Chapter 15 Ears

REVIEW OUTLINE
1. Bony Labyrinth
Cochlea
Introduction
●
● Vestibule
Inner Ear ● Semicircular Canals
2. Membranous Labyrinth
● Cochlear Duct
● Utricle and Saccule
● Semicircular Ducts
● Clinical Correlation: Ménière’s Syndrome
3. Sensory Regions
● Sensory Hair Cells
Histology Slides Licensed From © University of Michigan

Inner Ear Bootcamp.com
Auricle: Collect
Sound Waves Divisions of the Ear
The ear is a three-chambered sensory organ that
Ossicles: Three bones, functions as an auditory system for sound
amplify vibrations and
perception and as a vestibular system for balance.
transmits them to inner ear
via the oval window
Oval Window: Similar to

tympanic membrane
Vestibular Apparatus (Balance)

& Cochlea (Hearing)
External Acoustic Tympanic Membrane (Ear Drum):

Meatus: Conducts Sound waves converted to mechanical
Sound Waves vibrations transmitted to ossicles
Inner Ear
(Cast of cavities in bone)
Bony Labyrinth (Shell): Membranous Labyrinth Sensory Regions (Snail

Network of “hollow” (Snail): Network of ducts and Brain): Specialized
cavities and canals in the sacs, lined by epithelium, sensory hair cells are
temporal bone, lined by filled with endolymph fluid, located in six regions
periosteum, filled with suspended within the within the membranous
perilymph fluid. perilymph of the bony labyrinth. (one region for
cavities. hearing, five for balance)
Membranous Labyrinth
Bony Labyrinth
EL Membranous
Labyrinth
PL
Endolymphatic duct drains into Brain CSF
Ménière’s Syndrome
Tinnitus
The membranous labyrinth is composed of two functional divisions: the cochlear

labyrinth (auditory) and the vestibular labyrinth: saccule, utricle and 3
semicircular ducts (balance). Continuous ducts and sacs lined by epithelium,
specialized at six regions to contain sensory receptors. Lumen is filled with
endolymph (EL). Endolymph is drained into brain CSF by an “aqueduct” system.
3. Macula of Utricle
Sensory Regions
(Linear Acceleration and Gravity)
2. Crista Ampullaris of
Three Semicircular Ducts
1. Spiral Organ of Corti (Angular Acceleration)
of Cochlear Duct
(Hearing)
4. Macula of Saccule
(Linear Acceleration and Gravity)
Six sensory regions project from the wall of the membranous labyrinth into the
endolymphatic space. One region (1) for the auditory system and five (2-4) for
the vestibular system. Each region contains supporting structures and
specialized sensory hair cells: epithelial mechanoreceptors.
Sensory Hair Cells
Contain rows of apical stereocilia, and one true cilium, the kinocilium (some cells).
Tip links connect adjacent stereocilia near the site of mechanically gated ion
channels. Movement towards the kinocilium causes tip links to open ion channels
at the tips of stereocilia: convert mechanical energy into electrical energy.
Bony Labyrinth Cochlea

