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QUESTION 1

Describe the anatomical subdivision of ear and physiology

ANATOMY OF THE HUMAN EAR

THE EAR is a complex organ responsible for hearing and balance. It can be anatomically subdivided
into three main regions: the outer ear, the middle ear, and the inner ear. Each region serves distinct
functions in the process of auditory perception and balance. Basically the ear is housed in the
temporal bone

• 1. Outer Ear: Comprises

• Pinna(auricle)

• external auditory meatus (auditory canal)

• tympanic membrane

AURICLE (PINNA)

• Auricle (pinna): The visible, external part of the ear that collects and directs sound waves down
the auditory canal and supports worn glasses.

• Funnel-shaped and supported by elastic cartilage.

• Lined by adherent skin with hairs

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FIVE CRITICAL ELEMENTS OF AURICLE (PINNA)

 Incisura terminalis – between the crus of the helix and the tragus. It is devoid of cartilage.
Serves as site for surgical incisions to the ear.
 Intra- and inter-individual morphological variations exists

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 Cartilage free lobule forms the inferior attachment. Made of fibro fatty tissue.
 Three extrinsic muscles; anterior, superior and posterior auricular muscles attach the auricle
to the scalp.

EXTERNAL ACOUSTIC MEATUS (AUDITORY CANAL)

• About 3cm long and 7mm wide in adults.

• Extends from the conchal bowl to TM

• Anteroinferior wall is longer than posterosuperior due to the obliquity of the TM

• Lateral 1/3 is cartilaginous (wider).

• Medial 2/3 is bony

• Fissures of santorini: deficiencies (gaps) in the cartilage.

• Spread of infections b/n the parotid gland and lateral 1/3 of the meatus occur here.

• Hairs and glands (sebaceous and ceruminous) located at lateral 1/3.

• Hair traps foreign particles.

ceruminous and sebaceous glands secrete cerumen (ear wax).

1. sticky and coats guard hairs

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2. contains lysozyme with low pH that inhibits bacterial growth
3. Repel insects with its smell.
4. water-proofs canal and protects skin
5. Staphilococcus infections (boils) are common here due to the presence of the hair follicles.

• Osseo- cartilaginous junction (O-CJ): meeting of bony and cartilaginous parts.

• Isthmus: narrowest part of the meatus where Water and foreign materials most likely to lodge
here.

TYMPANIC MEMBRANE (EAR DRUM)

• Lies obliquely across the end of the meatus

• Consists of three layers:

• outer (cutaneous)

• intermediate (fibrous)

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• inner(mucous) layer.

• Has a thickened fibrocartilaginous ring at the greater part of its circumference, which is fixed
in the tympanic sulcus at the inner end of the meatus.

• Pars flaccida: a small triangular portion between the anterior and posterior malleolar fold
(deficient ring and lack of fibrous layer)

• Pars tensa:

1. cone of light: is a triangular reflection of light seen in the anterior–inferior quadrant.

2. Umbo(Latin for “knob”): the most depressed center point of the concavity
3. about 1 cm in diameter
4. • vibrates freely in response to sound
5. • innervated by sensory branches of the vagus and trigeminal nerves and highly sensitive to
pain

MIDDLE EAR (TYMPANUM)

• Middle ear - located in the air-filled tympanic cavity in temporal bone.

• About 2-3mm in diameter b/n outer and inner ears.

• It has two main openings;

• from epitympanic recess through the aditus to mastoid air cells and antrum

• Pharyngotympanic tube/auditory tube/Eustachian tube.

• It has two sealed openings;

• oval window sealed by the foot plate of the stapes and

• round window sealed by the secondary tympanic membrane

• Auditory (Eustachian) tube:

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• connects middle ear cavity to nasopharynx

• equalizes air pressure on both sides of tympanic membrane

• normally flattened and closed and swallowing and yawning opens it

• allows throat infections to spread to the middle ear

AUDITORY OSSICLES

a. malleus

• head: head articulates with the incus in the epitympanic recess

• Neck

• handle (manubrium): Its handle is fused to the medial surface of the tympanic membrane and
serves as an attachment for the tensor tympani muscle.

• anterior process

• lateral process

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INCUS (ANVIL)

• Consists of a body and two processes (crura)

• Its long process descends vertically, parallel to the handle of the malleus, and articulates with
the stapes.
• Its short process extends horizontally backward to the fossa of the incus and provides.
Provides attachment for the posterior ligament of the incus

STAPES (STIRRUP)

• Consists of a

• head

• neck

TWO PROCESSES (CRURA)

• neck: provides insertion of the stapedius muscle

• base (footplate): attached by the annular ligament to the margin of the oval window
(fenestra vestibule)

• otosclerosis: Abnormal ossification between the footplate and the oval window limits the
movement of the stapes, causing deafness

TWO MAIN MUSCLES

• Stapedius muscle

• Attached to the neck of the stapes.

