Original Paper W Travail original W Originalarbeit
Otorhinolaryngol Nova 2000;10:183–186
External Auditory Canal Measurements:
Localization of the Isthmus
Ijaz Ahmad a W.C. Lee a J.D. Binnington b
Departments of a Otolaryngology and b Audiology, Russells Hall Hospital, Dudley, UK
Key Words
External auditory meatus W Isthmus
Abstract
Objective: Foreign bodies are commonly impacted in the external
auditory meatus (EAM), and removal is sometimes difficult due to
the tortuous anatomy. A foreign body is more likely to be stuck at the
narrowest point of the EAM. This study was designed to determine
the location and cross-sectional shape of the narrowest point of the
EAM, i.e., the isthmus, by using silicone casting material in human
cadaver ears. Materials and Methods: Twelve impressions were
taken from 8 adults. All abnormal ears were excluded from the stu-
dy. The measurements of the impressions were done by using a
micrometer (Vernier caliper), calibrated to 0.1 mm. Results: The nar-
rowest point of the EAM, i.e., the isthmus, was located at the junc-
tion of the medial two thirds (mean 17.9 mm) to the lateral one third
(mean 9.8 mm) of the canal. The mean canal length was 27.7 (range
20–34.8) mm. The isthmus corresponds to the bony and cartilagi-
nous junction, which is traditionally thought to be narrowed by the
canal angulation. This narrowing was 5.7 (range 3–7) mm wide in
the anteroposterior plane, but 8.2 mm (range 6.5–10) mm wide in the
vertical plane. The cross-section of this area was either an inverted
pear or oval shape. Conclusions: The isthmus is a bony-cartilagi-
nous junction, and the narrowest point of the EAM is situated at the
junction of the outer one third of the inner two thirds of the canal
length. This is mainly an anteroposterior narrowing and is oval or
inverted pear shaped. Foreign bodies impacted at this point could be
removed by use of aural hook, using the potential space at the supe-
rior portion of the isthmus.
Copyright © 2001 S. Karger AG, Basel
Bestimmung des Isthmus des äusseren
Gehörganges anhand von Messungen
Fragestellung: Fremdkörper geraten häufig in den äusseren Gehör-
gang, und das Entfernen ist manchmal schwierig, bedingt durch die
gewundene Anatomie des Ganges. Oft bleibt der Fremdkörper an
der engsten Stelle hängen. Diese Studie setzte sich zum Ziel, die
© 2001 S. Karger AG, Basel
ABC 1014–8221/00/0105–0183$17.50/0
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E-Mail karger@karger.ch Accessible online at:
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Received: July 9, 1999
Accepted: June 13, 2000
Lokalisation und die Form des Querschnittes der engsten Stelle, also
des Isthmus, anhand von Silikonabdrücken von menschlichen Lei-
chenohren zu bestimmen. Methode: Wir entnahmen zwölf Abdrük-
ke von 8 erwachsenen Personen. Abnorme Ohren wurden nicht in
die Studie miteinbezogen. Die Messungen der Abdrücke führten wir
mit einer Schublehre (Vernier) durch, welche auf 0.1 mm geeicht
war. Ergebnisse: Die engste Stelle des äusseren Gehörganges befin-
det sich am Übergang zwischen den beiden mittleren (durchschnitt-
lich 17.9 mm) und dem äusseren Drittel (durchschnittlich 9.8 mm)
der Ganglänge. Die gesamte Länge betrug 27.7 (Bereich 20–34.8)
mm. Der Isthmus liegt dort, wo der knöcherne in den knorpeligen
Teil des äusseren Gehörganges übergeht. Diese Verengung wird
gemeinhin mit der Abwinkelung an dieser Stelle in Verbindung
gebracht. Die Enge betrug 5.7 (Bereich 3–7) mm in der anteroposte-
rioren und 8.2 mm in der senkrechten Ebene. Die Querschnitte an
dieser Stelle zeigten die Form einer auf dem Kopf stehenden Birne
oder diejenige eines Ovals. Schlussfolgerungen: Der Isthmus ist
eine knorpelig-knöcherne Verbindung des äusseren Gehörganges
und stellt dessen engste Stelle dar. Er liegt am Übergang zwischen
den inneren zwei Dritteln und dem äusseren Drittel der Ganglänge.
Es handelt sich hauptsächlich um eine anteroposteriore Verengung,
welche wie ein Oval oder eine auf den Kopf gestellte Birne aussieht.
Fremdkörper, welche an dieser Stelle eingeklemmt sind, können mit
einem Ohrhäckchen unter Ausnützung des Raumes oberhalb des
Isthmus entfernt werden.
Mesures du conduit auditif externe: localisation
de l’isthme
Introduction: Les corps étrangers sont fréquemment impactés dans
le conduit auditif externe (CAE) et leur retrait est souvent rendu diffi-
cile par une anatomie tortueuse. Un corps étranger est le plus sou-
vent bloqué au point le plus étroit du CAE. Cette étude cherche à
déterminer la localisation et la morphologie de la section du point le
plus étroit du CAE, c’est-à-dire l’isthme, en utilisant un matériau
d’empreinte siliconé au niveau d’oreilles de cadavres humains.
Matériel et méthode: Douze impressions ont été effectuées chez 8
adultes. Les oreilles anormales étaient exclues de l’étude. Les mesu-
