EAR

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 EAR
◼ For descriptive
purposes the ear
anatomy is
◼ Divided into
External, middle
and inner ears.

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Divisions
◼ The external ear consists of the auricle and external acoustic
meatus.
◼ The middle ear is the air-filled cavity, which receives air from
the nasopharynx via the auditory tube. It contains three ear
ossicles, which conduct the vibrations of the tympanic
membrane to the perilymph of the internal ear.
◼ The internal ear contains the membranous labyrinth; its chief
divisions are the cochlear labyrinth and the vestibular
labyrinth.
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4
Ear Introduction.
Primarily concerned with
balance & hearing.

The tympanic membrane

separates the first two parts.

The Labyrinthine wall

separates the last two parts.

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 EAR INTRO.
◼ The outer and middle are
concerned with the
transmission of sound to the
inner ear
◼ Inner ear converts sound to
fluid motion and then to
electrical impulses (action
potentials)

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 EXTERNAL EAR
◼ Composed of Auricle and External
Acoustic meatus.
◼ The Auricle collects and directs
sound into the external acoustic
meatus.
◼ The External Acoustic Meatus
conducts sound to the tympanic
membrane.
◼ The external acoustic meatus
develops from the ectoderm of the
first branchial cleft.
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 AURICLE OR PINNA
◼ Composed of:
i. Irregularly shaped elastic cart.
Covered by skin
Medial and lateral surfaces
i. Helix, the Superiorly elevated
margin
ii. Concha is the most profound
(deepest) depression
iii. Lobule, the non-cartilaginous
part.
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◼ The lobule (lobe) consists of
fibrous tissue, fat, and blood
vessels.
 Itis easily pierced for taking small
blood samples and inserting
earrings.
◼ The tragus is a tongue-like
projection overlapping the opening
of the external acoustic meatus.

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 The arterial supply to the auricle
◼ The arterial supply to
the auricle is derived
mainly from the
posterior auricular
and superficial
temporal arteries
from the external
carotid artery.

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Nerve supply of Auricle
◼ Sensory innervation to the
external ear is supplied by both
cranial and spinal nerves.
◼ Branches of the trigeminal, facial,
and vagus nerves (CN V, VII, X)
and the lesser occipital (C2, C3)
and greater auricular (C2, C3)
nerves are involved.
◼ The primary nerves to the skin of
the auricle are the great auricular
and auriculotemporal nerves.
Motor innervation to muscles of the external ear is supplied by branches of the facial nerve (CN VII). 11
Lymphatic drainage
◼ Lymphatic drainage is to the
parotid lymph nodes and the
mastoid and superficial
cervical lymph nodes, all
which drain to the deep
cervical nodes.

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Applied Anatomy
◼ Ear size increases with age. Ear cartilage grows throughout a
person's lifetime, while the pendulous lobule elongates under
gravity.
◼ The external ear (lobule) is often adorned with jewellery. Piercings
involving the cartilaginous parts of the ear may display poor
healing because of the relatively avascular nature of cartilage.
◼ Ear piercings are among susceptible individuals' most common
sites of keloid scar development. African Americans are 15
times more likely than whites to develop keloids.

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◼ Cauliflower ear is seen in boxers
and individuals who experience
frequent physical trauma to the
pinna.
◼ The deformity develops over time as
hematomas form between the
cartilage and its perichondrium,
resulting in the death of the cartilage
as it is cut off from its supply of
nutrients.
◼ Fibrosis sets in, deforming the ear.

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◼ The ear is relatively exposed and susceptible to sun
damage.
 The pinna is a frequent site of actinic keratosis (scaly spots or
patches on the top layer of skin), cutaneous horns, and skin
cancer.
◼ Conversely, the external ear is particularly susceptible to
frostbite.

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 Surfer’s ear or external auditory exostoses
(EAE)
◼ Surfer’s ear or external auditory
exostoses (EAE) is a slowly
progressive disease caused by
benign bone growth from chronic
cold-water exposure.
◼ It is most classically associated
with surfing but can be seen in any
individual who is repeatedly
exposed to cold water (swimmers).

