CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
Stapedius Tendon
A healthy 30-year-old female had a demonstration of the Wispr digital otoscope at the 2026 Pediatric Academic Societies (PAS) annual meeting. The following image was obtained with the Wispr digital otoscope.
Which bone of the middle ear is not visible by otoscopy?
A. The malleus (hammer)
B. The incus (anvil)
C. The stapes (stirrup)
D. The hyoid
Answer: C. The stapes (stirrup)
Bones of the Middle Ear
This is a beautiful example of a normal and healthy ear. In this image, two of the bones of the middle ear are visible through the partially transparent tympanic membrane (eardrum), the malleus and the incus. The stapes is not visible as it is deep to the incus. The hyoid is not a bone of the middle ear space. The malleus is almost always visible except in cases of distorted anatomy, such as from acute otitis media. The incus is often visible, but normal differences in anatomy can hide this bone. The stapes bone (not visible) connects the incus to the oval window of the inner ear, allowing the mechanical energy of the tympanic membrane to be communicated to the fluid in the inner ear. The stapedius (stapedial) tendon anchors the stapes bone to the ear canal. When loud noises occur, the stapedius tendon contracts, moving the stapes away from the round window and thus attenuating the perceived volume of noise.
Here is the complete video exam.
