access to the round window for cochlear implant electrode placement.
Keratinising squamous epithelium migrating through a marginal tympanic membrane perforation or retraction pocket fills the middle ear cavity with keratin debris, eroding the ossicles and adjacent bony structures including the tegmen, facial canal, and labyrinth; canal-wall-down or canal-wall-up mastoidectomy removes the cholesteatoma with reconstruction of the hearing mechanism.
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