ANATOMY & HISTOLOGY DEPT.

BRAWIJAYA MEDICAL FACULTY

 TO BE ABLE TO IDENTIFY THE
STRUCTURES OF THE EAR

 TO UNDERSTAND THE HEARING

MECHANISM
 EXTERNAL EAR
◦ PINNA OR AURICLE
◦ EXTERNAL AUDITORY CANAL
◦ TYMPANIC MEMBRANE

 MIDDLE EAR
◦ MALLEUS, INCUS AND STAPES
◦ EUSTATION TUBE

 INNER EAR
 VESTIBULE
 SEMI-CIRCULAR CANALS
 COCHLEA
 VESTIBULAR NERVE
 AUDITORY NERVE
1. AURICLE
(PINNA)
 Collects sound
 Helps in sound localization
 Amplifies sound approx. 5-
6 dB
 External and Internal
muscles
 EXTERNAL MUSCLES

M. AURICULARIS
SUPERIOR

M.
AURICULAPOS M. AURICULARIS
TERIORRIS ANTERIOR
 M. HELICES MAJOR

M. HELICES MINOR

M. TRAGICES
M. ANTITRAGICES
  Approx. 1 inch long
 “S” shaped
 Outer 1/3 of canal is
cartilage, inner 2/3 consists
of bone covered with skin /
thin, without loose conn tiss
 Allows air to warm before
reaching TM
 Protects the TM from
ISTHMUS
physical damage
 Cerumen glands  moisten
 /soften skin cerumen
obturans
(keras/menyumbat))
- Otitis erxterna ; infeksi pd kulit telinga luar,
bisa karena alergi dr perhiasan telinga.
Cerumen obturans, produk kelj cerumenosa
terkumpul  mengeras  mengganggu
pendengaran
- Infeksi disini akan terasa sangat nyeri krn
dibawah kulit tidak ada jar ikat longgar, shgg
oedem langsung menekan tlg rwn / tlg
 Otitis media, ditandai dg keluarnya cairan dr
telinga tengah
 ada : - otitis media akuta
 - Otitis media kronika
 - Otitis media purulenta / perforata 
membrana tympani pecah  keluar nanah
 Sebaiknya sebelum pecah sendiri, memb

tymp ditusuk spy cairan keluar dan

sembuhnya bagus
  Diameter 1cm
 Separates external
and middle ear.
 Translucent
membrane
Pars Flaccida  Pearly, gray color
 Cone of light
reflection when using
Os. malleus otoscope
 Oval and slightly
Pars tensa concave shape, pulled
in at center by malleus
Umbo  Changes acoustical
energy into
Cone of light mechanical energy
VASCULARISATION :
◦ Branches of A. carotis externa :
 A. auricularis posterior
 A. temporalis superficialis

INNERVATION :
Sensoris :
◦ N.Maxillaris (N.V.1) : N. auriculotemporalis
◦ Plexus cervicalis : N. auricularis magnus
 THE MIDDLE EAR
(TYMPANIC CAVITY)
 Tiny air–filled cavity in the temporal bone
contains:
 Auditory ossicles (bones)
Malleus
Incus
Stapes

 Openings to
Outer ear covered by tympanic membrane
Inner ear = oval and round windows
Eustachian tube connects middle ear to the
nasopharnyx for air passage (normally
closed, opens with swallowing/yawning)
• ISI CAVUM TYMPANI:
- Udara
- Ossiculae auditoria : MALLEUS, INCUS dan STAPES
 Sistem pengungkit bersudut untuk
mengkonduksikan getaran suara
- Otot : M. tensor tympani :(N.V.3)
Pars cartilagines tuba auditiva – malleus
M. stapedius ( N. VII)
Eminentia pyramidalis - stapes
Fungsi : Meredam vibrasi pada suara keras
 TYMPANIC REFLEX
- Chorda tympani
- Plexus tympanicus
1. Conducts sound vibration, from outer ear
to inner ear
2. Protects the inner ear by reducing the
amplitude of loud sounds
3. Eustachian tube allows equalization of air
pressure on each side of the ear drum to
avoid rupture ( high altitudes)
Bl tekanan tdk sama  oclusio tubae 
membrana tympani tidak datar = rasa tdk
enak ; mis kita masuk kedaerah tinggi ;
naik pesawat diberi permen supaya orang
menelan, lewat tuba Eustachius tekanan
jadi sama  membr tympani kembali datar
 STABILIZING
LIGAMENT

