Physiology, Ear


Article Author:
Arturo Sánchez López de Nava


Article Editor:
Savita Lasrado


Editors In Chief:
David Wood
Andrew Wilt
Hajira Basit


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
4/27/2019 11:40:47 PM

Introduction

The human ear is the organ of hearing and equilibrium. It detects and analyzes sound by the mechanism of transduction, which is the process of converting sound waves into electrochemical impulses. Audition cannot take place adequately if the anatomy is abnormal. This article will discuss the mechanisms implied in the conduction of sound waves into the ear, and its integration and transmission from the middle ear and inner ear to the brain.

Issues of Concern

Brief Anatomical Reminder

The human ear is a rudimentary shell-like structure that lies on the lateral aspect of the head. The ear is a cartilaginous structure. For physiological study purposes, it subdivides into three fundamental substructures: the external ear, the middle ear, and the inner ear.

  • The outer ear, also called auricle, is composed of cartilage and it is the part with the most contact with the external world. It has various anatomical demarcations like the helix, the antihelix, the tragus, and the antitragus and these demarcations lead to a depression called acoustic meatus. This meatus has a tube form and extends inward to end in the tympanic membrane. Two-thirds of this canal are cartilaginous, and the last third is bone, and the two external thirds have a lining with oil glands that produce cerumen to keep the canal clean from insects and other objects. At the end of the outer ear, lies the middle ear, which is limited externally by the tympanic membrane and internally by the oval window.
  • The middle ear is an air-filled space. It divides into an upper and a lower chamber, the epitympanic chamber (attic) and the tympanic chamber (atrium), respectively. It is like a room because it has a rectangular-like shape. It has anatomical relations with the jugular vein, the carotid artery, the inner ear, the eustachian tube, and the mastoid. The content of this room consists of ossicles; the malleus, the incus and the stapes, namely. These bony structures are suspended by ligaments which make them suitable for transmission of vibrations into the inner ear. The vibrations that come into this part of the middle ear than get transmitted by the action of the stapes, into the inner ear.
  • The inner ear is a space composed of the bony labyrinth and the membranous labyrinth, one inside the other. The bony labyrinth has a cavity filled with semicircular canals that are in charge of sensing equilibrium; this cavity is called the vestibule and is the place where the vestibular part of the VIII cranial nerve forms. The cochlea is the organ of hearing. It takes its name from the Greek language that means the shell of a snail and is the part from where the cochlear part of the VIII cranial nerve forms, thus constituting the vestibulocochlear nerve.

Sound Wave Transmission and its Physics

The hearing is the process by which sound vibrations transform from the external environment into action potentials. Vibrating objects produce sounds, like the strings of a guitar, and this vibrations pressure pulses into air molecules, better known as sound waves. So, the ear is equipped to distinguish different characteristics of sound, such as pitch and loudness; which refers to the frequency of sound waves and the perception of the intensity of sound, respectively. Frequency measurement is in hertz (Hz, cycles per second). The human ear can detect frequencies from 1000 to 4000 hertz, but a young ear can hear frequencies in the range between 20 and 20000 hertz. The intensity of sound is measured in decibels (dB); the range of human hearing on a decibel scale is from 0 to 130 dB (where the sound becomes painful). All these physical properties have to incur transformations to get into the central nervous system. The first transformation consists of the conversion of air vibrations into tympanic membrane vibrations. These vibrations then get transmitted into the middle ear and the ossicles. Then these vibrations transform into liquid vibrations in the inner ear and the cochlea, and these stimulate a region called the basilar membrane and the organ of Corti. Finally, these vibrations get transformed into nerve impulses, which travel to the nervous system.[1]

Development

The ultrastructure of the ear derives from the branchial arches. The first arch develops into the Merkel cartilage that forms the malleus head and neck, and the incus body. The second arch becomes the Reichert cartilage that forms the manubrium of the malleus and most of the stapes. The first branchial cleft forms the external auditory canal and the outer layer of the tympanic membrane.[2]

Organ Systems Involved

The system by which humans detect sounds is comprised of the external auditory canal and its microstructures (pinna, tragus, anti-tragus, namely), the tympanic membrane, the ossicles, the cochlear structure, and its contents (endolymph, organ of Corti) and the nerve fibers that give birth to the vestibular and cochlear divisions of the VIII cranial nerve.[3]

Mechanism

The outer ear serves the function of directing sound waves into the tympanic membrane. The auricle concentrates the majority of the sound waves and directs it into the funnel-shaped canal. Because the human auricle is almost immobile and not that large, it is less effective with sound gathering than the ears of other mammals. This resonance mechanism only works with short wavelength sound waves (frequencies between 2000 to 7000 Hz) thus determining the sensitivity of the human ear to some frequencies that help us distinguish vowels from consonants. Then, vibrations arrive at the tympanic membrane, triggering vibration there as well. This vibration stimulates a chain of ossicular structures that will transmit the energy to the cochlea, a spiral structure in the inner ear. In the cochlea, the energy is no longer in the form of vibrations, but in the form of hydraulic energy.[4]

