ANATOMY and PHYSIOLOGY of

CHRONIC OTITIS MEDIA

 Ear

• The ear is divided into 3 main regions: the

external ear, which collects sound
waves and channels them inward; the middle
ear, which convey sound
vibration to the oval window; and the internal
ear, which houses the
receptors for hearing and equilibrium
 External ( Outer) ear

• The external or outer ear consist of the

auricle, external auditory canal, and
eardrum. The auricle (pinna) is a flap of elastic
cartilage shape like the flared
and of a trumpet and covered by skin. The rim
of the auricle is the helix; the
inferior portion of the lobule. Ligaments and
muscles attach the auricle to
the head.
• The external auditory canal (audit=hearing) is
a curved tube about
2.5 cm long that lies in the temporal bone and
leads from the auricle to the
eardrum. The eardrum or tympanic
membrane (tympan= a drum) is a thin,
semitransparent partition between the
external auditory canal and middle
ear.
• The eardrum is covered by epidermis and lined by simple cuboidal
epithelium. Between the epithelial layers is connective tissue
composed of
collagen, elastic fibers, and fibroblasts. Near the exterior, the
external
auditory canal contains a few hairs and specialized sebaceous
glands called
ceruminous glands that secret earwax or cerumen. The
combination of hairs
and cerumen prevent dust and foreign objectives from entering the
ear.
• Cerumen usually dries up and falls out of the
ear canal. Some people,
however, produce a large amount of cerumen,
which can become impacted
and can muffle incoming sounds.
 Middle ear

• The middle is a small, air-filled cavity in the

temporal bone that is lined by
epithelium. It is separated from the external
ear by the eardrum and from
the internal ear by a thin bony partition that
contains 2 small membrane-
covered opening: the oval window and the
round window.
• Extending across
• the middle ear and attached to it by ligament are the 3
smallest bone in the
body, the auditory ossicles, which are connected by
synovial joints.
• The bones, named for their shapes, are the malleus,
incus, and stapes-commonly
called the hammer, anvil and stirrup, respectively. The
“handle” of the
malleus attaches to the internal surface of the eardrum.
• The head of the
malleus articulates with the body of the incus.
• The incus, the middle bone in
the series, articulates with the head of the stapes.
The base or footplate of
the stapes fits into the oval window. Directly below
the oval window is
another opening, the round window, which is
enclosed by a membrane,
called the secondary tympanic membrane.
• Besides the ligaments, 2 tiny
skeletal muscles also attach to the ossicles. The
tensor tympanimuscle,
which is innervated by the mandibular branch of
the trigeminal nerve or
cranial nerve number 5, limits movement and
increases tension on the
eardrum to prevent damage to the inner ear from
loud noises.
• The stapedious muscle, which is innervated by the facial
nerve (cranial nerve
VII), is the smallest of all skeletal muscle. By dampening
large vibrations if
the stapes due to loud noises, it protect s the oval
window but it also
decrease the sensitivity of hearing. For this reasons,
paralysis of the
stapedious muscle is associated with the hyperacusia
(abnormally sensitive
hearing).
• Because it takes a fraction of a second for the
tensor tympanic and
stapedious muscles to contract, they can protect
the inner from prolonged
loud noises, but not from brief ones such as a gun
shot. The anterior wall of
the middle ear contains an opening that leads
directly into the auditory
(pharyngotympanic) tube, commonly known as the
Eustachian tube.
• The auditory tubes, which consist of both
bone and hyaline cartilage, connect the
middle ear with the nasopharynx (upper
portion of the throat). It is normally
closed at its medial (pharyngeal) end. During
swallowing and yawning, it
opens, allowing air to enter or leave the
middle ear until the pressure in the
middle equals the atmospheric pressure.
• When the pressures are balanced,
the eardrum vibrates freely as sound waves
strike it. If the pressure is not
equalized, intense pain, hearing impairment,
ringing in the ears, and vertigo
• could develop. The auditory also is route
whereby pathogens may travel from
• the nose and throat to the middle ear.
 
