Ear

Dr. Yasrul Izad Abu Bakar

Medical Faculty, UniSZA

Strictly for instructional

use only
 Learning outcome

• Describe the anatomy of

1. Inner ear
2. Middle ear
3. Outer ear

• Discuss the clinical application

 Ear: introduction
• Organ of hearing &
equilibrium

• The ear is divided into 3

parts: outer, middle & inner

• The outer & middle parts

transfer sound to the inner
ear

• Inner ear contains organ

(receptor) for hearing &
equilibrium (balance)
External ear
 External ear
• Comprised of
1. Auricle (pinna)
2. External auditory
(acoustic) meatus (canal)

• Facilitate reception of
sound by funnelling them
toward the tympanic Auricle

membrane External
auditory
meatus
 Auricle
• Part of ear seen on the surface

• The greater superior part is made by

plate of elastic cartilage lined by skin

• Has several depressions & elevations

• Concha is the deepest depression

(leads to external acoustic meatus)

Concha
Lobule
 Auricle
Parts:
• Helix is the elevated margin
surroundings auricle
Concha
• Tragus is the tongue-like (cymba)

projection covering the

opening of external acoustic
meatus
Concha
(cavity)

Lobule (earlobe):
• Non- cartilaginous
• Consists of fibrous tissue, fat
& small blood vessels
 External acoustic meatus (EAM)
• Canal (meatus) from concha to
tympanic membrane (2-3cm
long) Bony part

• The canal is slightly S-shaped

 Outer part: anterior & upward
 Middle part: posterior & upward
 Inner part: anterior & downward
Cartilaginous
part

Divided into 2 parts:

• Lateral 1/3 is cartilaginous part
• Medial 2/3 is bony part
 Cartilaginous part of EAM
• Lined by skin continuous with skin of Cartilaginous
auricle part

• The skin is adherent to perichondrium

of cartilage

• The subcutaneous tissue contains

hairs, sebaceous glands &
ceruminous glands

• Ceruminous gland is modified sweat Cartilage

gland that produce cerumen (earwax)

 Bony part of EAM
Tympanic
• Lined by skin continuous with plate of
temporal
external layer of tympanic bone

membrane

• The skin is firmly adherent to

the periosteum of bone

• The canal is formed by

tympanic plate of temporal
bone
 Blood / nutrients supply of
cartilage???
• Avascular
Perichondrium
• A layer of dense CT covering the cartilage
• Important for growth & maintenance of cartilage

Elastic cartilage Location (4E):

1. Ear pinna
2. External auditory canals
3. Eustachian tube
4. Epiglottis
 Clinical application
• Injury (bleeding) of auricle may
lead to deformed auricle =
cauliflower ear

• May occur in sport e.g. boxing

• When haematoma developed
under the perichondrium, the
nutrients supply of cartilage is
disrupted, causing it to die &
fibrous tissue is formed in the
overlying skin
• As a result, the auricle becomes
permanently swollen &
deformed
 Tympanic membrane

The tympanic membrane separates the external ear

from the middle ear
 Tympanic membrane
• Membrane at the medial end of
external acoustic meatus

• Thin & semitransparent membrane

• It is oval in shape (1 cm)
• Placed obliquely

• Tympanic membrane moves in

response to air vibration. Then the
movements transmitted by auditory
ossicles to the internal ear. Tympanic
membrane
 Tympanic membrane: parts
1. Pars tensa:
• Greater part of tympanic
membrane
• Tightly stretched Pars
flaccida

• Made up of radial & circular

fibres
Pars
tensa
2. Pars flaccida:
• Between anterior & posterior
mallear folds
• Loose & thin (lacks of fibres)
• More reliable to rupture
• Cross internally by chorda
tympani
 Tympanic membrane: structure
Consists of:

1. Outer epidermal layer of skin

2. Middle fibrous layer

Outer Inner
surface surface

3. Inner mucous layer

 Tympanic membrane: surfaces
• 2 Surfaces:
1. Outer surface:
• Concave Malleus
(handle)

• Lined by thin skin

2. Inner surface: Outer

surface
Inner
surface

• Convex
• Lined by mucous membrane
• Provides attachment to handle of
malleus
• Maximum convexity is called Umbo
(tip of handle malleus lies)
Tympanic membrane: Otoscopic view
Malleus