Clinical Significance

Specific syndromes and disorders can affect the ear structure and dampen its function[5][6][7][8][9]:

  • Structural abnormalities: Structural abnormalities like preauricular pits and tags, stenotic and atretic ear canals can be associated with hearing loss.
  • Mandibulofacial dysostosis: This is an autosomal dominant condition, also known as Treacher Collins syndrome, characterized by downward slanting palpebral fissures, auricular malformations with preauricular blind fistulas, stenosis and/or atresia of the external ear canal and ossicular abnormalities.
  • Oculo-auriculo-vertebral spectrum: This spectrum is characterized by abnormal development of the first two branchial arches, resulting in anotia, preauricular tags, and atretic ear canals.
  • Craniofacial dysostosis: This is a rare syndrome, also known as Crouzon syndrome, that results in premature skull bone fusion, which causes the ear to be atretic or to have stenosis and low set ears[10][11][12]

  • Image 9942 Not availableImage 9942 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD

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Physiology, Ear - Questions

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What is the maximal acoustic amplification conferred by the external ear?



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A young child exhibits signs of hearing loss. A Rinne test reveals hearing loss of the right ear and a Weber test reveals lateralization to both ears. Which embryological arch is the most probable to be affected?



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A patient is complaining of difficulty while talking and articulating words, chewing food effectively with no associated pain, and sensory loss in the auricle, auditory canal, and in the cornea. Which nerve is the most likely to be affected?



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An 18-year-old patient with Type 1 Diabetes Mellitus complains of 4 months of severe right ear pain, a purulent and smelly ear secretion, hearing loss and aural fullness. At the otoscopic examination, the pinna retraction is painful, the tympanic membrane is intact, without retraction or bulging and the auditory canal is full of green and smelly secretion, with areas of necrosis. Why does the patient complain of hearing loss?



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A 7-year-old child with an external ear microabscess requires a draining procedure. To induce anesthesia successfully requires blunting the innervation to the selected structure of the ear in the following picture. What is the structure?

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    Contributed by Arturo López de Nava, MS
Attributed To: Contributed by Arturo López de Nava, MS



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A female pediatric patient falls while playing, injuring the side of her head, and suddenly complains of not being able to distinguish vowels from consonants when her mother talks to her. What precise region of the ear is the most likely to be affected?

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If a healthy person is exposed to a very intense sound, why does damage to the auditory structures occur only when intensity passes 85 dB?



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Physiology, Ear - References

References

White HJ,Peterson DC, Anatomy, Head and Neck, Ear Organ of Corti 2019 Jan;     [PubMed]
Maier W,Ruf I, Evolution of the mammalian middle ear: a historical review. Journal of anatomy. 2016 Feb;     [PubMed]
Shibazaki-Yorozuya R,Nagata S, Preferential Associated Malformation in Patients With Anotia and Microtia. The Journal of craniofacial surgery. 2019 Jan;     [PubMed]
Fuchs JC,Tucker AS, Development and Integration of the Ear. Current topics in developmental biology. 2015;     [PubMed]
Karmody CS,Annino DJ Jr, Embryology and anomalies of the external ear. Facial plastic surgery : FPS. 1995 Oct;     [PubMed]
Alvord LS,Farmer BL, Anatomy and orientation of the human external ear. Journal of the American Academy of Audiology. 1997 Dec;     [PubMed]
Renju R,Varma BR,Kumar SJ,Kumaran P, Mandibulofacial dysostosis (Treacher Collins syndrome): A case report and review of literature. Contemporary clinical dentistry. 2014 Oct     [PubMed]
Huang L,Vanstone MR,Hartley T,Osmond M,Barrowman N,Allanson J,Baker L,Dabir TA,Dipple KM,Dobyns WB,Estrella J,Faghfoury H,Favaro FP,Goel H,Gregersen PA,Gripp KW,Grix A,Guion-Almeida ML,Harr MH,Hudson C,Hunter AG,Johnson J,Joss SK,Kimball A,Kini U,Kline AD,Lauzon J,Lildballe DL,López-González V,Martinezmoles J,Meldrum C,Mirzaa GM,Morel CF,Morton JE,Pyle LC,Quintero-Rivera F,Richer J,Scheuerle AE,Schönewolf-Greulich B,Shears DJ,Silver J,Smith AC,Temple IK,van de Kamp JM,van Dijk FS,Vandersteen AM,White SM,Zackai EH,Zou R,Bulman DE,Boycott KM,Lines MA, Mandibulofacial Dysostosis with Microcephaly: Mutation and Database Update. Human mutation. 2016 Feb     [PubMed]
Beleza-Meireles A,Clayton-Smith J,Saraiva JM,Tassabehji M, Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update. Journal of medical genetics. 2014 Oct     [PubMed]
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