Hearing

The auditory ossicles conduct sound from the tympanic membrane to the inner ear.
Sound waves picked up by the external ear vibrate the tympanic membrane, which
in turn mobilizes the ossicular chain of the middle ear. The footplate of the stapes
applies a mechanic pressure on the oval window and the vibration reaches the
peri_lymphatic fluid of the cochlea. Inside the
inner ear these vibrations are converted to nerve signals that are carried by the auditory
nerve to the brain.

The inner ear houses the vestibulocochlear organ that

maintains balance and receives sound from the middle ear. It
has two parts: the bony labyrinth and the membranous
labyrinth. The bony labyrinth contains the otic capsule, which
is denser than the surrounding temporal bone. It contains fluid
called perilymph and three cavities, called the cochlea,
vestibule, and semicircular canals:
The sensor/ auditory system made of two parts mechanical and electrical.
The mechanical part is the external ear and the middle ear: the sound wave will
 pass through the external ear to the middle ear when the stapes moved over the
oval window the energy will be conducted to the fluid of the inner ear. The
movement of the fluid will take the basilar membrane up and down and then this
will move the cilia and hair cells. The hair cells will go to biochemical activity
result in sharing action between cilia of hair cell and tectorial membrane above
it. Then it will be conducted into electric signal as firing in auditory nerve which
is the sensory part.

And according to this hearing loss could be conductive when the problem is
either in the external or middle ear, sensory if the problem in the inner ear and
the ascending neural connections , or mixed.

Practically human ear hear from 250 kHz to 8000 kHz

the MOST COMMON congenital problem is hearing loss.

Bony Labyrinth
The bony labyrinth is a series of bony cavities within the petrous part of
the temporal bone. It consists of three parts – the cochlea, vestibule and the
three semi-circular canals.
Vestibule
The vestibule is the central part of the bony labyrinth. It is separated from the
middle ear by the oval window, and communicates anteriorly with the cochlea
and posterioly with the semi-circular canals. Two parts of the membranous
labyrinth; the saccule and utricle, are located within the vestibule.

Membranous Labyrinth
The membranous labyrinth is a continuous system of ducts filled
with endolymph. It lies within the bony labyrinth, surrounded by perilymph. It is
composed of the cochlear duct, three semi-circular ducts, saccule and the
utricle.

Vestibule: This small, oval chamber contains the utricle and

the saccule along with parts of the vestibular labyrinth. An oval
window is on its lateral wall. The vestibular aqueduct runs to the
posterior surface of the temporal bone.
Saccule and Utricle
The saccule and utricle are two membranous sacs located in the
vestibule. They are organs of balance which detect movement or acceleration
of the head in the vertical and horizontal planes, respectively.
The utricle is the larger of the two, receiving the three semi-circular ducts.
The saccule is globular in shape and receives the cochlear duct.

Semi-circular Ducts
The semi-circular ducts are located within the semi-circular canals, and share
their orientation. Upon movement of the head, the flow of endolymph within
the ducts changes speed and/or direction. Sensory receptors in the ampullae
of the semi-circular canals detect this change, and send signals to the brain,
allowing for the processing of balance.

The inner ear is innervated by the vestibulocochlear nerve (CN VIII). It

enters the inner ear via the internal acoustic meatus, where it divides into
the vestibular nerve (responsible for balance) and the cochlear
nerve (responsible for hearing):
• Vestibular nerve – enlarges to form the vestibular ganglion, which then
splits into superior and inferior parts to supply the utricle, saccule and three
semi-circular ducts.
• Cochlear nerve – enters at the base of the modiolus and its branches
pass through the lamina to supply the receptors of the Organ of Corti.
The facial nerve, CN VII, also passes through the inner ear, but does not
innervate any of the structures present.

