The tympanic membrane is an important part of the middle ear, and its developmental abnormalities can cause hearing loss. Prenatal diagnosis of structural abnormalities of the deep middle ear, such as external auditory canal atresia, has so far been difficult and has relied on indirect assessment of auricle morphology. Recent advances in ultrasound technology have enabled prenatal detection of tympanic ring abnormalities and provided new imaging markers for earlier assessment of external and middle ear development. The study evaluates normal and abnormal ultrasonographic manifestations of tympanic ring, important genes controlling its development, and associated syndromes. Ultrasonography of the tympanic ring is a valuable additional screening technique for fetal external and middle ear abnormalities, especially in combination with microtium assessment, which improves the prediction of the risk of external auditory canal atresia. Further research is needed to standardize prenatal ultrasound diagnosis, establish measurement criteria, and integrate multimodal imaging into clinical practice. The article serves as a comprehensive reference for prenatal diagnosis and genetic counseling.