- Footplate- sits in the oval window,

Anatomy secured by a fibrous annulus. Transmits

sound to the inner ear.
● Inner ear
● External ear
➢ Cochlea- organ for hearing
➢ Auricle (Pinna)
➢ Semicircular canals- organ
- collects sound waves and
for balance
directs vibration into the
➢ Cn VII and VIII
external auditory canal.
➢ Bony labyrinth- surrounds
➢ External auditory canal
and protects the
- 2 to 3 cm long
membranous labyrinth, which
➔ Skin of canal contains:
is bathed in a fluid called
- Hair
Perilymph.
- Sebaceous gland
➢ Membranous labyrinth
- Ceruminous gland
- composed of:
- Cerumen - ear wax
➔ Utricle
● Middle ear
➔ Saccule
➢ Tympanic membrane
➔ Cochlear duct
(eardrum)
➔ Semicircular canals
- protects the middle ear
➔ Organ of Corti
and conducts vibrations from
(All are surrounded by a fluid
the external canal to the
called Endolymph)
ossicles.
➢ Organ of Corti
- 1 cm in diameter and very
- housed in the cochlea
thin, normally pearl gray and
-snail shaped bony tube
translucent.
about 3.5 cm long
- 3 LAYERS TISSUE
-End organ of hearing
➔ Outer layer
➔ Fibrous middle layer
➔ Inner mucosal layer
- Pars Tensa- 80%
- Pars flaccida- 20%
➢ Ossicles
- 3 SMALLEST
BONES
➔ Stapes
➔ Malleus
➔ Incus
- 2 SMALL FENESTRAE
➔ Oval window
➔ Round
window-
provide exit
for sound
vibrations
 Function of the Ear ➔ Weber test - test uses bone
conduction to test
● Hearing lateralization of sound.
➔ Air conduction- travel over - uses a tuning fork ideally
air filled external and middle 512 Hertz
ear through vibration of the ➔ Rinne test - useful for
tympanic membrane and distinguishing between
ossicles conductive and sensorineural
➔ Bone conduction- travels hearing loss.
directly through bone to the - examiner shifts the stem of
inner ear, bypassing the a vibrating tuning fork
tympanic membrane and between 2 positions:
ossicles. ➢ 2 inches from the
opening of the ear
canal (air conduction)
➢ Against the mastoid
bone (bone
conduction)

● Balance and equilibrium

➔ Maintained by the
cooperation of:
➢ Muscles Diagnostic evaluation
➢ Joints
➢ Eyes ● Audiometry
➢ Labyrinth

Assessment of Hearing and Balance

● Inspection of the external ear

● Otoscopic examination
● Gross auditory acuity
➔ Whisper test - 1 to 2 feet
● Tympanogram
Severity of hearing loss

● Normal hearing - 0-15 dB

● Slight hearing loss - >15-25 dB
● Mild hearing loss - >25-40 dB
● Moderate hearing loss - >40-55 dB
● Moderate to severe hearing loss -
>55-70 dB
● Severe hearing loss - >70-90 dB
● Profound hearing loss - >90 dB

● Auditory brainstem response

Hearing loss

● 50% over the age of 70

● Increased incidence with age —
presbycusis (old hearing)
● Risk factor: exposure to excessive
noise levels
● Types:
➔ Conductive - caused by
external or middle ear
problem
● Electronystagmography
➔ Sensorineural - caused by
damage to the cochlea or
vestibulocochlear nerve
➔ Mixed - both conductive and
sensorineural
➔ Functional (psychogenic) -
caused by emotional problem
● Manifestations
➔ Tinnitus - perception of
sound ; often “ringing in the
ears”
➔ Increased inability to hear in
a group
➔ Turning up the volume on
the TV
● Platform posturography
➔ May feel deterioration of
● Sinusoidal harmonic acceleration
speech, fatigue, indifference,
● Middle ear endoscopy
social isolation or withdrawal
 ➢ Pathogen are most
commonly bacterial or viral
➢ Manifestation:
➔ Otalgia (ear pain)
➔ Fever
➔ Conductive hearing
loss
➢ Treatment:
➔ Antibiotic treatment
➔ Myringotomy or
Tympanotomy
● Serous otitis media
➢ Fluid in the middle ear
without evidence of infection
● Chronic otitis media
External ear conditions ➢ Result of recurrent acute
otitis media
● External otitis ➢ Chronic infection damages
➢ Inflammation most commonly the tympanic membrane,
caused by bacteria ossicle, and mastoid
Staphylococcus or ➢ Treatment:
Pseudomonas, or fungal ➔ Tympanoplasty
infection from Aspergillus ➔ Ossiculoplasty
➢ Manifestations include pain, ➔ Mastoidectomy
tenderness, discharge,
edema, erythema, pruritus,
hearing loss, feelings of ★ Stapedectomy
fullness in the ear - middle ear surgical procedure.
➢ Wick- may be inserted in the - stapes bone is removed from the middle
canal to keep it open and ear and replaced with prosthesis
facilitate medication
administration Inner ear conditions
● Malignant external otitis
➢ Rare, progressive infection ● Disorders of the vestibular system
that affects external auditory (BALANCE) may increase the risk
canal for falls:
➢ Pseudomonas Aeruginosa ➔ Dizziness - any altered
sense of orientation in space
Middle Ear conditions ➔ Vertigo - illusion of motion or
spinning sensation
● Tympanic membrane perforation ➔ Nystagmus - involuntary
● Acute otitis media rhythmic movement of the
➢ Most frequently seen in eyes associated with
children vestibular dysfunction
● Tinnitus - ringing in the ears ➔ BAHA (Bone-anchored
● Labyrinthitis - inflammatory hearing aid)
condition of the inner ear - implanted in mastoid area
● Benign positional vertigo - for conductive and mixed
● Ototoxicity - adverse effect
➔ MEI (Middle ear implant)
- used for sensorineural
Meniere Disease ➔ IMEHD (Implantable middle
ear hearing device)
● Abnormal inner fluid balance caused -2 styles
by malabsorption of the ➢ Piezoelectric- totally
endolymphatic sac or blockage of ➢ Electromagnetic-
the endolymphatic duct. partially
● Manifestation: ● Cochlear implant
➔ TRIAD OF SYMPTOMS: - auditory prosthesis
- Tinnitus - used with sensorineural (bilateral)
- Episodic vertigo
- Fluctuating
sensorineural hearing
loss
● Treatment:
➔ Low sodium diet ; 1000 to
1500 mg/day
➔ Meclizine (antivert)
➔ Tranquilizers- valium
➔ Antiemetics - promethazine
➔ Diuretics

Hearing aid

● Device through which speech and

environmental sounds are received
● Hearing loss exceeding 30 dB in the
range of 500 to 2000 Hz

Implanted hearing devices

● Bone conduction - transmit sound

through the skull to the inner ear,
used in patients with conductive
hearing loss.