Salute Vivamus 2023 | Central Philippine University | College of Medicine

Otolaryngology: S01L02

Basic Anatomy and Physiology of the Ear

Dr. Philip Jan Arenga | 09-10-2021 | F | 10:00-12:00 PM

OUTLINE → Tympanic
o Forms the floor and part of the anterior and posterior walls
I. Temporal Lobe F. Middle Ear Muscles
of the external canal
II. The Ear G. Tympanic Muscle
o Tympanic ring: where the bony external ear is derived
III. External/Outer Ear Reflex
→ Petrous portion
A. Physiology of H. Function of Middle
External Ear Ear Muscles • Projects medially from the other three portions where the
B. Auricle/Pinna V. Inner Ear sensory organs are found
C. External Auditory A. Cochlea • It is derived from the cartilaginous capsule of otic vesicle.
Canal B. Vestibular Apparatus
IV. Middle Ear VI. Functions of the Ear
A. Tympanic A. Hearing by Bone
Membrane or Conduction
Eardrum B. Function of the Central
B. Middle Ear Cavity Auditory System
C. Eustachian Tube VII. References
D. Middle Ear Facial VIII. Appendix
Nerve
E. Transformer
Mechanism of the
Middle Ear

I. TEMPORAL BONE
Figure 2. Parts of the temporal bone.

• Petromastoid
→ When petrous and mastoid are joined together
→ Most palpable part of the temporal bone which is located
behind the ear
• Styloid process
→ Anterior to the petromastoid.
→ Usually seen during surgery

II. THE EAR

Figure 1. Temporal bone.

• Found on each side of the skull and contains the organs for
hearing and balance
• The one that houses the ear
• Bony external ear canal is derived from the tympanic ring
• Divided into 4 major portions:
→ Squamous
o Appears as a thin bony (connected to the cranium) fanlike
projection superior and anterior to the opening of the
external auditory meatus
o This portion develops in cartilage
→ Mastoid Process (breast-like) Figure 3. Parts of the ear.
o Not present at birth; this means that the infant’s facial nerve
is very superficial III. EXTERNAL/ OUTER EAR
o A pneumatized bone: contains hollow areas composed of
air.
• Composed of:
o It is posterior and inferior to the ear canal that produces a
→ Auricle/Pinna
slight bulge felt behind the ear and has numerous air-filled
spaces or air-cells. → External Auditory Canal (EAC) / External Auditory Meatus
o Air cells are important to differentiate the normal radiologic (EAM) / Ear Canal
anatomy of the bone from the diseased one. → Eardrum

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 • Approximately 7mm diameter by 28mm length
• Among adults, it is approximately 24mm long, with the bony canal
being longer than the cartilaginous one
• Protection against physical trauma and entry of foreign bodies
→ If there is entry of foreign body (e.g. insects), flood the canal
with baby oil in order to kill the insect and prevent further
damage in the ear canal as well as the eardrum
• Protects the tympanic membrane and ossicles
• Permit sound waves to reach the tympanic membrane
• The skin lining the cartilaginous canal is thick and contains fine
hairs, sebaceous glands, and special glands that produce
cerumen

Figure 4. External ear.

A. PHYSIOLOGY OF EXTERNAL EAR

• Transmits sound waves to the middle ear

• Amplifies sound in the 2-4 kHz
• Localizing a sound source
• Acts as the windbreaker

B. AURICLE/PINNA

• Composed entirely of cartilage and skin except for the dependent

lobule, which contains no cartilage, only fat
• Fat from the lobule is used in obliterating sinuses
• Attached muscles are innervated by the facial nerve
• Aids in sound localization
• Boosts acoustic pressure
• Sound collector - intercepting sound energy and deflecting it to
the auditory canal

Figure 6. External Auditory Canal

IV. MIDDLE EAR

• Composed of:
→ Tympanic Membrane
→ Ossicles of the Middle Ear Cavity
→ Eustachian Tube