• The membrane is held tense

(handle)

by inward pull of tensor

tympani muscle (inserted at handle
of malleus)

• Otoscopic view: concavity

towards the EAM with central
depression (umbo = peak of the
depression)
Umbo
Middle ear
 Middleear
Middle ear
• Also known as tympanic cavity

• Is a narrow air filled chamber situated in

the petrous part of temporal bone

• Shape: cube
Tympanic
• In coronal section  biconcave because the cavity

medial and lateral wall are closest to each

other in the centre

• Functions: Transmission of tympanic

membrane vibrations to the inner ear
Petrous part of
temporal bone
 Middle ear: parts
Epitympanic
Has 2 parts: recess

• Tympanic cavity proper

(space opposite to tympanic
membrane)

• Epitympanic recess (space

superior to tympanic
membrane)
Tympanic
cavity
proper
 Tympanic cavity: walls
Shaped like a narrow box with 6 walls:
Tegmen
1. Tegmental wall (roof): formed by tympani
Middle cranial
tegmen tympani (separates tympanic cavity fossa
from middle cranial fossa)

2. Jugular wall (floor): layer of temporal

bone that separates the tympanic
cavity from superior bulb of IJV

3. Membranous wall (lateral): tympanic IJV

membrane & superiorly by lateral bony
wall
 Tympanic cavity - walls
Mastoid Tensor
antrum tympani
4. Labyrinthine wall (medial): separates from
inner ear. It has
Promontory:
 Rounded bulge produced by the
first turn of cochlea
Oval window:
 Oval opening to the vestibuli
 Closed by footplate of stapes Eustachian
Promontory tube
ICA

5. Carotid wall (anterior):

- inferior: carotid canal (ICA)
- middle: opening of pharyngotympanic tube
- superior: canal for tensor tympani

MEDIAL WALL OF TYMPANIC CAVITY

4. Mastoid wall ( posterior): mastoid antrum (LATERAL VIEW)
 Middle ear: contents
Consists of:
• 3 Small bones
• Ossicles

• 2 Skeletal muscles
1. Tensor tympani
2. Stapedius

• 2 Openings
1. Eustachian tube
2. Aditus to mastoid antrum

• 2 Nerves
1. Chorda tympani nerve
2. Tympanic plexus
 Auditory ossicles
Ossicles

• Form a mobile chain of small

bones across tympanic cavity from
tympanic membrane to the oval
window

• Include: malleus, incus & stapes

*Ossicle is the only bone fully formed at birth

 Malleus

• Resembles a hammer
• Largest & most lateral

Parts:
• Head – lies in epitympanic recess,
articulates with incus
• Handle – attached to tympanic
membrane
• Processes – anterior & lateral
 Incus

• Located (articulates) between

malleus & stapes

Parts:
• Body – articulate with malleus
• Long limb – articulates with stapes
 Stapes

• Smallest, most medial

Parts:
• Head – articulates with incus
• Base (footplate) – fits into
oval window
 Skeletal muscles
• There are 2 muscles:
1. Tensor tympani
2. Stapedius

• Both act
simultaneously to
damp down the LATERAL WALL OF TYMPANIC CAVITY
intensity of high (MEDIAL / INTERNAL VIEW)

pitched sound
 Tensor tympani muscle

• Lies in a bony canal

Tensor
tympani
• Superior to the auditory
tube

• Insertion: handle of
malleus

LATERAL WALL OF TYMPANIC CAVITY

(MEDIAL / INTERNAL VIEW)
 Stapedius muscle

• Lies in bony canal

posterior to tympanic
cavity

• Insertion: neck of
stapes
Stapedius

MEDIAL WALL OF TYMPANIC CAVITY

(LATERAL VIEW)
 Openings
• There are 2 openings
Mastoid
(communications): antrum
Mastoid
air cells

1. Auditory tube (Pharyngotympanic /

Eustachian tube)
• Connects tympanic cavity with
nasopharynx (anterior)

2. Aditus to mastoid antrum

Eustachian
• Connects tympanic cavity with tube
mastoid antrum & mastoid air
cells (posterior) MEDIAL WALL OF TYMPANIC CAVITY
(LATERAL VIEW)
 Openings
Aditus to mastoid antrum