INCUS
MALLEUS

CHORDA
TYMPANI M.TENSOR
TYMPANI
M.STAPEDIUS
STAPES
 THE WALLS OF
TYMPANIC CAVITY
 ADITUS ANTHRUM
MASTOIDEA
MBR. TYMPANI
CELLULAE
MASTOIDEA
TUBA
AUDITIVA
CANALIS
FACIALIS
A. CAROTIS
INTERNA
V.JUGULARIS
INTERNA
MEDIAL WALL OF TYMPANIC CAVITY :
ADITUS ANTHRUM MASTOIDEA

PROMONTORIUM

CANALIS M.TENSOR TYMPANI

TUBA AUDITIVA
 THE OSSICLES
 Ossicular chain = malleus, incus &
stapes
 Malleus

◦ TM attaches at Umbo
 Incus

◦ Connector function
 Stapes

◦ Smallest bone in the body

◦ Footplate inserts in oval window on
medial wall
Focus/amplify vibration of TM to smaller
area, enables vibration of cochlear
fluids
Pd orang tua, tulang2 ini bisa kaku 
sclerosis / otosclerosis
 Attaches to stapes
 Contracts in response to loud sounds
the Acoustic Reflex
 Changes stapes mode of vibration; makes
it less efficient and reduce loudness
perceived
 Absent acoustic reflex could signal
conductive loss or marked
sensorineural loss
 EUSTACHIAN TUBE
 Mucous-lined, connects
middle ear cavity to
nasopharynx
 “Equalizes” air pressure in
middle ear
 Normally closed, opens
under certain conditions
(chewing, swallowing)
 May allow a pathway for
infection
 Children “grow out of”
most middle ear problems
as this tube lengthens and
becomes more vertical
Eustachian tube
 ANTHRUM MASTOIDEA

 Ruangan pd Procc.
Mastoidea os Temporal, di
dorsal dari cavum tympani,
berisi cellulae mastoidea
dan udara,
 Mukosa yang melapisi sama

dengan cavum tympani 

memudahkan penyebaran
infeksi dr otitis media yg
tdk diobati  Mastoiditis 
terapinya  Mastoidectomi
 THE INNER EAR
 Contains the Bony Labyrinth which
holds the sensory organs for hearing
and equilibrium; and Membranous
Labyrinth
1. Vestibule
2. Semicircular canals
3. Cochlea (contains the central hearing
apparatus)
 AURIS INTERNA

SUPERIOR

UTRICULUS

LATERAL

VESTIBULUM
POSTERIOR

SACCULUS
AMPULLA
E
COCHLEA
Labyrinthus Osseus Labyrinthus Membranaceu

Canalis
semicircularis Duct. semicircularis
Utriculus
Vestibulum
Sacculus

Ductus
Cochlea cochlearis
CANALIS SEMICIRCULARIS
 Terdiri dari 3 saluran, yg saling tegak lurus :
(anterior/superior,posterior,lateral)
 Di dalamnya terdapat ductus semicircularis yang
ujungnya melebar disebut AMPULLA, berisi
epithelium sensorium (Crista Ampullaris)
VESTIBULUM
 Berhubungan dengan auris media melalui fenestra
vestibuli
 Terdiri dari :