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The External Auditory Canal
◼ It’s an S-shaped canal that
extends from the Concha to the
Tympanic Membrane. In the
newborn, the external meatus is
short and straight. It lacks a bony
part and has no constrictions.
◼ It measures about 2.5cm long in
adults. Consist of wider Lateral
Cartilaginous and narrow medial
Osseous parts.
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 External auditory canal (EAC)
◼ The lateral 1/3 is cartilage, and its
skin is normal skin. It contains Hair
follicles, Ceruminous glands and
Sebaceous glands
◼ Medial 2/3 is bone, and its skin is thin
with no fat, hair, or glands. Its thin
skin is continuous with the external
layer of the tympanic membrane.
◼ Cerumen (ear wax) is produced by
the cerumenous glands (modified
sweat glands).

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THE TYMPANIC
MEMBRANE

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The Tympanic Membrane
◼ The tympanic membrane, approximately 1 cm in
diameter, is a thin, oval, semitransparent membrane at
the medial end of the external acoustic meatus.
◼ It is covered with thin skin externally and mucous
membrane of the middle ear internally.

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 The tympanic membrane
◼ Separates the external auditory canal from the tympanic
cavity.
◼ Consists of three layers:
 Superficialsquamous epithelium,
 Intermediate fibrous,
 Deep mucosal.

◼ It is a semitransparent, thin fibroelastic connective tissue

membrane, covered by epidermis on the external side and a
simple low cuboidal mucous epithelium on the inner side
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◼ The tympanic membrane is divided into
two main parts:
◼ Pars tensa - forms most of the tympanic
membrane. It is thickened at its outer
margin to create a fibrocartilaginous
tympanic ring (annulus).
◼ Pars flaccida (Shrapnell's membrane)
- is a small triangular portion of the
membrane situated superior to the
lateral process of the malleus. More
specifically, it is located between the
anterior and posterior malleolar folds.
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 TYMPANIC MEMBRANE
◼ It has a concave
lateral surface and a
convex medial
surface.
◼ The lateral surface
faces laterally,
slightly interiorly and
downwards.

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◼ On an otoscopic view of the ear,
seen on the tympanic membrane is
where the manubrium of the malleus
attaches to its internal surface, pulling
its anterior and inferior portion
medially, creating a depression. The
central point of maximum depression
is called the umbo.
◼ When light shines onto a healthy
tympanic membrane, the malleus
causes a cone of light to appear in
the anterior–inferior quadrant

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 ◼ The umbo is the point of
maximum concavity of the
membrane and is created
by the attachment of the
malleus to the centre of the
membrane.

When the tympanic membrane is illuminated under light (otoscope), its

concavity produces a cone of light radiating from the umbo over the
inferior quadrant of the membrane.
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Otitis Media
◼ When viewed with an
otoscope, the normal
translucent appearance of
the tympanic membrane is
gone, the eardrum is
erythematous and
bulging, and the cone of
light is absent.

a | Normal tympanic membrane. b | Red and

bulging tympanic membrane indicative of acute
otitis media. c | Otitis media with effusion. d |
Presence of a ventilation tube in the tympanic
membrane. 26
◼ Blood supply: the outer part
receives blood via the deep
auricular artery, while the medial
surface receives blood via the
anterior and posterior tympanic
arteries.
◼ The anterior tympanic artery, is a
branch of the maxillary artery, and
the posterior tympanic artery, a
branch of the posterior auricular
artery.
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Nerve Supply
◼ The lateral surface is innervated by nervus intermedius (a branch of
CN VII), the auricular branch of the vagus nerve (CN X) and a branch of
the mandibular nerve auriculotemporal nerve (CN V3).

The medial surface is innervated by the

glossopharyngeal nerve (CN IX). 28
Function
◼ The tympanic membrane moves in response to air
vibrations that pass through the external acoustic meatus.
Movements of the membrane are transmitted by the
auditory ossicles through the middle ear to the internal
ear.
◼ The tympanic membrane serves as the physical barrier
between the middle and outer ear; thus protecting the
middle and inner ear structures.