Mastoid antrum: is a small,

circular, air filled space in the
mastoid process

Mastoid air cells: Cross section of temporal bone

intercommunicating spaces
present within the mastoid
process

*Aditus = access
 Chorda

Nerves tympani

1. Chorda tympani nerve

• Arises from Facial nerve
(CN VII) CN VII

2. Tympanic plexus
• Arises from
Glossopharyngeal nerve
(CN IX)
Tympanic
plexus
 Clinical application
Otoscopic (ear) examination:
• Begin with straightening the S-
shaped EAM by pulling auricle
upwards, backward & slightly
lateral
Perforated tympanic membrane
 Clinical application
Otitis media (infection of middle ear)

Pus may spread:

• Backward causing mastoid abscess
• To the roof causing meningitis / brain
abscess
• Erode the floor causing thrombosis of
IJV
• Discharged into external ear if tympanic
membrane ruptured

Throat infection may cause otitis media

(spread through pharyngotympanic tube)
Internal ear
 Internal ear
• A.k.a labyrinth Petrous part of
temporal

• Lies in petrous part of

temporal bone

• Consists of:
1. Bony labyrinth
2. Membranous labyrinth
Membranous
labyrinth Bony labyrinth
 1. Bony labyrinth
Semicircular
Is the bony canals & canals
compartment

Consists of 3 parts:
1. Cochlear canal
(anterior)

2. Vestibule (middle)

Cochlear
3. Semicircular canals Vestibule
canal
(posterior)
1. Bony labyrinth
 Cochlear canal Cochlea

• Is a spiral, bony shell

• It has a central axis =

modiolus
Modiolus

• The cochlear canal winds

2¾ turns around
modiolus
Cross section of
cochlea
 Cochlear canal: internal
From the modiolus, bony
processes, osseous spiral lamina Scala
vestibuli
project into cochlear canal & Osseus
partially divides it into spiral lamina

• 2 compartments:
1. Scala vestibuli
2. Scala tympani

• Basilar membrane completes

the division of the 2
compartments Scala Basilar
tympani membrane

Cross section: turn of cochlea

 Cochlear canal: internal
• Both compartments communicate at the
helicotrema (small opening at the apex of cochlea)

Helicotrema

Scala
Scala tympani
vestibuli
Cochlear canal: internal

Scala
vestibuli

Scala
tympani
 Vestibule
• Central part of bony labyrinth

• Laterally opens into oval window

(closed by footplate of stapes)

• Has recesses:
1. Spherical recess
2. Elliptical recess

Oval
window
Elliptical recess

Spherical recess
 Semicircular canals
• There are 3: anterior,
posterior & lateral Anterior
Posterior
semicircular canals

Lateral
Each canal:
• Dilated at the end to form
ampulla before opening into
vestibule
• 5 openings into vestibule
(because the anterior & posterior join to form
common limb)
Ampulla
 Semicircular canals

Position of each canal:

Anterior & posterior semicircular

canal:
• Lies in a vertical plane

Lateral semicircular canal:

• Lies in the horizontal plane
 2. Membranous labyrinth
• Is a continuous closed cavity Semicircular Utricle
that is filled with endolymph ducts

(fluid)
Saccule
• Located in the bony labyrinth

• Consist of 3 main parts:

1. Cochlear duct (anterior)
2. Utricle & saccule
(middle)
3. Semicircular ducts
(posterior)
Cochlear
duct
 2. Membranous labyrinth
• Parts of the epithelium in
membranous labyrinth
are specialized for:

1. Receptor of sound
(organ of Corti)
2. Static balance
(maculae)
3. Kinetic balance (cristae)
 Cochlear duct
• A.k.a scala media Vestibular
Cochlear
duct
membrane
• The spiral duct in between scala
vestibuli & scala tympani
• It is triangular in cross section

Boundaries:
• Roof: vestibular membrane
(Reissner’s membrane)
• Floor: basilar membrane Cross section of cochlea
• Apex: attached to osseus spiral
lamina
 Basilar membrane
Organ of Corti

• Is an elastic structure

• Organ of Corti (auditory

receptor) lies on the basilar
membrane
Basilar membrane
 Organ of Corti
• Is a specialized
receptors organ
associated with
sense of hearing
Hair cells