◦ UTRICULUS
◦ SACCULUS
Keduanya mengandung epithel sensorium, yaitu
macula sacculi dan macula utriculi
 COCHLEA
1. Canalis cochlearis : Saluran yang mengitari sumbu tulang
(modiolus)  perilymph
a. Scala vestibuli di atas ductus cochlearis dari fenestra
vestibuli, bertemu scala tympani di helicotrema.
Dinding
bawahnya dibtk oleh Lamina vestibuli
b. Scala tympani,  di bawah Ductus Cochlearis berakhir
di fenestra cochlea yg tertutup mbr. tympanica
secundaria
2. Ductus cochlearis (scala media)  endolymph
Dimulai dari saluran buntu : caecum vestibulare berakhir
di
cupula sebagai caecum cupulare. Dinding bawahnya
dibentuk
oleh Lamina basilaris  Organon Corti
 COCHLEA

SCALA VESTIBULI

MBR. VESTIBULI

SCALA MEDIA

MBR. BASILARIS

SCALA TYMPANI

ORGANON CORTI
 Snail shaped cavity within mastoid
bone
 2 ½ turns, 3 fluid-filled chambers
 Scala Media contains Organ of
Corti Converts mechanical energy
to electrical energy
 The end organ of hearing
◦ Contains stereocilia & receptor hair cells
◦ 3 rows OHC, 1 row IHC
◦ Tectorial and Basilar Membranes UTRICULUS
◦ Cochlear fluids

(From Augustana College, “Virtual Tour of the Ear”)

 Frequency specific
◦ High pitches= base of cochlea
◦ Low pitches= apex of cochlea
◦ Fluid movement causes
deflection of nerve endings
◦ Nerve impulses (electrical
energy) are generated and
sent to the brain
 Consists of three semi-
circular canals
 Monitors the position of the
head in space
 Controls balance
 Shares fluid with the cochlea
 Cochlea & Vestibular system
comprise the inner ear
 3 levels
1. Peripheral – ear transmits sound and
converts its vibrations into electrical
impulses that can be analyzed by the
brain. The electrical impulses are
conducted by the auditory process of
cranial nerve VIII (Acustic) to the brain
stem
1. Amplitude = loudness
2. Frequency = pitch
 Sound waves cause the eardrum to
vibrate
 Vibrations travel via the ossicles thru
the oval window, the cochlea and are
scattered against the round window
 The basilar membrane of the cochlea
contain the organ of Corti receptor
hair cells that translate the vibrations
to electric impulses
 The impulses go to the brainstem via
Acoustic nerve (VIII)  N. Cochlearis
2. Brain stem – function is binaural
interaction – permits identification of
sound and locating the direction of a
sound in space. The acoustic nerve
(Cranial nerve VIII) sends signals from
each ear to both sides of the brain stem.
Brainstem is sensitive to intensity &
timing from the ears depending on head
position
3. Cerebral cortex – interprets the meaning
of the sound and begins the appropriate
response
1. Air conduction (AC)– normal pathway of
hearing, the most efficient
2. Bone conduction (BC)– bones of the skull
vibrate and transmit vibrations to the
inner ear and acoustic nerve
1. Conductive – mechanical dysfunction of
the external or middle ear resulting in
partial hearing loss (if ↑ amplitude to
reach nerve elements in inner ear,
person can hear)
Causes : impacted cerumen, perforated
eardrum, pus/blood in the middle
ear, otosclerosis
2. Sensorineural ( perceptive) – pathology
of the inner ear, acustic nerve or
auditory areas of the cerebral cortex. ↑
amplitude may not help
Causes : Presbyacusis, a nerve
degeneration due to aging (50yrs) or
ototoxic drugs
3. Equilibrium – labyrinth feeds info to the
brain about the body’s position in space,
inflammation causes vertigo / tinitus
 VIII th Cranial Nerve or “Auditory Nerve”
◦ Bundle of nerve fibers (25-30K)
◦ Travels from cochlea through internal
auditory meatus to skull cavity and brain
stem
◦ Carry signals from cochlea to primary
auditory cortex, with continuous processing
along the way
 Auditory Cortex
◦ Wernicke’s Area within Temporal Lobe of the
brain
◦ Sounds interpreted based on
experience/association
 Peripheral Mechanism Central Mechanism