• It’s the smallest muscle in the body Pulls the head of the stapes in response to loud noise.
Prevents damage to the inner ear

• Innervated by the facial nerve.

• Hyperacusia (hyperacusis)- excessive acuteness of hearing due to paralyses of the

stapedius.

• tensor tympani muscles

• attached to the handle of the malleus. Contracts in response to loud noise to tense the TM
and reduce vibrations.

• Innervated by the trigeminal nerve(V3)

Otitis media (middle ear infection) is common in children

• auditory tube is short and horizontal

• infections easily spread from throat to tympanic cavity and mastoid air cells

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THE CHORDA TYMPANI NERVE TRAVERSE THE MIDDLE EAR CAVITY.

• The chorda tympani carries taste sensations to the anterior 2/3 of the tongue.

• Damage to this nerve during middle ear surgery or middle ear infection will lead to loss of taste to
the area it innervate.

INNER (INTERNAL) EAR

The inner ear also known the labyrinth is housed in the petrous part of the temporal bone. it consists
of

• Osseous (bony) labyrinth-passageways in temporal bone. Contains perilymph similar to

cerebrospinal fluid. Consists of the ff. parts

• vestibule

• three semicircular canals

• cochlea

• Membranous labyrinth- fleshy tubes lining the bony labyrinth. Contains endolymph similar to
intracellular fluid.

• Saccule and utricle lines the vestibule

• Semicircular ducts lines the semicircular canals

• Cochlea ducts lines the cochlea

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ANATOMY OF COCHLEA

• cochlea has three fluid-filled chambers separated by membranes:

– scala vestibuli – superior chamber

• filled with perilymph

• begins at oval window and spirals to apex

– scala tympani – inferior chamber

• filled with perilymph

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• begins at apex and ends at round window secondary tympanic membrane – membrane covering
round window

-- SCALA MEDIA (COCHLEAR DUCT) – triangular middle chamber

• filled with endolymph

• separated from: scala vestibuli by vestibular membrane and scala tympani by thicker basilar
membrane

• contains spiral organ - organ of Corti -acoustic organ – converts vibrations into nerve impulses

ANATOMY OF SPIRAL ORGAN (ORGAN OF CORTI)

• spiral organ has epithelium composed of hair cells and supporting cells

• hair cells have long, stiff microvilli called stereocilia on apical surface

• gelatinous tectorial membrane rests on top of stereocilia

• spiral organ has four rows of hair cells spiraling along its length

• inner hair cells – single row of about 3500 cells

• provides for hearing

• outer hair cells – three rows of about 20,000 cells

• adjusts response of cochlea to different frequencies

• increases precision

QUESTION 2.

Describe and interpret hearing test

1. Voice or Speech Test:

Description:

 A voice or speech test is a subjective hearing assessment that evaluates an individual's ability
to hear and understand spoken words. The test typically involves presenting spoken words,

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phrases, or sentences to the individual at various volumes and asking them to repeat or
respond.

Components of a Speech Test:

A. Word Recognition Test or Whispered Voice Test:

 The examiner stands at a certain distance from the individual and whispers words or
numbers. The person being tested is asked to repeat what was heard.

 The individual is presented with a list of common words at different volumes. The
percentage of correctly repeated words is measured.

B. Sentence Recognition Test:

 Sentences are presented at varying levels of difficulty (e.g., background noise). The
individual repeats or responds to the sentences, and the accuracy is assessed.

C. Speech-in-Noise Test:

 Evaluates the individual's ability to understand speech in the presence of background

noise.

Interpretation:

 The results of a speech test provide valuable information about an individual's ability to
understand spoken language in real-life situations. The audiologist may use the following
metrics for interpretation:

A. Speech Discrimination Score:

 Percentage of correctly repeated words or sentences in a word or sentence

recognition test.

 A high score indicates good speech discrimination, while a lower score may suggest
difficulties in understanding spoken words.

B. Speech Recognition Threshold (SRT):

 The level at which the individual can just correctly repeat 50% of the presented words.

 The SRT is often compared to pure-tone thresholds obtained through audiometry.

 Word recognition scores may be expressed as a percentage, indicating the percentage

of correctly identified words. Higher percentages suggest better speech
understanding.

C. Speech-in-Noise Performance:

 Assessing the ability to hear and understand speech in challenging, noisy

environments.

2. TUNING FORK TEST:

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Description:

 The tuning fork test is a diagnostic tool used to assess various aspects of hearing and auditory
function. It involves the use of a metal instrument called a tuning fork, which produces a pure
tone when struck. There are several tuning fork tests, with the two most common being the
Rinne test and the Weber test.