 Internal (inner) ear
• The internal ear is also called the labyrinth
because of its complicate d series
of canals. Structurally, it consists of 2 main
divisions; an outer bony labyrinth
that encloses an inner membranous labyrinth.
 . The only labyrinth is a series
of cavities in the temporal bone divided into 3 areas:

• 1. the semi circular

canals,
• 2. the vestibule, both if which contain
receptors for equilibrium, and
• 3. The choclea, which contains receptors for
hearing.
• The bony labyrinth is
lined with periosteum and contains perilymph. This
fluid, which is chemically
similar to cerebrospinal fluids, sorrounds the
membranous labyrinth, a series
of sacs and tubes inside the bony labyrinth and
having the same general
form. The membranous labyrinth is lined by
epithelium and contains
• endolymph.
• The level of potassium ions in endolymph is unusually
high for
an extracellular fluid, and potassium ions play a role in
the generation of
auditory signals. The vestibule is the oval central portion
of the bony
labyrinth. The membranous labyrinth in the vitibule
consists if 2 sacs called
the utricle (little bag) and the saccule (little sac), which
are connected by a
small duct.
• Projecting superiorly and posteriorly from the
vestibule is the 3
bony semicircular canals, each of which lies at
approximately right angles to
the other 2. Based on their positions, they are
named the anterior, posterior,
and lateral semi circular canals.
• The anterior and posterior semi circular
canals are vertically oriented; the lateral one is
horizontally oriented. At one
end of each canal is a swollen enlargement
called the ampulla (saclike duct).
The portions of the membranous labyrinth
that lie inside the bony semi
circular canals are called the semi circular
ducts.
• These structures
communicate with the utricle of the vestibule.
The vestibular branch of the
vestibulochoclear nerve (cranial nerve VIII)
consists of ampullary, utricular,
and saccular nervers. These nerves contain
both first order sensory neurons and motor
neurons that synapse with receptors for
equilibrium.
• The first
order sensory neurons carry sensory information
from the receptors, and the
motor neurons carry feedback signals to the
receptors, apparently to modify
their sensitivity. Cell bodies Of the sensory
neurons are located in the
vestibular ganglia. Anterior to the vestibule is the
choclea (snail shape) a
bony spiral canal that resembles a snail’s shell and
makes almost 3 turns
around a central bony core called the modiolus.
• Sections through the choclea reveal that it is divided into 3
channels.
Together, the partitions that separate the channels are shaped
like the letter
Y. the stem of the Y is bony shell that protrudes into the canal;
the wing of
the Y are composed mainly of membranous labyrinth. The
channel above the
bony partition is the scala vestibule, which ends at the oval
window; the
channel below is the scala tympani, which ends at the round
window.
• The
scala vestibule and scala tympani both contain perilymph
and are completely
separated, except for an opening at eh apex of the
cochlea, the helicotrema.
The cochlea adjoins the wall of the vestibule, into which
the scala vestibule
opens. The perilymph in the vestibule is continuous with
that of the scala
vestibule. The third channel is the cochlear duct or scala
media.
• The
vestibular membrane separate the cochlear duct from
the scala vestibule,
and the basilar membrane separates the cocholear from
the scala tympani.
Resting on the basilar membrane is the spiral organ of
corti. The spiral corti
is a coiled sheet of epithelial cells, including supporting
cells and about 16
thousands hair cells, which are the receptors for hearing.
 There are 2 groups
of hair cells:
• the inner hair cells are arranged in a single row
whereas the
outer hair called are arrange in 3 rows. At the apical
tip of each hair cell is a
hair bundle, consisting of 30-100 streocilia that
extends into the endolymph
of the cochlear duct. Despite their name, stereocilia
are actually long hair
like microvili arrange in several rows of graded
height.
• . At their ends, inner
and outer cells synapse both with first-order sensory neurons
and with motor
neurons from the cochlear branch of the vestibulucocholear.
Cells bodies of
the sensory neurons are located in the spiral ganglion.
Although outer hair
cells outnumber them by 3-1 the inner hair cells synapse 90-
95% of the first
order sensory neurons in the cochlear nerve that relay
auditory information
to the brain.
• By contrast 90% of the motor neurons in the
cochlear nerve
synapse in the outer hair cells. Projecting over
and in contact with hair cells
of the spiral organ is the tectorial membrane,
a flexible gelatinous
membrane.
THE END