VIII
Outer Middle Inner
Cranial Brain
Ear Ear Ear
Nerve
Acoustic energy, in the form of sound waves, is channeled
into the ear canal by the pinna. Sound waves hit the
tympanic membrane and cause it to vibrate, like a drum,
changing it into mechanical energy. The malleus, which is
attached to the tympanic membrane, starts the ossicles into
motion. The stapes moves in and out of the oval window of
the cochlea creating a fluid motion, or hydraulic energy.
The fluid movement causes membranes in the Organ of
Corti to shear against the hair cells. This creates an
electrical signal which is sent up the Auditory Nerve to the
brain. The brain interprets it as sound!
 Gelombang suara dikumpulkdn oleh pinna
 MAE menggetarkan mbr. tympani 
ossiculae auditiva fenestra vestibuli
menggetarkan perilymph (scala vestibuli)
diteruskan ke mbr. vestibuli ke
endolymph (scala media)
 Gerakan endolymph menggerakkan
membrana basilaris naik turun shgg
menggerakkan cilia pd Organon Corti
 Pergerakkan cilia merangsang sel sensoris
dan pelepasan impuls saraf
 HEARING MECHANISM :

◦ OUTER EAR : acustic to kinetic energy

◦ MIDDLE EAR : causes increase in kinetic
energy
◦ INNER EAR : kinetic to hydraulic energy then

hydraulic to electrical energy

Hearing loss :
Penurunan pendengaran : ringan – total
temporer – irreversibel
Ada 2 jenis :
1. Tuli konduksi
Gangguan transmisi getaran suara sampai ke auris
interna
Contoh : cerumen, ruptur mbr.tympani, otitis media
2. Tuli persepsi
Gangguan pada hair cell/ organon corti atau saraf
Contoh : occupational disease (musisi,teknisi mesin)
1. KESEIMBANGAN STATIS
• Kecepatan linier
• Aksi gravitasi
• Macula saculi dan
macula utriculi

2. KESEIMBANGAN
DINAMIS
• Kecepatan angular
• Perubahan posisi
kepala
• Crista ampullaris
 KESEIMBANGAN STATIS

MACULA UTRICULI
MACULA SACULI

OTOLITH
MBR. OTOLITH

HAIR CELL
SUPORTING CELL
 AMPULLA
CRISTA AMPULLARIS

HAIR CELL
CUPULA

SUPORTING CELL
Topics :
1. NASUS EXTERNUS
2. NASAL CAVITY
3. PARANASAL SINUS

Lab. Anatomy Histology FKUB

 FUNCTION OF THE NOSE
 Provides an airway for respiration
 Moistens and warms air
 Filters inhaled air
 Resonating chamber for speech
 Houses olfactory receptors
 The Nasal Cavity
1. VESTIBULUM
◦ Nares – apex
◦ Dilapisi kulit tipis : OLFACTORIUS
rambut, gld.cebacea,
gld sudorifera
2. REGIO RESPIRATORIUS
◦ 2/3 inferior cavum nasi
◦ Ciliated
pseudostratified
collumnar epithel
RESPIRATORIUS
3.REGIO OLFACTORIUS
◦ 1/3 superior cavum
nasi
◦ Diatas concha nas sup
◦ Non-ciliated VESTIBULUM
pseudostratified
collumnar epithel
◦ Sel-sel olfactorius
 ROOF :
◦ Os nasal
◦ Os sphenoidalis
◦ Os frontal
◦ Lamina cribrosa os Ethmoidalis
 FLOOR : Palatum durum
 LATERAL :
◦ Concha nasalis superior
◦ Concha nasalis media
◦ Concha nasalis inferior
◦ Proc. Frontalis os maxilla
 MEDIAL :
◦ Os vomer
◦ Lamina perpendicularis os
ethmoidalis
◦ Cartilago septi
 - Dermatitis
 - furunkel
 - Rhinitis : - infeksi
 - alergi = Rhinitis vasomotorika
 Pd rhinitis : oedem  terasa buntu
 over production mucous dr sel
goblet  pilek
 - Septum deviasi  orang mengeluh
hidungya berbau
 Nasal Conchae
 3 paired bony projections
along the lateral walls of the
nasal cavity