Figure 5. Parts of the auricle

C. EXTERNAL AUDITORY CANAL

• Two parts:
→ Outer cartilaginous portion
→ Inner Bony Portion
• Lazy “S” in shape
• Ending at the tympanic membrane, its superior wall is about 5mm
shorter than its anteroinferior wall, thus accounting for the oblique
Figure 7. Ear anatomy
positions of the tympanic membrane

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A. TYMPANIC MEMBRANE OR EARDRUM B. MIDDLE EAR CAVITY

• A conical structure with the point of the cone OSSICLES (OSSICULAR CHAIN)
• At the center is the umbo which is directed medially • Malleus (Hammer)
• Generally round • Incus (Anvil)
• The promontory of the medial wall extends laterally toward the → Malleus and incus vibrate as a unit, rocking on a linear axis
umbo of the tympanic membrane which runs from the anterior ligament of the malleus to the
• Borders: attachment of the short process of the incus in the fossa
→ Superior wall: floor of middle cranial fossa incudes.
→ Posterior wall: contains the aditus to the antrum of the • Stapes (Stirrup)
mastoid and below is the facial nerve; is wider than the → Usually attached to the oval window as it enters the cochlea
anterior wall, so the box is wedge-shaped → Moderate Intensity Sound
→ Lateral wall: bony wall of the epitympanum o Anterior end of the footplate with a greater amplitude than
→ Medial wall: bony promontory covering the first turn of the the posterior end
cochlea o Rocking movement occurs about the transverse axis near
• Stapedius muscle: Arises in the region of the facial nerve the posterior end
• Tendon: Passes through the bony pyramid to the neck of stapes o Fibers of the annular ligament are longer at the anterior end
than those at the posterior
• Chorda tympani nerve: From the facial nerve below
the stapedius and passes forward lateral to the incus but medial → High Intensity Sound
to the malleus o Side to side rocking movement is seen about an axis
running longitudinally through the length of the footplate
• 85 mm in surface area
2

• Contains 3 layers
• Pars densa: The middle layer of the pars densa is made up of
circular and longitudinal layer as compared to the pars flaccida
which is not arranged
• “Protects” the round window while “feeding” the ossicular chain
and oval window

Figure 9. The middle ear

TEGMEN
• Thin plate of bone separating cleft from the middle cranial fossa
Figure 8. Eardrum • It is the area where cholesteatoma develops, which is found in
cases of chronic otitis media with effusion leading to perforation
PARTS OF THE TYMPANIC CAVITY of the ear drum.
• Epitympanum: Contains the bodies of the malleus and incus • Persistent infection of the eardrum as well as the middle ear
extends above the upper limit of the tympanic membrane causes the formation of cholesteatoma.
• Hypotympanic: Extends below the tympanic membrane
• Three layers
→ Outer epidermal layer
→ Middle fibrous layer
o Handle of the malleus is embedded
o Missing above the lateral process of the malleus Which
causes Shrapnell’s membrane to be flaccid
→ Inner mucosal layer
o The most common part encountered during training
o Tragus, lobule, and the concha of the auricle.
o Because sometimes a portion of cartilage is removed in
order to correct the defect in the nose or during rhinoplastic
cases
Figure 10. Tegmen tympani Figure 11. Cholesteatoma

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C. EUSTACHIAN TUBE D. MIDDLE EAR FACIAL NERVE

• Opens from the lateral wall of the nasopharynx just above the • Lesions of the facial nerve may cause facial paralysis and Bell’s
plane of the floor of the nose. palsy
• Connects the middle ear cavity with the nasopharynx.
→ Functions in equalizing the pressure in the middle ear so that
the sound from the external ear is not intense before it enters
the cochlea
→ Lateral part: bony (12mm long)
→ Medial 2/3: cartilaginous (24mm long)
• Runs across the base of the skull to enter the pharynx above
the superior constrict
→ Behind the eardrum is a hollow space that connects the ear
to the nose which is located on the posterior portion
→ In this area, you will be able to see tubal tonsils
o Palatine: commonly removed
o Pharyngeal
o Lingual
• Tonsils behind the nose are called adenoids
Figure 14. Relation of Mastoid process with the Middle Ear

E. TRANSFORMER MECHANISM OF THE MIDDLE EAR

• Middle ear matches the low impedance of the air with the high
cochlear impedance by concentrating the incident sound
pressure from the large area of the tympanic membrane onto the
small area of the oval window
• The sound heard in the environment is not the same as the one
we hear. It is being controlled based on its intensity.
• The ossicular chain also contributes to transformer action of the
middle ear by bringing down the vibration amplitude.
• While the amplitude is greatly reduced at the oval window as
compared with the amplitude at the tympanic membrane, the
force of vibrations at the oval window is increased on the same
proportion.

