Yilkal Zemene, M.D., ENT, Head and Neck Surgeon Mekelle University, Mekelle

Yilkal Zemene, M.D.
,
ENT, Head and Neck Surgeon
Mekelle University, Mekelle.
Ear
• Hearing
• Balance
I. External ear- the auricle, the external canal and the drum
A. Auricle has different part
B. External auditory canal. measuring around 25mm in length
Composed of
 Cartilage (lateral 1/3) – continuous with the auricle except
in anterio superior part.
o Lined by normal skin
 bone medial 2/3.-lined with skin devoid of hair and gland
The medial end is called tympanic sulcus
 Has anterior and posterior relations
Auricle
Anatomy of the Ear
C. The tympanic membrane- is an oval ,concave
and translucent membrane at the medial end
of the EAC.
• Composed of
 Two parts- pars tensa and pars flaccida
 Three layers- Skin, middle fibrous layer and
inner mucosal layer
middle ear cleft is an air field space consisting of
middle ear cavity- divided in to three parts
 Epitympanum,- above the level of the TM
 Mesotympanum-lie opposite the TM
 Hypotympanum-the inferior portion below the level of the
TM
 Has six walls and narrower from side to side

 Contents of the middle ear includes
Air, three small ossicles, two muscles ,two
nerves and small blood vessels
Middle Ear
Middle Ear
Eustachian tube connect middle ear with the
nasopharyx
 Closed at rest but swallowing and
yawning
 Function –equalize air pressure and drain
the middle ear
 In infants- wide short and horizontal
Mastoid –it contains air field cavities lined by

mucous membrane
the air cells are arranged in groups.
Has different Cellularity
III. Inner ear
 Vestibular portion and cochlear portion
a) Bony labyrinth
 The bony cochlea ,
 The bony vestibule and
 Three semicircular canals
b) Membranous labyrinth-
 Membranous chochlear duct,
 Utricle and saccule,
 semicircular ducts.
C) Perilymph vs endolymph
Nerve supply of the ear
I. Sensory-
• Auricle and external auditory canal
 Greater auricular nerve and lesser occipital nerve
 Auriculo temporal nerve
 Auricular branch of the Vagus
• Middle ear- by tympanic branch of the
glossopharyngeal nerve
• Mastoid antrum and cells by mengial twigs from
Gasserian ganglion
II. Motor supply
 Facial nerve- the auricle and the stepidus
muscle
 Mandibular nerve- supply the tensor tympani
muscle
Assessing the Hearing
• Clinical
• Tuning fork
• Audiometric
I. Clinical:
a. History
b. Otoscopic examination
c. Hearing assessment
 Talking to the patient
- Whispered voice (WV) at 60 cm: hearing
impairment.
- Conversational voice (CV) at 15 cm: Deaf
II. Tuning fork:
 Helps to diagnose:
• Conductive hearing loss
• Sensory neural hearing loss
 Two types:
• Rinne test
• Weber test
Tuning Fork
• Interpretation:
 Rinne:
• Rinne is positive: AC > BC
• Rinne is negative: AC < BC
• Tells you outer and middle ear dysfunction
 Weber:
• Sound heard in the deaf ear: Conductive
• Sound heard with better ear: Sensory-neural
III. Audiometry:
 Pure tone audiometry:
• Generates pure tone signal of 125Hz-12KHZ
• Signal fed through ear phones for AC and vibrator to
mastoid process for BC.
 Speech audiometry:
• Ability to discriminate the spoken word at different
intensities
• Impedance Tympanometry:
 Measures the compliance of middle ear
structure, not hearing.
• Oto-acoustic emissions (OAE):
 Measures emission of sound emitted from the
cochlea.
• Interpretation:
 0-25db: Normal range- straight line
 25-40 db: Mild hearing loss
 40-55 db: Moderate hearing loss
 55-70 db: Moderately Severe hearing loss
 70-90 db: Severe hearing loss
 > 90 db: profound
Normal audiometry
125Hz 1000Hz 3000Hz 6000Hz

0
10
20
BC
30 AC
40
50
Conductive deafness on audiometry
125Hz 1000Hz 3000Hz 6000Hz

0
10
20
BC
30 AC
40
50
• Low frequency affected:
– Congenital hearing loss,menier’s disease
• High frequency affected:
– presbycusis
• Both Tonal and speech audiometry have
similar pattern:
Pre cochlear hearing loss
• Tonal normal and speech abnormal:
– Retrocochlear hearing loss.
Vestibular function assessment
• Rotation test
• Caloric test- COWS
• Fistula test: Lateral semi circular canal
dehiscence
push the tragus in ward---------air pushed in to the
defect, look for nystagmus to affected side

Yilkal Zemene, M.D., ENT, Head and Neck Surgeon Mekelle University, Mekelle

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Yilkal Zemene, M.D., ENT, Head and Neck Surgeon Mekelle University, Mekelle

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Yilkal Zemene, M.D.

 Has six walls and narrower from side to side

Mastoid –it contains air field cavities lined by

125Hz 1000Hz 3000Hz 6000Hz

125Hz 1000Hz 3000Hz 6000Hz

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