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EARS: ANATOMY AND PHYSIOLOGY
EARS: ANATOMY AND PHYSIOLOGY
Ears

External Middle Ear Inner

-auricle -Ossicles á


-external -Eustachian tube á

auditory canal á á   
-tympanic
membrane

Hearing and Balance

Hearing
 EARS: ANATOMY AND PHYSIOLOGY
Inner Ear:
— Auricle- collects sound waves and directs them
to the external acoustic meatus

— External Acoustic Meatus- a passageway that

leads to the eardrum
3eruminous glands- produces cerumen.

— Tympanic Membrane: a thin membrane

Separates external and middle ear
 EARS: ANATOMY AND PHYSIOLOGY
Middle Ear: air filled cavity
— Auditory Ossicles:
Malleus (hammer)- attached to the medial

surface of tympanic membrane

Incus (anvil)- connects malleus to stapes

Stapes (stirrups)- seated in the oval window;

sorrounded by flexible ligament

— Eustachian Tube: enables air pressure to be

equalized between outside air and middle ear
cavity.
 EARS: ANATOMY AND PHYSIOLOGY
Inner Ear
— Bony Labyrinth- interconnecting tunnels and
chambers within temporal lobe
3ochlea: hearing

Vestibule and Semicircular canals: balance

— Membranous Labyrinth- filled with clear fluid

(endolymph)
— Organ of 3orti
contains auditory sensory cells, or "hair cells."
 EARS: HEARING FUN3TIONS
Hearing
— Air 3onduction
Travel over the air-filled external and middle
ear through the vibration of the tympanic
membranes and ossicles.

— Bone 3onduction
Travel directly through the bone to the inner
ear, bypassing the tympanic membrane and
ossicles.
EARS: HEARING FUN3TIONS

m

Sound

Bone

Inner Ear
(sound bypasses ,external ear
and middle ear)
 Sound

m
External auditory canal

Tympanic membrane

Ossicles vibrate
(Malleus Incus Stapes Foot plates)

(Perforated TM)
(Healthy TM)
Oval Window Round Window
Oval Window
Lag Time
Round window
Hear Loss
Hair cells of 3orti

3ranial Nerve VIII

3NS interprets sounds

 EARS: EQUILIBRIUM FUN3TIONS

— Static -associated with the vestibule and is

involved in evaluating the position of the head
relative to gravity

— Maculae, located in the vestibule, consist of

hair cells with the microvilli embedded in a
gelatinous mass that contains otoliths. The
gelatinous mass moves in response to gravity
EARS: EQUILIBRIUM FUN3TIONS
Kinetic- associated with semicircular canals
and is involved in evaluating changes in the
direction and rate of head movements

There are three semicircular canal contains

a crista ampullaris, which has hair cells with
microvilli embedded in gelatinous mass , the
cupula
EAR: ASSESSMENT
OTOS3OPE
— Held in right hand
in pencil-hold
position
— Auricle is pulled
upward and
backward.
— 5mm- largest
speculum
EAR: ASSESSMENT
Healthy Tympanic
Membrane
— pearly gray
— Positioned obliquely at
the base of canal
 EAR: ASSESSMENT
Whisper Test
— One ear is covered with
palm of hand

— The examiner whispers

softly from a distance of
1 or 2 feet from occluded
ear and out of patient·s
sight

— The patient should

correctly repeat
 EAR: ASSESSMENT
Weber Test
— Uses bone conduction

— Tests laterization of sound

— a vibrating tuning fork (either 256 or 512 Hz) is

placed in the middle of the forehead,chin, head
equidistant from the patient's ears.

