ENT(EAR,NOSE,THROAT)

EAR: ANATOMY
EAR
The ear is the organ of hearing and balance. The
parts of the ear include:
External or outer ear,consisting of:
Pinna or auricle. This is the outside part of the ear.
External auditory canal or tube.This is the tube that
connects the outer ear to the inside or middle ear.
Tympanic membrane(also called the
eardrum).The tympanic membrane divides the
external ear from the middle ear.
Middle ear(tympanic cavity),consisting of:
Ossicles.Three small bones that are connected and
transmit the sound waves to the inner ear. The bones are
called:
Malleus
Incus
Stapes
Eustachian tube.A canal that links the middle ear with the
back of the nose. The eustachian tube helps to equalize the
pressurein the middle ear.Equalized pressure is neededfor
the proper transfer of sound waves. The eustachian tube is
Inner ear, consisting of:
Cochlea.This contains the nerves for hearing.
Vestibule.This contains receptors for balance.
Semicircular canals.This contains receptors for
balance.
 EAR: HEARING MECHANISM
How do we hear?
Hearing starts with the outer ear.
When a sound is made outside the outer ear, the sound waves, or vibrations, travel
down the external auditory canal and strike the eardrum (tympanic membrane).
The eardrum vibrates.
The vibrations are then passed to 3 tiny bones in the middle ear called the ossicles.
The ossicles amplify the sound and send the sound waves to the inner ear and into
the fluid-filled hearing organ (cochlea).
Once the sound waves reach the inner ear, they are converted into electrical
impulses, which the auditory nerve sends to the brain. The brain then translates
these electrical impulses as sound.
The Mechanics of Hearing

Hearing occurs as sound enters the ear canal and sets in motion the vibration of the
eardrum and middle ear bones. Motion begins in the entrance to the inner ear and
produces a traveling wave, which activates the hair cells of the basilar membrane. It
is the hair cells that convert the energy of sound into a neurologic (nerve) impulse,
which can be understood by the brain. These impulses are transmitted through the
cochlear nerve, via the brainstem, to the brain cortex. The hearing organ is the
cochlea, which is a snail-like structure divided into three chambers. The three
chambers are called the scala tympani, the scala media and the scala vestibuli .
 THE MECHANICS OF EQUILIBRIUM/BALANCE

The balance portion of the inner ear is another delicate organ; it consists of the utricle, saccule, and 3
semicircular canals. Like the hearing portion of the inner ear, it contains fluid (endolymph) and is suspended
in fluid (perilymph). This delicate organ is housed in three half circles of hard bone: the superior, lateral and
posterior semicircular canals. At each end of the canals are structures that contain sensory hair cells. These hair
cells are tipped with calcium deposits, which make the ends of the hair cells top-heavy and motion-sensitive.
When the head is turned, endolymph moves through the semicircular canals past the hair cells. As these cells
are stimulated, electrical impulses are transmitted through the balance nerve to the brain.
The brain acts as a computer, analyzing constant signals being sent its way from the semicircular canals. As
the person changes position, the brain processes this information. Based upon the data received from the inner
ear, the brain then sends messages to the muscles of the body to maintain balance. Any disturbance in inner
ear results inhearing difficultiesand/orbalance difficulties.
AUDITORY RECEPTORS
Resting on the basilar membrane of the cochlear duct is the spiral organ of Corti which contains the

auditory receptor cells along with several types of supporting cells. The neuroepithelial receptor cells

are classified as inner and outer hair cells. The inner hair cells are the receptors for hearing, while the

outer hair cells are for modulation.

The inner hair cells are arranged in a single row along the entire length of the cochlear duct, that is,

from its base to its apex. They are surrounded by supporting cells, the inner phalangeal cells. The outer

hair cells are arranged in three rows in the basal coil of the cochlea and in four or five rows in the

apical coil. They are supported by the outer phalangeal cells. Hence, both the inner and the outer hair

cells rest on the supporting cells, not the basilar membrane. Extending laterally from the outer

phalangeal cells are several rows of cells that become continuous with the epithelium lining the outer

wall of the cochlear duct at the external spiral sulcus. Extending medially from the inner phalangeal

cells are border cells which become continuous with the epithelium lining the inner wall of the cochlear
 INNER EAR PHYSIOLOGY
Thebasilar membraneand the hair cells of the cochlea function as a sharply tuned frequency
analyzer.Sound is transmitted to the inner ear via vibration of thetympanic membrane, leading
to movement of themiddle ear bones(malleus, incus, and stapes). Movement of the stapes on
theoval windowgenerates a pressure wave in theperilymphwithin the cochlea, causing the
basilar membrane to vibrate. Sounds of different frequencies vibrate different parts of the basilar
membrane, and the point of maximal vibration amplitude depends on the sound frequency.
As the basilar membrane vibrates, thehair cellsattached to this membrane are rhythmically
pushed up against thetectorial membrane, bending the hair cellstereocilia. This opens
mechanically gated ion channels on the hair cell, allowing influx of potassium (K +) and
calcium(Ca2+) ions. The flow of ions generates an AC current through the hair cell surface, at the
same frequency as the acoustic stimulus. This measurable AC voltage is called the cochlear
microphonic (CM), which mimics the stimulus. The hair cells function as a transducer, converting
the mechanical movement of the basilar membrane into electrical voltage, in a process
requiringATP from the stria vascularis as an energy source.
The depolarized hair cell releases neurotransmitters across a
synapse to primary auditory neurons of thespiral ganglion. Upon
reaching receptors on the postsynaptic spiral ganglion neurons, the
neurotransmitters induce apostsynaptic potentialor generator
potential in the neuronal projections. When a certain threshold
potential is reached, the spiral ganglion neuron fires an action
potential, which enters the auditory processing pathway of the
brain.
STUDY OF DIFFERENT POTENTIAL CHANGES
IN INTERNAL EAR
A resting endolymphatic potential of a normal cochlea is + 80 mV.
There are at least 3 other potentials generated upon cochlear
stimulation:
Cochlear microphonic (CM)
Summating potential (SP)
Action potential (AP)
the cochlear microphonic (CM) is an alternating current (AC) voltage that mirrors the waveform of the
acoustic stimulus. It is dominated by the outer hair cells of the organ of Corti. The magnitude of the
recording is dependent on the proximity of the recording electrodes to the hair cells. The CM is
proportional to the displacement of the basilar membrane.

The summating potential (SP), is the direct current (DC) response of the hair cells as they move in
conjunction with the basilar membrane. The SP is the stimulus-related potential of the cochlea. Although
historically it has been the least studied, renewed interest has surfaced due to changes in the SP reported
in cases of endolymphatic hydrops or Mnire's disease.

The auditory nerve action potential is the most widely studied component in ECochG. The AP represents
the summed response of the synchronous firing of the nerve fibers. It also appears as an AC voltage. The
first and largest wave (N1) is identical to wave I of auditory brainstem response (ABR). Following this is
N2, which is identical to wave II of the ABR. The magnitude of the action potential reflects the number
of fibers that are firing. The latency of the AP is measured as the time between the onset and the peak of
the N1 wave.