Semicircular
Perilymph filled Scala Vestibuli Vestibule
Canals (3)
Periosteum lined Scala Tympani
Cochlear Duct Semicircular
Endolymph filled Utricle & Saccule
(Scala Media) Ducts (3)
Epithelium lined
Organ of Corti with stereocilia
Sensory Region
anchored to Tectorial Macula with
Specialized Hair Cells with Crista ampullaris
Membrane stereocilia anchored
stereocilia, Surrounded by with stereocilia
above and supporting cells to Otolithic
supporting cells. Attached to anchored to Cupula
anchored to Basilar Membrane
Gel Membranes
membrane below
Hair cells initiate Head tilt (position)
Angular head
sensory signal when Hearing and linear head
accelerations
stereocilia bend acceleration
Auditory System Vestibular System
Inner Ear
Organ of Corti of
Cochlear Duct
Macula of Utricle
Crista Ampullaris of
Semicircular Ducts
1: Temporal Bone
2: Cochlea
3: Cochlear Duct
4: Vestibule
5: Saccule
6: Utricle
7: Ampulla of
Macula of Saccule Semicircular Duct
References
Slide 2
<ahref="https://commons.wikimedia.org/wiki/File:1404_The_Structures_of_the_Ear.jpg">
OpenStax</a>, <a href="https://creativecommons.org/licenses/by/4.0">CC BY 4.0</a>,
via Wikimedia Commons
Slide 7 Green EM
<ahref="https://commons.wikimedia.org/wiki/File:Stereocilia_of_frog_inner_ear.01.jpg">B
echara Kachar</a>, Public domain, via Wikimedia Commons
Slide 7 B&W EM
<ahref="https://commons.wikimedia.org/wiki/File:Haircell_frog_sacculus.jpg">A. James
Hudspeth, M.D., Ph.D.</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via
Wikimedia Commons
Bony Labyrinth
Semicircular
Perilymph filled Cochlea Vestibule
Canals (3)
Periosteum lined
Semicircular
Endolymph filled Cochlear Duct Utricle & Saccule
Ducts (3)
Epithelium lined
Sensory Region
Specialized Hair Cells with
Organ of Corti Macula Crista ampullaris
stereocilia
Attached to Gel Membranes

Angular head
accelerations
acceleration
Auditory System Vestibular System
Overview
Knowledge Check
A 56-year-old comes to the office due to difficulty hearing. If it was
determined that this patient’s hearing loss was caused by Ménière’s
Syndrome, a condition where excess endolymph buildup causes increased
pressure and distention of the membranous labyrinth, which of the following
structures would also be at risk of being damaged?
A. Vestibule periosteum
B. Saccule perilymph
C. Semicircular canals
D. Crista ampullaris
E. Cochlear canal
REVIEW OUTLINE
1. Bony Labyrinth
Cochlea
Introduction
●
● Vestibule
Inner Ear ● Semicircular Canals
2. Membranous Labyrinth
● Cochlear Duct
● Utricle and Saccule
● Semicircular Ducts
● Clinical Correlation: Ménière’s Syndrome
3. Sensory Regions
● Sensory Hair Cells
REVIEW OUTLINE
1. Cochlea Compartments
Scala Vestibuli
Inner Ear
●
● Scala Media
Cochlea ●
●
Scala Tympani
Endolymph and Perilymph
2. Scala Media
● Stria Vascularis
● Clinical Correlation: Strial Atrophy
● Organ of Corti
● Basilar Membrane
● Auditory Transduction
● Clinical Correlation: Conductive
Hearing Loss
● Spiral Ganglion
● Cochlear Nerve
● Clinical Correlation: Neural
Presbycusis

Cochlea Bootcamp.com

Semicircular
Canals (3)
Epithelium lined
Sensory Region
Membrane stereocilia
above and supporting cells anchored to
anchored to Basilar Otolithic Membrane
Gel Membranes
membrane below
Angular head
accelerations
Organ of Corti
of Cochlear Duct
1: Temporal Bone
2: Cochlea
3: Cochlear Duct
The (membranous) cochlear duct divides the (bony) cochlear canal

into three parallel compartments/scalae
EL Bony Labyrinth
PL
Bony Labyrinth (Cochlea): EL: Endolymph PL: Perilymph

PL Scala Vestibuli (SV)
Vestibular Membrane
Membranous Labyrinth (Cochlear Duct):

EL Scala Media (SM)
Basilar Membrane
Bony Labyrinth (Cochlea):
PL Scala Tympani (ST)
Between its base and the apex, the cochlea makes about 2.75 turns
around a central core of spongy bone called the modiolus. Nerve
fibers travel through the modiolus to form the cochlear nerve.
Modiolus
Cochlear Nerve
PL Cochlea
Scala EL
Vestibuli
PL
Scala
Media
Scala Tympani
Scala Media
Cochlear Duct
4. Spiral
Ligament
1. Vestibular
Membrane
SV
SM
Cochlear Duct
(Scala Media) 3. Modiolus Projection
ST
2. Basilar Membrane
The Scala Media is a triangular space with its acute angle attached to the modiolus.
Boundaries: Vestibular Membrane, Basilar Membrane, Modiolus, Spiral Ligament.
Scala Media
Spiral Ligament Cochlear Duct
(Lateral Attachment)
Vestibular Membrane
Modiolus Projection
(Medial Attachment)
Tectorial Membrane
Basilar Membrane (BM)