I. Ahmad, FRCSEd
Manor Hospital
Walsall WS2 9PS (UK)
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E-Mail IAhmad6188@aol.com
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Fig. 1. Oblique posterior view of a right-ear impression; the arrow
shows a constriction at concho-meatal junction.
res des impressions ont été effectuées grâce à un micromètre
(Vernier), calibré à 0,1 mm. Résultats: Le point le plus étroit du
CAE (isthme) était localisé à la jonction des deux tiers médiaux
(moyenne 17,9 mm) et du tiers latéral (moyenne 9,8 mm) du
canal. La longueur moyenne du canal était de 27,7 mm (écart
20–34,8 mm). L’isthme correspond à la jonction osseuse et carti-
lagineuse, traditionnellement considérée comme rétrécie par
l’angulation canalaire. Ce rétrécissement était en moyenne de
5,7 mm (écart 3–7 mm) dans le plan antéro-postérieur mais de
8,2 mm (écart 6,5–10 mm) dans le plan vertical. La section de
cette surface était en poire inversée ou ovale. Conclusion: L’isth-
me correspond à la jonction ostéo-cartilagineuse, soit le point le
plus étroit du CAE, situé à la jonction du tiers externe et deux
tiers internes du canal. C’est principalement un resserrement
antéro-postérieur, de forme ovale ou en poire inversée. Les
corps étrangers impactés en ce point peuvent être retirés à
l’aide d’un crochet auriculaire en exploitant l’espace potentiel
situé à la portion supérieure de l’isthme.
Introduction
Foreign bodies are commonly impacted in the external
auditory meatus (EAM), and removal is sometimes diffi-
cult due to the tortuous anatomy. A foreign body is more
likely to be stuck at the narrowest point of the EAM. This
study was designed to determine location and cross-sec-
tional shape of the narrowest point of EAM, i.e., isthmus,
by using silicone casting material in human cadaver ears.
Materials and Methods
Twelve impressions were taken from 8 adult cadavers with a
mean age of 68 (range 60–79) years. The EAM were dewaxed, and
tympanic membranes were examined before taking the impression.
Ears with tympanic membrane perforations and mastoid cavities
were excluded from the study.
184 Otorhinolaryngol Nova 2000;10:183–186
Fig. 2. Superior view of a right-ear impression (of different cadav-
ers); the arrows show an anteroposterior narrowing (the isthmus) of
the EAM.
The technique used to produce casts of the external ears was
closely followed that used by Smelt et al. [1]. Aural impression mate-
rial (Dreve Otoplastik, Otoform-K2), a condensation vulcanizing sil-
icone impression material (Werth), was used in preference to addi-
tion vulcanizing silicones due to a longer polymerization time
required by the latter at the low temperatures found in the mortuary
storage.
The impression material was introduced into the specimen ear
with an aural impression syringe. The nozzle of the syringe was
inserted as far into the ear canal as possible, the plunger depressed,
and the syringe slowly withdrawn, as ear canal and outer ear were
filled. The purpose of introducing the nozzle of the syringe as far into
the ear canal as possible was to reduce to a minimum the volume of
trapped air between the tympanic membrane and the advancing
front of the impression material. The impression material was left in
the ear to consolidate for 10–15 min, and then the impressions were
removed carefully from the ear canals with manipulation of the outer
ear.
The measurements were done using a micrometer (Vernier cali-
per) which is calibrated to an accuracy of 0.1 mm. On the casts, the
length of the EAM was measured from the junction of the concha
with EAM (concho-meatal junction) to the annulus of the tympanic
membrane. The concho-meatal junction is taken as the point of max-
imal concavity on the cast (fig. 1), where the anterior edge of the con-
chal bowl merges with the posterior wall of the external auditory
meatus. Despite inserting the nozzle as far into the ear canal as possi-
ble, the quality of the cast of the tympanic membrane remained unsa-
tisfactory in most of the ears. Therefore, the more prominent annulus
was used as the fixed point for canal length measurement to enhance
accuracy. The impressions were later cut into cross-sections at differ-
ent levels of the canal casts, and the cross-sectional shape of the nar-
rowest section, i.e., the isthmus, was examined.
Results
All measurements are shown in table 1. The mean
canal length was 27.7 mm, as calculated from a mean
measurement of the anterior length and posterior length
of the EAM. The anterior wall being longer than the poste-
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Table 1. Measurements of twelve
Narrowest Narrowest Anterior Posterior Distance of Canal
impressions diameter antero- diameter length TM to length TM to concha to length,
posterior, mm vertical, mm isthmus, mm isthmus, mm isthmus, mm mm