• Consists of:
i. Hair cells
(neuroepithelial cells)

ii. Supporting cells

 Hair cells
• The cell receptors of auditory
system
• Act by converting mechanical
energy into electrical energy

• On apical surface, comprised of:

i. Numerous stereocilia
ii. Single kinocilium
 First order neuron
Is a Bipolar neurons:

• Dendrite of peripheral
processes synapse with Peripheral
hair cells (organ of Corti) process

• Cell bodies housed in

spiral (cochlear)
Central
ganglion process
 First order neuron
• Cell bodies in spiral ganglion Spiral
ganglion

• Central processes of bipolar

neurons collect to form the
cochlear nerve (myelinated)

Cochlear Organ of Corti

nerve
 First order neuron
• Central Spiral ganglion

processes of
bipolar neurons Cochlear nerve
collect to form
the cochlear
nerve
 Cochlear nerve

First order neuron

• The cochlear nerve

joins the vestibular
nerve to form the Vestibular nerve
vestibulocochlear
Internal acoustic meatus
nerve (CN VIII)

• Pass through internal

acoustic meatus

• Enters the posterior

cranial fossa
Internal acoustic meatus
 First order neuron
Central processes:
• Enters brainstem at
pontomedullary angle

• Separate back into vestibular CN VIII

& cochlear nerves

• Cochlear nerve terminates at

cochlear nuclei
• Vestibular nerve terminates at
vestibular nuclei
 Utricle & saccule

Utricle :
• Lies in the elliptical recess of
vestibule (posterosuperior part)

• Larger than saccule

Utricle
 Utricle & saccule
Saccule :
• lies in the spherical Saccule

recess of vestibule
(anteroinferior part)

• Connected to the basal

turn of cochlear duct by
ductus reuniens
Ductus
reuniens
 Utricle & saccule

• Both utricle & saccule

contain specialized sensory
organ called maculae

• Maculae are receptors that

give information about
position of head
 Utricle & saccule: Macula
Macula of utricle: At floor of
utricle & parallel with the base
of the skull
• Stimulated by horizontal
linear motion e.g in moving
car

Macula of saccule: At medial

wall of saccule and vertically
placed
• Stimulated by vertical linear
motions e.g inside elevated Macula
lift
 Macula
• Macula have glycoprotein
membranes called otolithic
membrane on their surface

• Otoliths are crystals made

of calcium carbonate

• The weight of otoliths are

pulled by gravity, thus
otolithic membranes are
influenced by gravitational
forces
 Macula

Macula of
saccule

Macula of
utricle
 Semicircular ducts
• 3 semicircular ducts lie within the
corresponding semicircular canals

• Each duct has ampulla corresponding

to the bony canal

• Ampulla contains receptors known as

ampullary crest / cristae ampullares

Ampulla
 Cristae ampullares
Glycoprotein membrane of
cristae ampullares is dome-
shaped called cupula

• Cupula is influenced by
endolymphatic flow

• Cristae ampullares detect

changes on endolymph
caused by movement of the
head e.g turning head
 Vestibular system
1. Vestibular receptors
(macula & cristae
ampullares)

2. Vestibular nerve - of the

vestibulocochlear nerve
(CN VIII)

3. Vestibular nuclei & its

projections
 Vestibular
nuclei

Vestibulocochlear
nerve

Cochlear
nuclei
Vestibular pathway
 Clinical application
• Hearing defects can be categorized into:

1. Conductive deafness - involved outer or middle ear

• perforated tympanic membrane
• otosclerosis

2. Nerve deafness - involved inner ear or nerves

• prenatal rubella infection affecting the cochlea
• acoustic neuroma: Tumor arising from Schwann cells
covering CN VIII
 Clinical application

Acoustic neuroma
• Tumor arising from Schwann cells covering CN
VIII
 Clinical application
Rinne’s test
• Conductive & nerve deafness can be
differentiated using Rinne’s test
• Rinne’s test: vibrating tuning folk is held on
ear & then at mastoid process of temporal
bone

Findings:
• Normal: air conduction of sound is better
than bony conduction
• Conductive deafness: bony conduction
better than air
• Nerve deafness: both conduction are lost
Thank you & all the best

yasrulizadh@unisza.edu.my