Anatomy and Physiology of the Ear
Functions
- Hearing
- Maintenance of balance
External ear (pinna)
- The external ear is embedded in the temporal bone
bilaterally at the level of the eyes.
- The external ear extends from the auricle through the
external canal to the tympanic membrane or eardrum.
- The external ear includes the mastoid process, the bony
ridge located over the temporal bone.
Middle ear
- The middle ear consists of the medial side of the tympanic
membrane.
- The middle ear contains three bony ossicles.
o Malleus
o Incus
o Stapes
- Functions of the middle ear
o Conduct sound vibrations from the outer ear to
the central hearing apparatus in the inner ear
o Protect the inner ear by reducing the amplitude of
loud sounds
o The auditory canal (eustachian tube) allows
equalization of air pressure on each side of the
tympanic membrane so that the membrane does
not rupture.
Inner ear
- The inner ear contains the semicircular canals, cochlea,
and distal end of the eighth cranial nerve.
- The semicircular canals contain fluid and hair cells
connected to sensory nerve fibers of the vestibular portion
of the eighth cranial nerve.
- The inner ear maintains the sense of balance or
equilibrium.
- The cochlea is the spiral-shaped organ of hearing.
- The organ of Corti (within the cochlea) is the receptor and
organ of hearing.
- Eighth cranial nerve
o The cochlear branch of the nerve transmits
neuroimpulses from the cochlea to the brain,
where they are interpreted as sound.
o The vestibular branch maintains balance and
equilibrium.
Hearing and equilibrium
- The external ear conducts sound waves to the middle
ear.
- The middle ear, also called the tympanic cavity,
conducts sound waves to the inner ear.
- The middle ear is filled with air, which is kept at
atmospheric pressure by the opening of the auditory
canal.
- The inner ear contains sensory receptors for sound and
for equilibrium.
- The receptors in the inner ear transmit sound waves
and changes in body position as nerve impulses.
Diagnostic Tests for the Ear
Tomography
o Description
- Tomography may be performed with or without
contrast medium.
- Tomography assesses the mastoid, middle ear,
and inner ear structures.
- Multiple radiographs of the head are obtained.
- Tomography is especially helpful in the diagnosis
of acoustic tumors.
o Interventions
 - All jewelry is removed.
- Lead eye shields are used to cover the cornea to
diminish the radiation dose to the eyes.
- The client must remain still in a supine position.
- No follow-up care is required.
Audiometry
o Description
- Audiometry measures hearing acuity.
- Audiometry uses two types, pure tone audiometry
and speech audiometry.
- Pure tone audiometry is used to identify problems
with hearing, speech, music, and other sounds in
the environment.
- In speech audiometry, the client’s ability to hear
spoken words is measured.
- After testing, audiographic patterns are depicted
on a graph to determine the type and level of the
hearing loss.
o Interventions
- Inform the client regarding the procedure.
- Instruct the client to identify the sounds as they
are heard.
Electronystagmography (ENG)
o Description
- Electronystagmography is a vestibular test that
evaluates spontaneous and induced eye
movements known as nystagmus.
- ENG is used to distinguish between normal
nystagmus and medication-induced nystagmus, or
nystagmus caused by a lesion in the central or
peripheral vestibular pathway.
- ENG records changing electrical fields with the
movement of the eye, as monitored by electrodes
placed on the skin around the eye.
o Interventions
- The client is instructed to remain NPO for 3 hours
before testing, avoiding caffeine-containing
beverages for 24 to 48 hours before the test.
- Unnecessary medications are withheld for 24 hours
before testing.
- Instruct the client that this is a long and tiring
procedure.
- The client should bring prescription eyeglasses to
the examination.
- The client sits and is instructed to gaze at lights,
focus on a moving pattern, focus on a moving point,
and then close the eyes.
- While sitting in a chair, the client may be rotated to
obtain information about vestibular function.
- In addition, the client’s ears are irrigated with cool
and warm water, which may cause nausea and
vomiting.
- Following the procedure, the client begins taking
clear fluids slowly and cautiously because nausea
and vomiting may occur.
- Assistance with ambulation may also be necessary
following the procedure.
Magnetic resonance imaging (MRI)