1 4.5 9.5 22.5 19.5 6.0 27.0

2 3.0 8.0 26.5 22.0 8.5 32.0
3 5.0 8.5 16.0 14.0 8.0 23.0
4 6.5 7.0 27.0 22.5 10.0 34.8
5 5.5 8.0 24.5 17.0 13.0 33.8
6 6.0 9.0 13.0 11.0 8.0 20.0
7 6.0 8.0 22.0 17.5 8.0 27.8
8 7.0 8.5 22.0 14.0 12.5 30.5
9 6.5 8.0 15.5 13.5 11.0 25.5
10 6.0 8.0 14.5 12.5 12.0 25.3
11 7.0 10.0 14.5 14.0 9.5 23.8
12 6.0 6.5 19.5 15.5 11.5 29.0
Mean 5.7 8.2 19.8 16.0 9.8 27.7

TM = Tympanic membrane.

rior wall due to the oblique placement of the tympanic
membrane, as shown in table 1.
The narrowest point of the EAM, i.e., the isthmus, was
located at an average distance of 9.8 mm from the concha.
This narrowing was 5.7 (range 3–7) mm wide in the ante-
roposterior plane, but 8.2 (range 6.5–10) mm wide in the
vertical plane.
The cross-sections of the isthmus looked like inverted
pear shape in nine and oval shape in three impressions.
Discussion
In this study, the mean length of the EAM was 27.7
(range 20.0–34.8) mm. In Gray’s Anatomy [2] this mea-
surement has been described to be 25 mm, taken from the
bottom of the concha to the tympanic membrane. In our
study, the concho-meatal junction, being a prominent
landmark to locate on the cast, was used as a reference
point for the measurement. The bottom of the concha
being closely in line with the concho-meatal junction
should produce the same canal measurement as in this
study. The method of measurement in Gray’s anatomy [2]
was presumably a direct measurement, and the length of
the EAM was similar to that of this study though slightly
shorter.
Two constrictions in the EAM are described in stan-
dard anatomical textbooks. One constriction is at the
junction of bony and cartilaginous parts and the other at
the isthmus. The isthmus has been recognized as the nar-
rowest point 5 mm lateral to tympanic membrane, where
a prominence of the anterior canal wall reduces the diam-
eter [3]. However, in Gray’s Anatomy [2], the isthmus has
been described as the junction of the bony and cartilagi-
nous canal due to angulation at that point. We take the
isthmus as a narrowest point in the canal which is situa-
ted at the junction of medial two thirds (length 17.9 mm)
to lateral one third (length 9.8 mm) of the canal. The isth-
mus thus corresponds to the bony-cartilaginous junction.
The narrowing is more in the anteroposterior plane than
in the vertical plane (fig. 2). This study did not show any
evidence of other narrowing medial to the isthmus. Our
results show that the cross-sectional area of the isthmus
represents an inverted pear shape or an oval shape in the
majority of aural impressions. This anteroposterior and
often oval or pear shaped narrowing is most probably
intrinsic and not simply due to angulation of the ear
canal. In this study, the ‘other isthmus’ situated more
deeply than the bony-cartilaginous junction as described
in textbook was not found to be the narrowest point in
the ear canal.
The concho-meatal junction is often compressed ante-
roposteriorly into an oval narrowing, as seen on the
impression presented in figure 1. This apparent narro-
wing could be enlarged by pulling the pinna posteriorly of
by insertion of an aural speculum in the clinical setting.
The funnelling of the EAM has been described as the
shape of the outer ear canal [4]. This was not found to be a
feature in our study, and the canal is essentially a cylindri-
cal tube throughout its length with an anteroposterior oval
or inverted pear-shaped constriction at the isthmus.
We also admit that on the basis of only twelve measu-
rements it is hard to defy or change the textbook descrip-
tion of the EAM narrowing. It is also clear that there is a
place for more anatomical studies to support this idea.

Ear Canal Measurements: Isthmus Otorhinolaryngol Nova 2000;10:183–186 185

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Localization
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 Conclusions
The isthmus is a bony-cartilaginous junction, and the
narrowest point of the EAM is situated at the junction of
the outer one third of the inner two thirds of the canal
length. This appears to be mainly an anteroposterior nar-
rowing and is oval or inverted pear shaped. We felt for-
eign bodies impacted at this point could be removed by
means of an aural hook using the potential space at the
superior portion of the EAM.
186 Otorhinolaryngol Nova 2000;10:183–186
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LH: External acoustic meatus; in: Gray’s Anat-
omy, ed 36. London, Churchill Livingstone,
1980, pp 1221–1222.
3 Wright A: Anatomy and ultrastructure of hu-
man ear; in Kerr AG, Gleeson M (eds): Scott-
Brown’s Otolaryngology, ed 6. Oxford, Butter-
worth Heinemann, 1997, vol. 1, pp 11–14.
4 Abel SM, Rockley T, Goldfarb D, Hawke M:
Outer ear canal shape and its relation to the
effectiveness of sound attenuating earplugs. J
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