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The incudo-malleal joint

THE primary function of the middle ear is to transmit vibrations in air to the perilymph of the cochlea. The acoustic impedance matching system of the middle ear, achieved by the hydraulic transformer mechanism and the lever action of the ossicles, represents the acoustic component of the middle ear. The second function of the middle ear, too often overlooked, is the 'buffering' matching system of the middle ear, determined by its mechanical components. Even with a variation in the order of magnitude of 10^, both matching systems are too often mixed and confused. The aim of this paper is to establish clearly the essential role played by the mechanical components of the middle ear, of which the incudomalleal articulation appears to be the main part. Since Helmholtz's basic publication'The sensation of Tone', published in 1863, our knowledge of the anatomy and physiology of the middle ear has remained relatively unchanged and little has been added to the original information provided by such authors as Eolitzer (1884), Toynbee (1865), von Bekesy (1960), and Wever and Lawrence (1954). Surprisingly, many errors and imperfections have appeared systematically in the literature over the years; even more surprisingly anatomical-physiological descriptions, which were previously accurate, have been disregarded. This is particularly true for some parts of the middle ear. for example, the incudo-malleal joint which, though thoroughly studied by Helmholtz, Pappenheim, Kobrak and others, has generally been disregarded in modern literature. Authors such as Dahmann (1930) and Frank (1923) suggested a functional role for this articulation, in contrast to Barany (1910) and von Bekesy (1939) who regarded the incudo-malleal block as a rigid body, without acknowledging its articular movement Consequently this latter opinion has been generally accepted. This paper attempts to bring together some old, and more recent, information concerning the anatomy and physiology of this articulation.