Scala Media
Cochlear Duct
Strial Atrophy
Organ of Corti
(sensory region)
Stria Vascularis:
Pseudostratified
epithelium.
Vascular tissue, Cochlear nerve
K+ homeostasis fibers (originating
of endolymph at Organ of Corti)
Tectorial Membrane Organ of Corti
Stereocilia
Hair Cell
Phalangeal Cells
(metabolic and
mechanical support)
Cochlear Nerve
(Afferent and Basilar Membrane
Efferent Fibers)
Cochlear duct/scala media filled

with endolymph Organ of Corti
Tectorial Membrane
Hair Cells
Tunnel
Basilar Membrane
Phalangeal Cells
Scala tympani filled with perilymph Cochlear nerve fibers

Auditory Transduction
Ossicles Oval
Window
Perilymph filled
Scala Vestibuli (SV)
Scala Media (SM)

Tympanic Membrane
containing Organ of Corti
Perilymph filled
Scala Tympani (ST)
Round
Window
1. Ossicles transmit sound waves from ear drum to oval window.

2. Perilymph waves travel through SV and ST to round window.
3. Fluid waves cause vibrations of tectorial and basilar membranes:
“bending” of Organ of Corti hair cell stereocilia. Conductive Hearing Loss
Auditory Transduction
Summary
Basilar Membrane
Pseudo-resonant structure that, like strings on an instrument, varies in width and stiffness
(at different points along its length): basis for tonotopic map.
Noise Induced Hearing Loss

Presbycusis
Spiral Ganglion: Cell bodies of bipolar neurons found within the modiolus,
fibers originate at hair cells in the Organ of Corti. Forms the Cochlear Nerve
Spiral Ganglion
Cochlear Nerve Neural Presbycusis

Presbycusis
Bilateral age-related hearing loss Cochlear Implant vs. Heading Aids
Sensory Presbycusis
Atrophy of organ of
Corti hair cells
Neural Presbycusis
Spiral ganglion neuron
degeneration
Metabolic Presbycusis
Atrophy of stria
vascularis
Mechanical Presbycusis
Stiffening of the basilar
membrane
Overview
Overview
Knowledge Check
What fluid would be found in the
space indicated by the black arrow?
What is the function of the structure