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 Using an otoscope correctly
◼ The external meatus is straightened to facilitate an
otoscopic examination by pulling the auricle upwards and
backwards.
 Inchildren, the auricle should be pulled downward and backwards.
This process will move the acoustic meatus in line with the canal.
◼ The earpieces of a stethoscope are angulated to accommodate
the anteromedial direction of the external acoustic meatus.

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Children younger than age 3 Adult
To inspect an infant’s or a young To inspect an adult’s ear, grasp the
child’s ear, grasp the lower part of upper part of the auricle and pull it
the auricle and pull it down and back up and back

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The Eustachian tube

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 The Eustachian tube
◼ It equalises the pressure between the middle ear and the air
outside. When you "pop" your ears as you change altitude (going
up a mountain or in an aeroplane), you equalise the air pressure
in your middle ear.
◼ Equalizing pressure ("popping the eardrums") is commonly
associated with yawning and swallowing.
◼ The tube is derived from the first pharyngeal pouch.
◼ A portion of the tube (~1/3) proximal to the middle ear is made of
bone; the rest is composed of cartilage and in the nasopharynx,
where it opens in a raised tubal elevation, the torus tubarius.
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Four muscles associated with its function
◼ Levator veli palatini (innervated by the vagus nerve)
◼ Salpingopharyngeus (innervated by the vagus nerve)
◼ Tensor tympani (innervated by the mandibular nerve)
◼ Tensor veli palatini (innervated by the mandibular nerve)

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◼ The pharyngotympanic tube
connects the tympanic cavity to
the nasopharynx, opening ◼ .
posterior to the inferior nasal
meatus.
◼ The posterolateral third of the
tube is bony, and the remainder
is cartilaginous.
◼ By allowing air to enter and leave
the tympanic cavity, this tube
balances the pressure on both
sides of the membrane

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 The pharyngotympanic tube
◼ The walls of the cartilaginous part
of the tube are usually in
apposition and must be actively
opened.
◼ It is opened by a combination of the
expanding girth of the belly of the
levator veli palatine as it contracts
longitudinally, pushing against one
wall and the tensor veli palatini
pulling on the other.
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Applied anatomy
◼ Acute otitis externa (swimmer’s ear) involves inflammation
of the external acoustic meatus, usually because the
protective earwax has been washed from the ear.
◼ Otitis media is an inflammation of the middle ear and is
common in children younger than 15 years because the
auditory tube is short and relatively horizontal at this age,
which limits drainage by gravity and provides a route for
infection from the nasopharynx.

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 The eustachian tube is about 36 mm long. Its bony Lateral 1/3rd
and its cartilaginous Medial 2/3rd at an angle—isthmus.

Children “grow out of” most middle ear problems as this tube
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lengthens and becomes more vertical
MIDDLE EAR

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◼ The tympanic cavity or
cavity of the middle ear is
Middle Ear
the narrow air-filled
chamber in the petrous part
of the temporal bone.
◼ The cavity has two parts: the
tympanic cavity proper,
the space directly internal to
the tympanic membrane,
and the epitympanic
recess, the space superior
to the membrane.

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◼ The middle ear is shaped like a block, Middle ear.
compressed from side to side. In the
coronal section, it resembles a
biconcave disk, like a red blood cell.
◼ It is an air-filled cavity in the petrous
part of the temporal bone.
◼ It has the opening of the Eustachian
tube.
◼ It is lined with mucous membrane that is
continuous with the lining of the
pharyngotympanic tube, mastoid
cells, and mastoid antrum.
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The middle ear as an opened-out box

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TYMPANIC CAVITY
◼ Functions.
1. It is involved in the efficient transfer of energy from the
relatively weak vibration in the elastic, compressible air
in the Ext Acoustic Meatus to overcome the inertia of the
incompressible fluid in the cochlear.
2. It also equalises pressure on both sides of the tympanic
membrane.