Figure 12. Eustachian Tube Area Ratio

Tympanic Membrane: Oval Window

20:1
Ossicular Chain Malleolar Arm: Incudal Arm
Lever Ratio
1.3:1
Effective Area
14:1
Ratio
Table 1. Impedance Matching

F. MIDDLE EAR MUSCLES

Figure 13. Anatomy of Nasopharynx

Figure 15. Stapedius

and Tensor Tympani

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STAPEDIUS • Composed of three compartments:
• Pulls the stapes footplate backward and into the oval window → Scala Vestibuli
→ Smallest muscle in the body → Scala Tympani
→ Arises from the bony pyramid in the posterior wall of the → Scala Media
middle ear and attaches to the neck of the stapes • Is coiled like a snail shell or horn of plenty for two and one-half
→ Supplied by a branch of the seventh nerve turns
→ Tilt the stapes posteriorly and to fix it in the oval window • Lies in a horizontal plane
• The basal end is the medial wall of the middle ear
TENSOR TYMPANI • Translates the sound energy into a form suitable for stimulating
• Pulls the handle of the malleus inward the auditory nerve
→ Originates from a bony semicanal above the Eustachian tube • Codes acoustical parameters so that the brain can process the
→ Emerges as a tendon near the neck of the malleus information contained in the sound stimulus
→ Tense the TM by pulling the handle of the malleus inward • Modiolus: axis of spiral
→ Contains the nerve bundles and arterial supply from the
vertebral artery
• Function of the cochlea
→ Frequency analysis: macromechanical
→ Biomechanical amplification: micromechanical

Figure 16. Middle Ear Muscles

Figure 17. Three compartments of Cochlea

G. TYMPANIC MUSCLE REFLEX

• Cause alteration in tension and stiffness as well as movement of

the structures to which they are attached THE THREE CHAMBERS OF THE COCHLEA
• Provide stability of suspension for the ossicular chain • Scala vestibule: contains the perilymph
• Selectively augments auditory function at low and moderate • Scala media: contains the endolymph
sound levels • Scala tympani: contains the perilymph
→ At high sound levels, the attenuation of the masking effect of
low frequency noise by the muscle reflex may will be valuable
in making more intelligible the wanted middle and high
frequencies

H. FUNCTION OF MIDDLE EAR MUSCLES

• Support and stiffen the ossicular chain

• Protect the Inner Ear against over stimulation by loud sounds
• Attenuate low frequency masking sounds

V. INNER EAR
• Composed of the end organ receptors for hearing and equilibrium
• Contained in the petrous portion of the temporal bone

A. COCHLEA

• Aka pars inferior and is our organ of hearing

Figure 18. The 3 Chambers of the Cochlea

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SCALA MEDIA (COCHLEAR DUCT) BASILAR MEMBRANE MOTION – THE TRAVELLING
• Reissner Membrane: divides scala media from scala vestibule WAVE
• Basilar Membrane: Organ of Corti and Teotorial Membrane • Otherwise called tonotopic tuning. It happens when the sound
• Stria Vascularis vibration enters the cochlea creating a motion within the basilar
membrane that pushes the outer hair cells toward the tectorial
membrane resulting to creation of a tuning force.
• Once the hair cells bend, they create a signal which will be
transmitted to the nerve fibers and then towards the brain
• Difference between outer and inner hair cells:
→ Outer hair cells: receive low frequency sound

Figure 19. Location of the Scala Media relative to the Scala vestibuli and Scala tympani