 512Hz is used in clinical practice

a. Rinne Test:

Procedure:

1. The tuning fork is struck, producing a vibrating sound.

2. The base of the vibrating tuning fork is placed against the mastoid bone behind one ear (bone
conduction).

3. The examiner notes when the individual indicates they can no longer hear the sound through
bone conduction.

4. The tuning fork is then placed near the ear canal without touching it (air conduction).

5. The individual indicates when they can no longer hear the sound through air conduction.

Interpretation:

 Normal Hearing: If air conduction is heard longer than bone conduction, the test is
positive (AC > BC). This suggests normal hearing or sensorineural hearing loss.
 Conductive Hearing Loss: If bone conduction is heard longer than air conduction, the
test is negative (BC > AC), indicating conductive hearing loss.

b. Weber Test:

Procedure:

1. The tuning fork is struck, producing a vibrating sound.

2. The base of the vibrating tuning fork is placed on the forehead or midline of the skull.

3. The individual indicates whether they hear the sound equally in both ears or if it's louder in
one ear.

Interpretation:

 Normal Hearing: If the sound is heard equally in both ears, the test is normal.

 Sensorineural Hearing Loss: If the sound lateralizes (is louder) to the better-hearing ear, it
suggests sensorineural hearing loss in the opposite ear.

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 Conductive Hearing Loss: If the sound lateralizes (is louder) to the impaired ear, it indicates
conductive hearing loss in that ear.

3. AUDIOMETRY:

Description:

 Audiometry is a comprehensive hearing test that measures an individual's hearing thresholds

across different frequencies and intensities. It is conducted in a soundproof booth using
calibrated equipment. The primary aim is to assess the type, degree, and configuration of
hearing loss.

1. Air Conduction Testing:

 Pure-tone air conduction audiometry involves the individual wearing headphones and
responding when they hear a series of pure-tone sounds at varying frequencies
(measured in Hertz) and intensities (measured in decibels). The results are plotted on
an audiogram.

 Interpretation:

 The audiogram reflects the softest sounds an individual can hear at different
frequencies.

 Different symbols are used to represent the right and left ears.

 Type of Hearing Loss:

 Conductive: Elevated thresholds primarily for air conduction.

 Sensorineural: Elevated thresholds for both air and bone conduction.

 Mixed: Combination of conductive and sensorineural components.

2. Bone Conduction Testing:

 Bone conduction audiometry involves presenting tones directly to the bones behind
the ear using a bone oscillator. This bypasses the outer and middle ear, assessing the
inner ear and auditory nerve.

 Interpretation:

 Comparing air and bone conduction thresholds helps differentiate between

conductive and sensorineural hearing loss.

3. Speech Audiometry:

 Speech audiometry evaluates the individual's ability to understand and repeat spoken
words. It may include tests like:

 Word Recognition Score (percentage of correctly identified words).

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 Speech Reception Threshold (softest level at which the person can understand
speech).

 Interpretation:

 Speech audiometry provides information about the person's ability to

comprehend spoken language, which may not be fully captured by pure-tone
audiometry.

4. OBJECTIVE HEARING TESTS:

Objective hearing tests are diagnostic assessments that do not rely on the individual's subjective
responses. These tests provide measurable and quantifiable information about specific aspects of the
auditory system. Two commonly used objective hearing tests are Otoacoustic Emissions (OAE) and
Auditory Brainstem Response (ABR).

1. Otoacoustic Emissions (OAE):

Description:

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 Otoacoustic Emissions measure the sounds produced by the inner ear (cochlea) in response to
a stimulus, typically a series of clicks or tones. These emissions can be measured using a
sensitive microphone placed in the ear canal.

Interpretation:

 Normal Hearing:

 Individuals with normal hearing typically produce OAEs.

 Hearing Loss:

 Absence or reduced amplitude of OAEs may indicate hearing loss, especially

sensorineural hearing loss.

 Clinical Application:

 OAEs are commonly used in newborn hearing screenings and can help identify hearing
loss, particularly in individuals who may not be able to provide reliable subjective
responses.

2. Auditory Brainstem Response (ABR):

Description:

 Auditory Brainstem Response measures the electrical activity of the auditory nerve and
brainstem in response to auditory stimuli, such as clicks or tones. Electrodes are placed on the
scalp to record the neural responses.

Interpretation:

 Normal Hearing:

 Clear and consistent ABR waveforms are observed in individuals with normal hearing.

 Hearing Loss:

 Absence or abnormality of ABR waveforms may indicate hearing loss, especially

neural or brainstem-related issues.

 Clinical Application:

 ABR is often used in pediatric populations and for individuals who may have difficulty
with conventional audiometry. It provides information about the integrity of the
auditory nerve and brainstem pathways.