indicated by the black bracket?
Knowledge Check
A 56-year old comes to the office due to difficulty hearing. He first tried
using hearing aids, but this did not alleviate his symptoms. Hearing aids are
used to treat conductive hearing loss, they amplify sound waves in order to
compensate for stiffening of various structures within the inner ear. All of
the following structures vibrates during auditory transduction and can cause
conductive hearing loss when stiffened EXCEPT:
A. Tympanic membrane
B. Oval window
C. Otolithic membrane
D. Basilar membrane
E. Tectorial membrane
Knowledge Check
Your patient’s family complained
that he speaks too loudly, and
watches TV in extremely high
volume. He has also
experienced difficulty
understanding speech and
detecting all high pitch sounds
overall but hasn’t noticed any
changes in hearing low pitch
sounds. Which of the regions
labelled in the image is most
likely damaged giving rise to
this patient’s condition?
References
Slide 14
<a href="https://commons.wikimedia.org/wiki/File:Journey_of_Sound_to_the_Brain.ogv">National Institute on
Deafness and Other Communication Disorders, part of the National Institutes of Health</a>, Public domain, via
Wikimedia Commons
Slide 12 and 15
<ahref="https://commons.wikimedia.org/wiki/File:1408_Frequency_Coding_in_The_Cochlea.jpg">OpenStax</a
>, <a href="https://creativecommons.org/licenses/by/4.0">CC BY 4.0</a>, via Wikimedia Commons
Slide 6, 7 and 12
<a href="https://commons.wikimedia.org/wiki/File:1406_Cochlea.jpg">OpenStax</a>, <a
href="https://creativecommons.org/licenses/by/4.0">CC BY 4.0</a>, via Wikimedia Commons
Slide 10
<a href="https://commons.wikimedia.org/wiki/File:1407_The_Hair_Cell.jpg">OpenStax</a>, <a
Slide 15 Harp
<a href="https://commons.wikimedia.org/wiki/File:Harp_Illustration.svg">User:Martin Kraft</a>, <a
href="https://creativecommons.org/licenses/by-sa/3.0">CC BY-SA 3.0</a>, via Wikimedia Commons
Slide 13
<ahref="https://commons.wikimedia.org/wiki/File:1405_Sound_Waves_and_the_Ear.jpg">OpenStax</a>, <a
Slide 17 <ahref="https://commons.wikimedia.org/wiki/File:Blausen_0244_CochlearImplant_01.png">BruceBlaus.
When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of
Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.</a>,
<a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
REVIEW OUTLINE
1. Cochlea Compartments
Scala Vestibuli
Inner Ear
●
● Scala Media
Cochlea ●
●
Scala Tympani
Endolymph and Perilymph
2. Scala Media
● Stria Vascularis
● Clinical Correlation: Strial Atrophy
● Organ of Corti
● Basilar Membrane
● Auditory Transduction
● Clinical Correlation: Conductive
Hearing Loss
● Spiral Ganglion
● Cochlear Nerve
● Clinical Correlation: Neural
Presbycusis
Histology Slides Licensed From © Histology Guide

REVIEW OUTLINE
1. Semicircular Canals
Semicircular Ducts
Inner Ear
●
● Crista Ampullaris
Vestibular System ● Cupula
2. Vestibule
● Utricle
● Saccule
● Macula
● Otolithic Membrane
● Vestibulocochlear Nerve
● Clinical Correlation: Benign
Paroxysmal Positional Vertigo

Vestibular System Bootcamp.com
Vestibular System Crista Ampullaris of 3

Semicircular Ducts
Macula of Saccule
Macula of Utricle
Crista Ampullaris:
Angular Acceleration
Macula:
Linear Acceleration and Gravity

Semicircular
Canals (3)
Epithelium lined
Organ of Corti with
Sensory Region
stereocilia anchored to Macula with
Tectorial Membrane stereocilia
Gel Membranes
membrane below
Angular head
accelerations
Semicircular Ducts Semicircular Duct

Membraneous Labyrinth
Bony Labyrinth
EL Membranous
Labyrinth
PL
Endolymph
Epithelial Lining
Perilymph
Semicircular Canal
Bony Labyrinth
Ampulla
Ampulla of
Semicircular Duct
Crista Ampullaris of
Semicircular Ducts
Ampulla Of Semicircular Ducts

Perilymph
Cupula
Endolymph
Crista Ampullaris
Hair cells Nerve Fibers and LCT
Supporting Cells
Each ampulla of the semicircular ducts contain a crista

ampullaris, a thickened transverse epithelial ridge with
sensory hair cells. Hair cells attach to a cupula
(gelatinous cap) that projects into the endolymph filled
lumen: moved by endolymph during head rotations.
Bony Labyrinth
Crista Ampullaris & Cupula
Vertigo
When the head is turned (angular acceleration), the endolymph in

the semicircular ducts lags behind due to inertia and this moves the
gelatinous cupula. The cupula bends the stereocilia of the hair
cells in the crista ampullaris: synaptic transmission

