Symptomatic foramen tympanicum

Case contributed by Dr Andrew Dixon


Chronic discharge left ear for 4 years. Increased fluid when eating. Tympanic membrane intact. ? external acoustic canal erosion

Patient Data

Age: 50 years
Gender: Male

Expanded left foramen tympanicum measuring 3.5 mm in diameter extending from the mandibular fossa through the anterior aspect of the left external acoustic canal. No secondary degenerative features of the left temporomandibular joint. Intact, normal appearing tympanic membrane. No middle or inner ear abnormality seen. No right foramen tympanicum identified. Mild generalized mucosal thickening of the paranasal sinuses identified with mucous retention within the maxillary sinuses inferiorly. Left C2-3 facet joint arthropathy and uncovertebral osteophyte results in narrowing of the neural exit foramen. 


Although not well visualized, the TMJ MRI does demonstrate partial herniation of the retrodiscal component of the TMJ through the foramen tympanicum. The degree of herniation is similar on open and closed mouth images and does not appear to be fluid signal intensity. 

Annotated image

Foramen tympanicum (red arrow).

Case Discussion

A case of symptomatic large left foramen tympanicum forming a communication between the retrodiscal portion of the left temporomandibular joint and the anterior aspect of the left external acoustic canal. The patient's history of chronic ear discharge which increases when eating is classical. Foramen tympanicum is a relatively common anatomical variant however large and symptomatic cases are rare.  

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Case information

rID: 52798
Published: 22nd Apr 2017
Last edited: 6th Apr 2020
System: Head & Neck
Inclusion in quiz mode: Included

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