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Borders
◼ Roof – (tegmen tympani) formed
by a thin bone from the petrous
part of the temporal bone. It
separates the middle ear from the
middle cranial fossa.
◼ Floor – (jugular wall) consists of a
thin layer of bone, which separates
the middle ear from the internal
jugular vein

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◼ Lateral wall – made up of
the tympanic membrane
and the lateral wall of the
epitympanic recess.
◼ Medial wall – Promontory,
 Oval window (fenestra
vestibuli)
 Round window (fenestra
cochleae),
 Bulge produced by the facial
nerve as it travels nearby.
 Bulge of lateral semicircular
canal
The tympanic plexus is formed on the tympanic promontory by branches of Jacobson's
nerve (tympanic branch of the glossopharyngeal nerve) and caroticotympanic nerves
originating from the internal carotid artery plexus. 45
◼ Anterior wall – a thin bony plate with
two openings for the auditory tube and
the tensor tympani muscle. It
separates the middle ear from the
internal carotid artery.
◼ The posterior wall (mastoid wall) is the
bony partition between the tympanic
cavity and mastoid air cells.
 Aditus to the mastoid antrum allows the
two areas to communicate.
 Below, a small, hollow, conical projection,
the pyramid, houses the stapedius
muscle.
 Posterior canaliculus for chorda tympani
The facial nerve (CN VII) is a main
feature of the posterior wall. 46
Contents of the Middle Ear.
◼ In the mucous lining:
 Air

◼ Outside the mucous lining:

3 small bones named ear ossicles: malleus, incus and stapes.
 2 muscles: tensor tympani and stapedius.
 2 nerves: chorda tympani and tympanic plexus.
 Vessels supplying and emptying the middle ear.
 Ligaments of the ear ossicles.

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 COMMUNICATION
◼ Posterosuperioly with
mastoid antrum and
through this with
mastoid air cells.
◼ Anteromedially with
nasopharynx through
the pharyngotympanic
tube.

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Middle Ear Bones
◼ The ossicles (the smallest
bones in the body) amplify the
sound 20 X due to leverage
◼ Advantage: sensitivity to soft
sounds
◼ Disadvantage; possible
damage to sensory cells from
loud sounds

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 Middle Ear Bones
◼ The ossicles are joined by
synovial joints and create a
bony chain that stretches
across the tympanic cavity from
the tympanic membrane to the
oval window.
◼ They conduct sound vibrations
from the tympanic membrane to
the oval window and then to the
inner ear fluid.
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◼ Malleus: (L. a hammer) Malleus
attaches to the tympanic
membrane.
◼ The rounded superior head
of the malleus lies in the
epitympanic recess.
◼ The head of the malleus
articulates with the incus;
the tendon of the tensor
tympani inserts into its
handle near the neck.

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Incus
◼ Incus: (L. an anvil) is located
between the malleus and the
stapes and articulates with
them.
◼ It has a body and two limbs.

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 Stapes
◼ Stapes: It resembles a stirrup. It is
composed of head, neck, anterior
and posterior crura and footplate.
The footplate shuts the oval
window and is connected to its
margin by annular ligament.
◼ Attached to the oval window. It
Vibrates in response to vibrations
in the tympanic membrane.

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 Ligaments of the Middle Ear
◼ The ossicles are anchored by six
ligaments to the walls of the middle ear
cavity. The malleal ligaments (3) include
the anterior, lateral, and superior
ligaments.
◼ The incus is supported (2) by the
posterior and superior ligaments.
◼ The annular ligament (1) anchors the
perimeter of the stapes footplate to the
bony oval window.
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 Applied anatomy
◼ Otosclerosis: An abnormal
ossification of the annular ligament,
which anchors the footplate of the
stapes to the oval window. This
impedes the movements of the
stapes and causes deafness.
◼ It is the most frequently encountered
cause of conductive deafness in
adults.

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 Muscles of the Middle Ear (Stapedius)
◼ The smallest skeletal muscle in the human
body.
◼ Connects to the stapes (the stirrup)
◼ When it contracts, it reduces the action of the
stapes (i.e., it reduces amplification)
◼ It contracts just before speaking and chewing
because this could be loud enough to damage
the inner ear if the sounds were further amplified.
◼ Nerve supply: branch of the Facial Nerve (CN
VII).
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Applied Anatomy
◼ Paralysis of the stapedius muscle is usually caused by a
lesion of CN VII, resulting in wider oscillation of the
stapes; consequentially, there is a heightened reaction of
the auditory ossicles to sound vibration.
◼ This condition is known as hyperacusis and results in an
increased sensitivity to loud sounds.