Figure 22. Role of the Basilar Membrane in Sound Reception

ORGAN OF CORTI
• Hair cells are present which conduct signals responsible for • Listening to music using earphones for more than 3 hours can
hearing; it is the last conduit before transmitting sound toward cause hearing loss
the brain • Once we adapt to a very loud noise, we start undergoing hearing
→ Outer hair cells (3) loss. It is because our stereocilia stretches more, and once it
→ Inner hair cells (1) stretches for more than its capacity, it tends to break causing
• Stereocilia irreversible damage, leading to hearing loss.
• Classification of Hearing Loss
→ Mild
→ Moderate
→ Severe
→ Profound
• Medications may be given to control the hearing loss at a specific
level only. If it goes beyond that, the management would be the
use of hearing aid.
• As the sound enters the cochlea, the frequency decreases from
3000 Hz to 50 Hz
• High frequency as it enters the oval window up to the end of the
cochlea with the low frequency sound

B. VESTIBULAR APPARATUS

• Aka pars superior and is concerned with balance.

Figure 20. Hair Cells
• Labyrinth: Convoluted shape
• Membranous Labyrinth
→ Derivatives of the otic vesicle form a closed cavity
→ Endolymph: the only extracellular fluid in the body that is high
in potassium and low in sodium
→ Perilymph
o Surrounds the endolymph
o High in sodium and low in potassium

Figure 23.
Sound
conduction
through the
inner ear

Figure 21. Organ of Corti

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• Osseous (bony) Labyrinth
• Both bony and membranous labyrinth have vestibular and
cochlear portion
→ Vestibular portion: pars superior: Concerned with balance
→ Cochlear portion: pars inferior (the organ of hearing)
→ Mandible lays behind the vibration of the skull so that the head
of the mandible causes vibrations of the cartilaginous meatus
from which is transmitted by the round air conduction route to
the cochlea

Figure 24. Bony Labyrinth

NICE TO KNOW!
Is it possible that the condyle of the mandible will get cracked?

• The mandible is divided into different parts. The condyle is

attached to the skull base. It will be possible if you have TMJ
disease. The most common disease would be arthritis.
• Management: aspirating contents in the joint spaces using large
bore needle and infiltrate with corticosteroids to lessen
inflammation. If synovial fluid hardens, it can lead into fracture of
the head of the condyle. Figure 25. Central Auditory Connections
.

VI. FUNCTIONS OF THE EAR B. FUNCTION OF THE CENTRAL AUDITORY SYSTEM

• Pinna: collector of sound • Tonotopic: frequency processing

• External auditory canal: amplifies the sound • Non-tonotopic: temporal information
→ Region of 2-4 Hz it will amplify it to 10-15dB • Polymodal (ex. stapedius reflex)
• Middle ear: contains malleus, incus, stapes • Sound localization: binaural auditory information
→ Impedance-matching device between air and liquid • Sound pattern recognition: naming and identification of a sound
→ Only 0.1% is transmitted source
→ It compensates for the loss primarily because the tympanic
membrane has an area 17 times greater than the stapedial VII. REFERENCES
footplate
• The vibrations of sound are transmitted through the external • ViVa Trans
auditory canal and middle ear to the inner ear via stapes • Boies Fundamentals of Otolaryngology p.27-38
• The peak of travelling wave along 35mm long basilar membrane • Doc. Arenga’s PPT
is determined by the frequency of the sound wave
→ results to the bending of stereocilia by shearing action VIII. APPENDIX
potentials in the attached auditory nerve fibers
→ mechanical sound waves are converted to electrochemical
energy for transmission via 8th cranial nerve

A. HEARING BY BONE CONDUCTION

• Translatory or inertial mechanism

→ Vibration of the skull can produce motion between the middle
ear ossicles and the surrounding bone causing the stapes to
oscillate and stimulate the cochlea because of its inertia that
lags behind the general vibration of the skull
• Compressional mechanism
→ Bony capsule of the labyrinth is alternately compressed and
decompressed by fluctuating twisting forces in the
surrounding bone
• Effect of the mandible
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 Figure 26. Central Auditory System

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