Anatomy of the ear
Assessing ear
The ear is the sense organ of hearing and equilibrium. It consists of three distinct
parts:
A. the external ear,
B. the middle ear, and
C. the inner ear.
The tympanic membrane separates the external ear from the middle ear.
Both the external ear and the tympanic membrane can be assessed by direct
inspection and by using an otoscope.
The middle and inner ear cannot be directly inspected. Instead, testing hearing
acuity and the conduction of sound assesses these parts of the ear. Before
learning assessment techniques, it is important to understand the anatomy and
physiology of the ear.
STRUCTURES OF THE EAR
I. External Ear
The external ear is composed of the
1. auricle, or pinna, and
2. the external auditory canal.
S-shaped in the adult.
The outer part of the canal curves up and back;
the inner part of the canal curves down and forward.
Modified sweat glands in the external ear canal secrete cerumen, a wax-like substance that keeps the
tympanic membrane soft.
Cerumen has bacteriostatic properties, and its sticky consistency serves as a defense against foreign
bodies.
The tympanic membrane, or eardrum, has a translucent, pearly gray appearance and serves as a partition
stretched across the inner end of the auditory canal, separating it from the middle ear.
o The membrane itself is concave and located at the end of the auditory canal in a tilted position such
that the top of the membrane is closer to the auditory meatus than the bottom.
o The distinct landmarks of the tympanic membrane include:
a. Handle and short process of the malleus—the nearest auditory ossicle that can be seen
through the translucent membrane
b. Umbo—the base of the malleus, also serving as a center point landmark
c. Cone of light—the reflection of the otoscope light seen as a cone due to the concave
nature of the membrane
d. Pars flaccida—the top portion of the membrane that appears to be less taut than the
bottom portion
e. Pars tensa—the bottom of the membrane that appears to be taut
II. Middle Ear
• The middle ear, or tympanic cavity, is a small, air-filled chamber in the temporal bone.
It is separated from the external ear by the eardrum and from the inner ear by a bony partition containing
two openings, the round and oval windows.
The middle ear contains three auditory ossicles: the malleus, the incus, and the stapes.
These tiny bones are responsible for transmitting sound waves from the eardrum to the inner ear through
the oval window.
Air pressure is equalized on both sides of the tympanic membrane by means of the eustachian tube, which
connects the middle ear to the nasopharynx
III. Inner Ear
The inner ear, or labyrinth, is fluid filled and made up of the bony labyrinth and an inner membranous labyrinth.
The bony labyrinth has three parts:
1. the cochlea,
The inner cochlear duct contains the spiral organ of Corti, which is the sensory organ for hearing.
2. the vestibule, and
Sensory receptors, located in the vestibule and in the membranous semicircular canals, sense
position and head movements to help maintain both static and dynamic equilibrium
3. the semicircular canals.
Nerve fibers from these areas form the vestibular nerve, which connects with the cochlear nerve to
form the eighth cranial nerve (acoustic or vestibulocochlear nerve).
HEARING
Sound vibrations traveling through air are collected by and funneled through the external ear, causing the
eardrum to vibrate.
Sound waves are then transmitted through auditory ossicles as the vibration of the eardrum causes the
malleus, the incus, and then the stapes to vibrate.
As the stapes vibrates at the oval window, the sound waves are passed to the fluid in the inner ear.
The movement of this fluid stimulates the hair cells of the spiral organ of Corti and initiates the nerve
impulses that travel to the brain by way of the acoustic nerve.
The transmission of sound waves through the external and middle ear is referred to as “conductive hearing,”
and the transmission of sound waves in the inner ear is referred to as “perceptive” or “sensorineural
hearing.”
Therefore, a conductive hearing loss would be related to a dysfunction of the external or middle ear (e.g.,
impacted ear wax, otitis media, foreign object, perforated eardrum, drainage in the middle ear, or
otosclerosis).
A sensorineural loss would be related to dysfunction of the inner ear (i.e., organ of Corti, cranial nerve VIII,
or temporal lobe of brain).
In addition to the usual pathway for sound vibrations detailed previously, the bones of the skull also conduct
soundwaves.
This bone conduction, though less efficient, serves to augment the usual pathway of sound waves through
air, bone, and finally fluid .