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Tensor tympani
◼ Arises from the superior surface of the
cartilaginous part of the pharyngotympanic
tube, the greater wing of the sphenoid,
and the petrous part of the temporal bone.
◼ It inserts on the malleus and acts to tense
the tympanic membrane, reducing the
effectiveness of sound transmission and
protecting the inner ear during loud sounds.
◼ Nerve: a branch of the mandibular nerve
(CN V3 ).
This action tends to prevent damage to the internal ear when one is exposed to
loud sounds. 60
CLINICAL SIGNIFICANCE
◼ Middle ear infection (otitis media): This is common in
babies and youngsters. It reaches the middle ear from the
upper respiratory tract via the pharyngotympanic tube.
◼ The longstanding infection results in chronic
suppurative otitis media (CSOM), which presents as
ear discharge and perforation of the tympanic
membrane.

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◼ The spread of infection from the middle ear may result in:
 Acute mastoiditis and mastoid abscess, when the infection
spreads into mastoid antrum and mastoid air cells in the posterior
wall.
 Meningitis and temporal lobe abscess may happen if the infection
spreads upwards via the thin roof (tegmen tympani).
 Lower motor neuron type of facial palsy if the infection erodes the
papery, thin, bony wall of the facial canal.
 Transverse and sigmoid sinus thrombosis if infection spreads via
the floor.
 Labyrinthitis if the infection spreads deep into the medial wall. The
labyrinthitis causes vomiting and vertigo.
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◼ 1. Tegmen tympani
◼ 2. Tensor tympani muscle
◼ 3. Pharyngotympanic tube
◼ 4. Lesser petrosal nerve
◼ 5. Branch from internal carotid plexus
◼ 6. Internal carotid plexus (sympathetic)
◼ 7. Internal carotid artery
◼ 8. Chorda tympani nerve
◼ 9. Tympanic branch of the glossopharyngeal nerve [IX]
◼ 10. Internal jugular vein
◼ 11. Round window
◼ 12. Facial nerve [VII]
◼ 13. Chorda tympani nerve
◼ 14. Pyramidal eminence (encloses stapedius muscle)
◼ 15. Oval window
◼ 16. Aditus to mastoid antrum
◼ 17. Prominence of lateral semicircular canal
◼ 18. The prominence of the facial canal
◼ 19. Promontory
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INNER EAR

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◼ It comprises a series of fluid-filled
cavities, sacs, and ducts, which INTERNAL EAR
contain the Vestibulocochlear
organ, which is concerned with
receiving sound and maintaining
balance.
◼ It's composed of a Bony labyrinth
(cavities), a membranous
labyrinth (sacs and ducts), and
the surrounding Otic capsule
(bone).
◼ Perilymph and endolymph fill the
bony and membranous labyrinths,
respectively
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 The bony labyrinth
◼ The bony labyrinth is contained within the otic capsule of
the petrous part of the temporal bone. It is made of
bone that is denser than the remainder of the petrous
temporal bone and can be isolated (carved) from it using
a dental drill.
◼ The bony labyrinth is the fluid-filled space surrounded by
the otic capsule. It is a cast of the otic capsule after the
removal of the surrounding bone.

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 BONY LABYRINTH

The bony labyrinth is structurally and functionally divided into the vestibule, the
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semicircular canals and the cochlea.
 Bony Labyrinth

◼ The labyrinth itself consists of

spaces in the petrous temporal
bone, and it contains the
membranous labyrinth

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The bony labyrinth And The Membranous Labyrinth

◼ Bony labyrinth: includes the vestibule, the three

semicircular canals, and the cochlea, which are all housed
within the temporal bone and filled with perilymph
◼ Membranous labyrinth: is suspended within the perilymph of
the bony labyrinth and is filled with endolymph; consists of
the cochlear duct (the organ of hearing) and the utricle,
saccule, and semicircular ducts (the organs of balance)