3. Tympanometry:

Description:

 Tympanometry is a diagnostic test that assesses the mobility of the eardrum (tympanic
membrane) and the function of the middle ear. It is commonly used to evaluate conditions
such as otitis media (middle ear infection) and eustachian tube dysfunction.

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Procedure:

1. The individual sits or lies down while a probe is placed in the ear canal.

2. The probe changes air pressure in the ear canal, and a tone is emitted.

3. The tympanogram, a graph of the compliance of the eardrum at different pressures, is

recorded.

Interpretation:

 Normal Tympanogram (Type A):

 Indicates normal middle ear pressure and mobility of the eardrum.

 Most common in healthy ears.

 Flat Tympanogram (Type B):

 Indicates little or no mobility of the eardrum.

 May suggest middle ear effusion (fluid) or eardrum perforation.

 Peak-Shifted Tympanogram (Type As or Ad):

 Indicates reduced compliance of the eardrum, often seen in conditions like

otosclerosis.

 May suggest stiffening of the ossicles in the middle ear.

 Wide Tympanogram (Type C):

 Indicates negative middle ear pressure.

 May suggest eustachian tube dysfunction or conditions leading to impaired aeration

of the middle ear.

Clinical Application:

 Tympanometry helps identify middle ear conditions, assess the function of the eustachian
tube, and differentiate between conductive and sensorineural hearing loss.

QUESTION 3

Describe types of hearing loss

HEARING LOSS can be categorized into several types, each with different causes and characteristics.
The three main types of hearing loss are conductive, sensorineural, and mixed. Here's a brief
description of each:

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1. Conductive Hearing Loss:

 Description: Conductive hearing loss occurs when sound is not effectively conducted
through the outer ear, ear canal, or middle ear to the inner ear. This can result from
problems such as earwax blockage, fluid in the middle ear, ear infections, or issues
with the ear canal or eardrum.

 Characteristics:

 Reduced ability to hear soft sounds.

 Speech may sound faint or distant.

 Typically, bone conduction thresholds are within the normal range, while air
conduction thresholds are elevated.

2. Sensorineural Hearing Loss:

 Description: Sensorineural hearing loss results from damage to the inner ear (cochlea)
or the auditory nerve. It is often related to aging, exposure to loud noise, genetic
factors, or certain medical conditions like Meniere's disease.

 Characteristics:

 Difficulty hearing soft sounds and understanding speech, especially in noisy

environments.

 Sounds may seem distorted or muffled.

 Both air and bone conduction thresholds are typically affected.

3. Mixed Hearing Loss:

 Description: Mixed hearing loss is a combination of both conductive and sensorineural

hearing loss. It involves issues in both the outer or middle ear and the inner ear or
auditory nerve.

 Characteristics:

 Individuals with mixed hearing loss may experience a variety of symptoms,

including difficulties in hearing both soft sounds and speech.

 The specific characteristics depend on the degree and nature of both the
conductive and sensorineural components.

4. Functional Hearing Loss (Psychogenic Hearing Loss):

Description: Functional hearing loss refers to hearing difficulties without any detectable organic cause.
It may be influenced by psychological or emotional factors.

Causes:

Emotional stress

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Psychological conditions

Treatment: Counseling and psychotherapy may be beneficial in addressing underlying emotional

factors.

5. Other classifications based on the degree of hearing loss include:

Mild, Moderate, Severe, and Profound Hearing Loss:

 Description: Hearing loss severity is categorized based on the extent of impairment,

ranging from mild to profound.

 Characteristics:

 Mild: Difficulty hearing soft sounds.

 Moderate: Difficulty hearing regular conversation.

 Severe: Limited ability to hear most sounds.

 Profound: Very limited or no ability to hear sounds.

6. High-Frequency and Low-Frequency Hearing Loss:

 Description: This classification is based on the frequency range of sounds affected by

the hearing loss.

 Characteristics:

 High-Frequency: Difficulty hearing high-pitched sounds, affecting speech

clarity.

 Low-Frequency: Difficulty hearing low-pitched sounds, impacting the

perception of certain voices and environmental sounds.

7. Central Hearing Loss:

 Description: Central hearing loss occurs when there is damage to the central auditory nervous
system, particularly in the auditory pathways and centers of the brain.

 Causes:

 Tumors

 Neurological disorders

 Stroke

 Treatment: Management often involves addressing the underlying neurological condition.

Hearing aids may provide some benefit in some cases.

8. Auditory Processing Disorder (APD):

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 Description: APD is a condition where the central auditory nervous system has difficulty
processing auditory information, even when hearing sensitivity is normal.

 Causes:

 Genetic factors

 Perinatal or developmental factors

 Treatment: Management strategies may include auditory training, environmental

modifications, and educational support.

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