The protympanum, protiniculum and subtensor recess

an endoscopic morphological anatomy study

N. Jufas*, A. Rubini, D. Soloperto, M. Alnoury, M. Tarabichi, D. Marchioni, N. Patel

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)


Objectives. An anatomical study was performed to describe the endoscopic anatomy and variations of the protympanum, including classification of the protiniculum and subtensor recess.

Methods. A retrospective review was conducted of video recordings of cadaveric dissections and surgical procedures, which included visualisation of the protympanum, across 4 tertiary university referral centres over a 16-month period. A total of 97 ears were used in the analysis.

Results. A quadrangular conformation of the protympanum was seen in 60 per cent of ears and a triangular conformation in 40 per cent. The protiniculum was type A (ridge) in 58 per cent, type B (bridge) in 23 per cent and type C (absent) in 19 per cent. The subtensor recess was type A (absent) in 30 per cent, type B (shallow) in 48 per cent and type C (deep) in 22 per cent.

Conclusion. The protympanum is an area that has been ignored for many years because of difficulties in visualising it with an operating microscope. However, modern endoscopic equipment has changed this, providing detailed anatomical knowledge fundamental to ensuring the safety of endoscopic surgical procedures in the region.

Original languageEnglish
Pages (from-to)489-492
Number of pages4
JournalJournal of Laryngology and Otology
Issue number6
Publication statusPublished - Jun 2018


  • Endoscopy
  • Ear
  • Middle
  • Eustachian Tube
  • Anatomy

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