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◼ The vestibule is the central portion of the
bony labyrinth
◼ The vestibular window (oval window)
serves as a membranous interface between
the stapes from the middle ear and the
vestibule of the inner ear.
◼ The membranous labyrinth within the
vestibule consists of two connected sacs
called the utricle and saccule.
◼ Both the utricle and saccule contain
receptors (the maculae) sensitive to
gravity and linear movements of the
head.
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The Membranous Labyrinth
◼ Comprises the utricle and
saccule (in the vestibule),
the semicircular ducts (in
the semicircular canals)
and the duct of the cochlea
(in the cochlea).

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◼ The three bony semicircular
inner ear canals are at right
angles.
◼ The narrow semicircular
ducts of the membranous
labyrinth are within the
semicircular canals.
◼ Receptors within the
semicircular ducts are
sensitive to angular
acceleration and deceleration
of the head, as occurs in
rotational movement.
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 The macula is basically hair cells. Its normal function is to
detect linear acceleration in a vertical plane

◼ The saccule and utricle

are within the vestibule,
united by the narrow Y-
shaped endolymphatic
duct.
◼ Both contain a small area
of projecting hairs, the
maculae, the end-organ of
static balance.

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 Crista is a sense organ in the ampullae of the inner ear's semicircular
canals. It is also known as crista ampullaris, and it is a sensory organ
of rotation

◼ The narrow semicircular ducts each possess a dilated

ampulla containing a sensory area, the crista, the organ of
kinetic balance.
◼ The normal function of the crista is to sense the angular
acceleration and deceleration directed along the plane of
the duct.

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Cochlea.
◼ The cochlea is the shell-
shaped part of the bony
labyrinth that contains the
cochlear duct and is the part
of the internal ear concerned
with hearing.
◼ The spiral canal of the cochlea
begins at the vestibule and
makes 2.5 turns around a
bony core, the modiolus

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◼ Snail-shaped cavity within the mastoid bone and has 2 ½ turns, with
three fluid-filled chambers
◼ The middle compartment is the Scala Media and contains the Organ
of Corti that Converts mechanical energy to electrical energy

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 Cochlea
◼ The other two chambers are:
◼ Scala vestibuli that forms the
upper chamber of the cochlea.
◼ The scala vestibuli begins at
the oval window (vestibular
window), which is continuous
with the vestibule and
contains perilymph.

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◼ Scala tympani Forms the lower
chamber of the cochlea.
◼ The scala tympani terminates at
the round (cochlear) window and
contains perilymph.
 Helicotrema. The scala vestibuli
and the scala tympani are
separated completely, except at
the narrow apex of the cochlea
called the helicotrema, where
they are continuous.

The round window serves to decompress

acoustic energy that enters the cochlea via
stapes movement against the oval window. 80
 Cochlear duct (Scala Media).
◼ Forms the middle chamber of the
cochlea.
◼ The cochlear duct is filled with
endolymph and ends at the
helicotrema.
◼ The cochlear duct houses the spiral
organ (of Corti), where sound
receptors transduce mechanical
vibrations into nerve impulses.

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◼ The roof of the cochlear duct
is called the vestibular
membrane (aka Reissner’s
membrane), and the floor is
called the basilar membrane.

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SPIRAL ORGAN OF CORTI
◼ The Organ of Corti is an inner ear organ located within the
cochlea. It has a single row of inner hair cells and three
rows of outer hair cells, separated by the supporting
cells.
◼ Vibrations caused by sound waves bend the stereocilia on
these hair cells via an electromechanical force.
◼ The hair cells convert mechanical energy into electrical
energy transmitted to the central nervous system via the
auditory nerve to facilitate audition.
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◼ The supporting cells are also
named Dieters' or phalangeal
cells.
◼ The hair cells within the organ of
Corti have stereocilia that attach
to the tectorial membrane.
◼ Shifts between the tectorial
and basilar membranes move
these stereocilia and activate or
deactivate the hair cell surface
receptors.