 Superior and middle nasal

conchae - part of the
ethmoid bone

 Inferior nasal conchae -

separate bone

 Function - Particulate matter

deflected to mucus-coated
surfaces
 Nasal Meatuses

 Meatus - cleft underlying each nasal conchae.

Nasus Externus :
Branch of A. facialis : A. angularis
Branch of A. maxillaris : A. dorsalis nasi

Cavum Nasi : Plexus Kiesselbach (consists of :)

 Branch of A. facialis : A. labialis superior

 Branches of A. opthalmica (from. A. carotis
interna :
◦ A. ethmoidalis anterior
◦ A. ethmoidalis posterior
 Branches of A. maxillaris :
◦ A. sphenopalatina
◦ A. palatina major
◦ A. septalis
Plexus Kiesselbach
EPISTAXIS

a.Anterior

b. Posterior
General sensoris : N. Trigeminus (N.
V)
 Anterior : N. opthalmica (N. V.1)
◦ N. ethmoidalis anterior
◦ N. ethmoidalis posterior
 Posterior :N. maxillaris (N. V.2)
◦ R. posterior superior n. nasalis lateralis
◦ R. posterior superior n. nasalis medialis
◦ R. posterior inferior n. nasalis
◦ N. nasopalatina
Parasimpatis : N. facialis (N.VII)
 N. facialis (N. VII) : N. petrosus major
Special Sensoris : N. Olfactorius (N. I)
 Receptors are part of the olfactory epithelium
 Olfactory epithelium composed of:
◦ Cell bodies of olfactory receptor cells
◦ Supporting cells – columnar cells
◦ Basal cells – form new olfactory receptor cells
 Axons of olfactory epithelium
◦ Gather into bundles – filaments of the
olfactory nerve
◦ Pass through the cribriform plate of the
ethmoid bone
◦ Attach to the olfactory bulbs
SINUS FRONTALIS
SINUS MAXILLARIS
SINUS ETHMOIDALIS ANT.
SINUS ETHMOIDALIS POST.
SINUS SPHENOIDALIS
Figure 7.11a, b
 Paranasal sinuses- air- filled pockets in the cranium
 Purpose
◦ ↓ weight of the skull
◦ Serve as resonators for sound
◦ Provide mucous for the nasal cavity

 Sinus openings are narrow = susceptible to

occlusion
 The mucous = nasal cavity

predisposition factor of inflammation/sinusitis

 THE OPENING OF PARANASAL SINUSES

Sinus
frontalis

Sinus sphenoidalis
Sinus
ethmoidalis ant.

Hyatus maxillaris

Sinus
maxillaris
 THE OPENING OF PARANASAL SINUSES

◦ Sinus Frontalis
◦ Sinus Maxillaris Meatus Nasi
Media
◦ Sinus Ethmoidalis Ant.
◦ Sinus Ethmoidalis Post. Meatus Nasi
Superior
◦ Sinus Sphenoidalis Recessus spheno-

ethmoidale
 Bentuk piramid, tdp.pd. Corpus maxilla
 Apex ke depan sampai os zygomaticus
 Atap dari sinus dibentuk oleh dasar cavum

orbita
 Radix gigi M2 sering menonjol ke dasar sinus
 Bermuara ke meatus nasi media : Hyatus

Semilunaris
 Letak muara lebih cranial dari dasar sinus

penyulit terapi sinusitis o.k drainage secret

terhambat
 Radang hidung (rhinitis) mudah jadi sinusutis

krn dilapisi oleh epithel yng sama

 THANK YOU
 AND
 GOOD
LUCK

 GOD BLESS YOU