{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:32:00Z","timestamp":1747150320804,"version":"3.40.5"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Retraction pockets and marginal perforations of the pars tensa of the tympanic membrane (TM) are most commonly found at superior posterior quadrant (SPQ). The patulous Eustachian tube tends to manifest in the same quadrant. Variation in the structure of the TM may explain these observations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A line defined by the manubrium was used to divide the pars tensa into anterior and posterior portions. A transverse line centered on the umbo divides the pars tensa into superior and inferior parts, resulting in four quadrants. Surface areas of each of the TM quadrants were measured in a sample of 23 human adult formalin\u2010fixed temporal bones. The TMs were completely excised, faced medially, and placed against graph paper to maintain scale measurements, photoed, and measured.<\/jats:p><jats:p>TM thickness was measured on a different set of 20 human temporal bones (TB) preparations with normal external and middle ears. Four random loci were chosen from each pars tensa's TM quadrant. The thickness was measured using high\u2010magnification power microscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The SPQ was the largest and thinnest of the four quadrants. It occupies 31% of the pars tensa area. It is 69\u2009\u03bcm as compared to approximately 85\u2009\u03bcm in the other quadrants. The radial lines between the umbo and the annulus are in descending order from superior posterior toward the anterior\u2010superior radials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The SPQ has the largest vibratory area and is the thinnest of the four TM quadrants. Variation in the thickness of the middle, fibrous layer accounts for the variation in the thickness of the TM. These findings may explain the tendency of pathologies related to Eustachian tube dysfunction to preferentially manifest in or originate from the SPQ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence: 5<\/jats:title><\/jats:sec>","DOI":"10.1002\/lio2.861","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T11:26:36Z","timestamp":1657106796000},"page":"1164-1170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Possible clinical implications of the structural variations between the tympanic membrane quadrants"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3715-1120","authenticated-orcid":false,"given":"Firas","family":"Kassem","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2425-5414","authenticated-orcid":false,"given":"Or","family":"Dagan","sequence":"additional","affiliation":[{"name":"Department of Dermatology Soroka Medical Center, Ben\u2010Gurion University of the Negev  Beer\u2010Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3768-6216","authenticated-orcid":false,"given":"Ameen","family":"Biadsee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Western University  London Ontario 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University  Tel Aviv Israel"},{"name":"Department of communication Disorders Sackler faculty of Medicine, Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5904-1291","authenticated-orcid":false,"given":"Omer J.","family":"Ungar","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Otolaryngology, Head, Neck and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center  Tel\u2010Aviv 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