84
◼ Sound waves enter the ear via the auditory canal and cause tympanic
membrane vibration.
◼ Movement of the tympanic membrane causes subsequent vibrations
within the ossicles.
◼ The three bones of the middle ear transfer energy to the cochlea
through the oval window.
◼ As the oval window moves, waves propagate through the perilymph
fluid inside the scala tympani and then the scala vestibuli of the
cochlea.
◼ When the fluid moves through these structures, the basilar membrane
(located between the scala media and scala tympani) shifts to the
tectorial membrane.

85
◼ The organ of Corti is within the scala media of the cochlea. It resides on
the basilar membrane, which separates the scala tympani and scala
media.
◼ The scala media contains endolymph with a high (150 mM) K+
concentration. The endolymph helps to regulate the electrochemical
impulses of the auditory hair cells.
◼ Shifts between the tectorial and basilar membranes move these
stereocilia and activate or deactivate the hair cell surface receptors.
◼ When cation channels open on the hair cells, potassium ions flow into the
hair cells, the cells depolarise, and the depolarisation causes voltage-
gated calcium channels to open.
◼ The calcium influx releases glutamate from the hair cells into the
auditory nerve. The auditory nerve then sends a stimulus from the sound
wave to the brain, recognising it as sound. 86
 Blood Supply
◼ The labyrinthine artery most
commonly originates from the
anterior inferior cerebellar artery.
◼ About 15% of the time, the auditory
or labyrinthine artery can
occasionally branch directly from the
basilar artery.
◼ This artery may originate less
commonly from the superior
cerebellar or vertebral artery.
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The modiolus
◼ The modiolus contains
canals for blood vessels
and for the distribution of
the branches of the
cochlear nerve.
◼ The apex of the cone-
shaped modiolus is
directed laterally,
anteriorly, and inferiorly.

The large basal turn of the cochlea produces the promontory of the
labyrinthine wall of the tympanic cavity 88
Hearing loss
◼ Sensorineural hearing loss results from damage to the
hair cells within the inner ear, the vestibulocochlear nerve,
or the brain's central processing centers.
◼ This differs from conductive hearing loss, which results
from the inability of sound waves to reach the inner
ear. Conductive hearing loss is due to a physical
obstruction that keeps sound from reaching the inner
ear.
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◼ Sensorineural hearing loss is the most reported cause of auditory
deficits. It often results from exposure to loud sounds or ototoxic drugs.
◼ Exposure to loud noises causes the vibrational shift between the tectorial
and basilar membranes to increase. This shift can damage the stereocilia
of the outer hair cells.
◼ Aminoglycoside antibiotics are an example of an ototoxic drug. These
drugs are K+ channel blockers, blocking the ability of both inner and outer
hair cells to depolarise.
◼ These drugs can also change the concentration of ions within the
perilymph, leading to damage or death of both inner and outer hair
cells; destruction of the hair cells causes permanent auditory deficits
because they do not regenerate.

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 Weber and Rinne Tests
◼ Sensorineural hearing loss suggests a disorder of the internal ear or
the cochlear division of CN VIII.
◼ Conductive hearing loss suggests a disorder of the external or
middle ear (eardrum, ear ossicles, or both).

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Weber and Rinne tests offer an easy way to differentiate between sensorineural and conductive hearing loss.
Weber and Rinne Tests

READ IT UP https://www.youtube.com/watch?v=FgF91K7dU8Y 92
◼ The inner ear is more sensitive to sound via air conduction
than bone conduction (in other words, air conduction is
better than bone conduction).

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 Cochlear Implant
◼ Cochlear implant consists of a
speech processor and
implanted electrodes. An
external microphone detects
sound, which is converted by
the processor into electrical
signals transmitted to the
cochlear implant and
vestibulocochlear nerve.

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Vertigo
◼ A condition involving the peripheral vestibular system
(Ménière’s disease Labyrinthitis (toxic or allergic) or its CNS
connections and characterised by the illusion or perception
of motion is called vertigo.
◼ Central types of vertigo may be caused by multiple sclerosis,
migraine, vascular disease (associated with the
vestibulobasilar region), or brainstem tumours (especially at
the cerebellopontine angle).
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