Semicircular
Canals (3)
Epithelium lined
Sensory Region
Membrane stereocilia
Gel Membranes
membrane below
Angular head
accelerations
1: Vestibule
2: Saccule
3: Utricle
Macula of
Utricle
Macula of
Saccule
Utricle & Saccule Macula: Linear Acceleration and Gravity
The utricle and saccule each contain a Utricle

macula: thickened epithelial region
with sensory hair cells. Hair cells
attach to a otolithic membrane
(gelatinous cap) adjacent to the
endolymph filled lumen.
Utricle & Saccule

Membraneous Labyrinth
Perilymph Endolymph
Saccule
EL
Vestibule PL
Bony Labyrinth
Macula Membranous
Utricle & Saccule
Endolymph
Otolithic Membrane
(Gel Layer) with Otoliths
Otoliths: Calcium
carbonate crystals Vestibular Nerve Fibers
Hair cells
Supporting cells
LCT and Nerve Fibers

Macula & Otolithic Membrane
1
The otoliths make the otolithic membrane
considerably heavier than the structures and
fluids surrounding it; thus, when the head tilts,
gravity causes the membrane to shift relative
to the macula.
2 When the head undergoes linear

accelerations, the greater relative mass of the
otolithic membrane causes it to lag behind the
macula. In both cases, the otolithic membrane
bends the stereocilia of the hair cells in the
macula: synaptic transmission
Linear Acceleration
Standing Accelerating Constant Movement Decelerating

Vestibulocochlear Nerve
Cochlear nerve (hearing impulses from organ of Corti) and vestibular nerve
(carries balance information from the three cristae ampullares and two
maculae) form the vestibulocochlear nerve (cranial nerve VIII).
Vestibular Nerve Fibers
Cochlear Nerve Fibers

Linear Acceleration and Head Tilt (Gravity)

2. Macula of Utricle Angular Acceleration
1. Crista Ampullaris
of 3 Semicircular
Ducts
3. Macula of Saccule
2
1
3
Benign Paroxysmal Positional Vertigo
BPPV is caused by the detached otoliths from the macula of the utricle that is lodged in
one of the three cristae ampullares, usually in the posterior semicircular duct (due to its
anatomical proximity to the utricle). The otoliths remain either free floating within the canal
(canalithiasis) or are attached to the cupula (cupulothiasis), causing inappropriate
movement of the stereocilia at the apical surface of the receptor hair cells.
Overview
Overview
Knowledge Check
Identify the structure indicated by the
black arrow. What is its function?
Knowledge Check
A 20-year-old female visits her physician complaining of recurring but brief episodes of
unexplained vertigo and intense dizziness, usually when she turns over or sits up in bed.
Lately even walking has been triggering these symptoms, causing her to lose her balance.
Her physician performs a series of maneuvers to confirm the suspected diagnosis of benign
paroxysmal positional vertigo (BPPV), a condition caused by otoliths becoming dislodged
from their normal location. During BPPV, otoliths become dislodged from their normal
location. Which of the following best describes the normal location of otoliths?
A. Tectorial membrane of Organ of Corti

B. Cupula of the crista ampullaris
C. Otolithic membrane of the cupula
D. Macula of the crista ampullaris
E. Otolithic membrane of the macula
Knowledge Check
Which of the following findings would be associated with BPPV symptoms?
A. Otoliths bending macula stereocilia during linear movements of the head