The best protected organ in the body is the

ear: it is inside the Petrous Bone (which is the strongest bone in the
body, it protects the cochlea.
The first sense in our body start to develop is hearing. At
the age of 3 months the fetus starts to hear, full
development of hearing is in the 5th month. Vision is
weeks and weeks after.
-Hearing is the strongest sense in our body. It is the
first sense developed and the last one lost in
sleeping, sedation and after death.
It has the widest range of 360 degrees, it is not limited
by the room you are in or corners, of course it has a
range of space but vision for example is only 180
degrees horizontally and 145 degrees vertically.

The inner ear has two main parts. The cochlea , which
is the hearing portion, and the semicircular canals is the
balance portion.

The semi-circular canals are also known as the

labyrinthine. These little canals are lined up at right
angles (90°) to each other. This allows the brain to
know in which direction the head is moving. These
semi-circular canals are filled with fluid and have some
small calcium crystals embedded in the lining.

Coming from the inner ear and running to the brain is

the eighth cranial nerve, the auditory nerve. This nerve
carries both balance and hearing information to the
brain.
 The balance system works by sending continuous
electrical impulses to the brain. Moving the head
causes the fluid in the semi-circular canals to shift. This
in turn changes the electrical impulses to the brain. The
brain uses this information to make any adjustments the
body needs for balance.

Organ of corti
The organ of corti is supported by a membrane called the basilar membrane. It about the size
of a pea, and acts as a transducer, converting vibration into nerve impulses. It has hair cells
and supporting cells. Hair cells have long stiff microvilli called stereocilia on their apical
surfaces. Microvilli are fine hair-like structures on cells that help to increase cell surface area.
On top of these stereocilia is a jelly-like membrane called the tectorial membrane. Four rows
of hair cells spiral along the length of the organ of Corti. Of these, there are about 3500 inner
hair cells (IHCs), each with a cluster of 50-60 stereocilia graded from short to tall. There are
another 20 000 outer hair cells (OHCs) that are arranged in three rows opposite the IHCs.
Each OHC has about 100 stereocilia with their tips embedded in the tectorial membrane
above them. These outer hair cells adjust the response of the cochlea to different sound
frequencies so as to enable the inner hair cells to function more accurately. The physiological
mechanisms,
Tuning fork tests
These are tests of hearing most often used to differentiate between a
conductive and a sensorineural hearing loss. They should be performed
with a tuning fork of 512 Hz. If the frequency is lower, vibrations are
produced that can mislead patients who think this is an auditory stimulus.
The ends of a tuning fork are known as tynes. The loudest sound from
the tuning fork is produced at the end of the tyne.
Start the tuning fork by hitting your elbow or knee. Plucking the tynes
produces less efficient sound, and hitting a table or desk edge produces
overtones. Weber’s and Rinne’s test’s are performed together to help
identify the type of hearing loss.
Weber’s test
In this test the tuning fork is placed at the top of the patient’s
head. The patient then says which ear hears the sound loudest, or if it is
in the middle.
In normal hearing, sound is not localized to either ear. In sensorineural
hearing loss, the non-affected ear hears the sound loudest. In conductive
loss the sound is heard loudest in the affected ear.
Rinne’s test
This test is used to compare air conduction with bone conduction.
The activated tuning fork is placed behind the patient’s ear, against
the mastoid process. The patient is asked to say when they stop hearing
the stimulus. The tuning fork is then moved to a position 2 cm away from
the EAC and held with the tips of the tynes level and in line with the ear
canal. The patient is then asked if they can hear the sound.
This test can be modified by moving the tuning fork from the mastoid
to the EAC before the sound has diminished. The patient is then asked
which is the louder sound.
The test results can be confusing, because a pathological test result
is called a negative test! This is contrary to almost all other tests in medicine,
where a positive result is an abnormal result and a negative result
is normal. Often a description of the findings is used instead.
- Positive test: air conduction is better than bone conduction
(AC > BC). This is a normal finding.
- Negative test: bone conduction is better than air conduction
(BC > AC). This is abnormal and suggests conductive hearing loss.
False negative Rinne’s test
This happens when the sound is actually being heard by the other ear.
Sound conducted by bone is absorbed and travels across the skull, so
when the tuning fork is placed on the left side it will be heard almost as
well by the right inner ear as the left.