B. Otoliths at the macula of the saccule
C. Otoliths within the membranous sacs of the vestibule
D. Otoliths bending crista stereocilia during subtle angular movements of the head
E. Otoliths bending macula stereocilia during tilting of the head
Knowledge Check
In this histological slide of the inner ear, the cells
indicated by the arrow are responsible for detecting:
A. Angular acceleration
B. Linear acceleration, vertical
C. Linear acceleration, horizontal
D. Sound perception. high pitch
E. Sound perception, low pitch
References
Slide 6 and 7
<a href="https://commons.wikimedia.org/wiki/File:1410_Equilibrium_and_Semicircular_Canals.jpg">OpenStax
College</a>, <a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 11 and 12 Diagram
<a href="https://commons.wikimedia.org/wiki/File:1409_Maculae_and_Equilibrium.jpg">OpenStax College</a>,
<a href="https://creativecommons.org/licenses/by/3.0">CC BY 3.0</a>, via Wikimedia Commons
Slide 11 Histologic Image
<a href="https://commons.wikimedia.org/wiki/File:4OTO-Sacc-JB4.jpg">Cesar D. Fermin</a>, <a
Slide 13
<ahref="https://commons.wikimedia.org/wiki/File:In%C3%A9rcia_nos_%C3%B3rg%C3%A3os_otol%C3%ADtico
s.png">Cristiane Tilelli</a>, <a href="https://creativecommons.org/licenses/by-sa/4.0">CC BY-SA 4.0</a>, via
Wikimedia Commons
Slide 16
<ahref="https://commons.wikimedia.org/wiki/File:BPPV_otoconia-web.jpg">‫<دﻻل اﻟﺷرﯾف‬/a>, <a
Slide 14
<ahref="https://commons.wikimedia.org/wiki/File:VestibularSystem_la.png">VestibularSystem.png:
*VestibularSystem.gif: user:Thomas.haslwanterderivative work: Ortisa (talk)derivative work: Icewalker cs</a>,
<a href="http://creativecommons.org/licenses/by-sa/3.0/">CC BY-SA 3.0</a>, via Wikimedia Commons
REVIEW OUTLINE
1. Semicircular Canals
Semicircular Ducts
Inner Ear
●
● Crista Ampullaris
Vestibular System ● Cupula
2. Vestibule
● Utricle
● Saccule
● Macula
● Otolithic Membrane
● Vestibulocochlear Nerve
● Clinical Correlation: Benign
Paroxysmal Positional Vertigo

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REVIEW OUTLINE

Histology Slides Licensed From © University of Michigan

Oval Window: Similar to

Vestibular Apparatus (Balance)

External Acoustic Tympanic Membrane (Ear Drum):

Bony Labyrinth (Shell): Membranous Labyrinth Sensory Regions (Snail

Endolymphatic duct drains into Brain CSF

The membranous labyrinth is composed of two functional divisions: the cochlear

Sensory Hair Cells

Bony Labyrinth Cochlea

Auditory System Vestibular System

Hair cells initiate Head tilt (position)

Auditory System Vestibular System

Histology Slides Licensed From © University of Michigan

Bony Labyrinth Cochlea

The (membranous) cochlear duct divides the (bony) cochlear canal

Bony Labyrinth (Cochlea): EL: Endolymph PL: Perilymph

Membranous Labyrinth (Cochlear Duct):

Basilar Membrane (BM)

Tectorial Membrane Organ of Corti

Cochlear duct/scala media filled

Scala tympani filled with perilymph Cochlear nerve fibers

Scala Media (SM)

1. Ossicles transmit sound waves from ear drum to oval window.

Noise Induced Hearing Loss

Cochlear Nerve Neural Presbycusis

What is the function of the structure

Histology Slides Licensed From © Histology Guide

Histology Slides Licensed From © University of Michigan

Vestibular System Crista Ampullaris of 3

Bony Labyrinth Cochlea

Semicircular Ducts Semicircular Duct

Ampulla Of Semicircular Ducts

Hair cells Nerve Fibers and LCT

Each ampulla of the semicircular ducts contain a crista

Crista Ampullaris & Cupula

When the head is turned (angular acceleration), the endolymph in

Bony Labyrinth Cochlea

Utricle & Saccule Macula: Linear Acceleration and Gravity

The utricle and saccule each contain a Utricle

Utricle & Saccule

LCT and Nerve Fibers

Macula & Otolithic Membrane

2 When the head undergoes linear

Standing Accelerating Constant Movement Decelerating

Vestibular Nerve Fibers

Cochlear Nerve Fibers

Linear Acceleration and Head Tilt (Gravity)

Benign Paroxysmal Positional Vertigo

A. Tectorial membrane of Organ of Corti

A. Otoliths bending macula stereocilia during linear movements of the head

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