— Patient reports in which ear the sound is heard

louder

— Normal: both ears hears same loudness

 EAR: ASSESSMENT
Rinne Test
— Tuning fork is shifted in two positions:
2 inches from the opening of ear canal (air

conduction)
Against mastoid bone (bone conduction)

— Normal: air conducted sound is louder than

bone-conducted sound

— 3onductive hear loss: bone conduction sounds

as long as or longer than air-conducted

— Sensorineural hear loss: air conducted sound

longer than bone conducted
 DIAGNOSTI3 EVALUATION
Frequency : number of sound waves emanating
for source per second
— Normal- 20-20,000Hz

Pitch: describes frequency

— Low-100Hz
— High-10,000 Hz

Intensity- pressure exerted by the sound

— [0dB- critical level of loudness
— 80dB- can damage inner ear
 DIAGNOSTI3 EVALUATION
Audiometry
— Pure Tone Audiometry
Sound stimulus consist
of a pure or musical tone
The louder the tone
before the patient
perceives, the greater
the hear loss

— Speech Audiometry
Uses spoken words to

determine ability to hear

and discriminate sounds
and words
 DIAGNOSTI3 EVALUATION
Tympanogram (impedance audiometry)
— Measures
inner ear muscle reflex to sound
stimulation
compliance of the tympanic membrane
by changing the air pressure in a
sealed ear canal
 DIAGNOSTI3 EVALUATION
Auditory Brain Stem Response
— Detectable electrical potential from cranial
nerve VIII and the ascending auditory
pathways of the brainstem in response to
sound stimuli

Electronystagmography
— Measurement and graphic recording of the
changes in electrical potentials created by eye
movements during spontaneous, positional, or
callorically evoked nystagmus
 DIAGNOSTI3 EVALUATION
Platform Posturography
— Used to investigate postural control capabilities such
as vertigo

Sinusoidal Harmonic Acceleration

— (rotary chair) used to assess the vestibulo-ocular
system

Middle Ear Endoscopy

— Evaluate suspected perilymphatic fistulaand new
onset conductive hearing loss
 DIAGNOSTI3 EVALUATION
Romberg·s Test
— based on the premise that a person requires at least
two of the three following senses to maintain
balance while standing:

proprioception (the ability to know one's body in

space),

sensation (the ability to feel touch, pressure, or

vibration -- e.g., to feel one's feet against the
ground),

vision (which can be used to monitor changes in

balance).
 DIAGNOSTI3 EVALUATION
Romberg·s Test
— The patient is asked to stand erect and close
eyes

— Watch the movement of the body in relation to

a perpendicular object behind the subject

— Positive sign: swaying and toppling

(Rombergismor)
 EARS: DISORDERS
Hearing Impairment
— 3onduction Deafness- mechanical deficiency in
transmission of sound waves fro the outer ear
to spiral organ.

— Sensorineural Hearing Loss- involves spiral

organ or nerve pathways and is more difficult
to correct
 EARS: DISORDERS
u

 
 

0-15 Normal

>15-25 Slight Hear loss

>25-40 Mild hearing loss

>40-55 Moderate

>55-70 Moderate to severe

>70-90 severe

>90 Profound hear loss

 EARS: DISORDERS
Otitis Media : inflammation of the middle ear, or
middle ear infection.
— Acute
Lasts less than 6wks

— Serous
Also called middle ear effusion

Involves fluid, without evidence of active

infection
— 3hronic
Results from recurrent AOM

3auses irreversible tissue pathology and

persistent perforation of the tympanic membrane
 EARS: DISORDERS
Tinnitus
— 3onsist of phantom sound sensations (roaring,
buzzing, or ringing in the ears)
Motion Sickness
— 3onsist of nausea and weakness
— 3aused by continuous stimulation of the semicircular
canals.
Space Sickness
— Occurring in zero gravity and resulting from
unfamiliar sensory input to the brain.
 EARS: DISORDERS
Meniere·s Disease
— Unknown cause but appears to involve a fluid
abnormality in one or both ears.
— Symptoms: vertigo, tinnitus, and a feeling of
fullness.

Vertigo
— a feeling of motion when one is stationary
— due to a dysfunction of the vestibular system in the
inner ear.
— It is often associated with nausea and vomiting as
well as difficulties standing or walking.
EARS: PROTE3TORS

Thermal earmuffs, worn in

cold environments to keep
a person's ears warm.

worn as hearing protection

 EARS: PROTE3TORS
protect the wearer's
ears from loud noises or
the intrusion of water,
foreign bodies, dust or
excessive wind.
EARS: PROPER NOSE BLOWING
Blow your nose gently
Avoid the "both-nostrils-open"
blow
Press a finger over one nostril.

Gently blow your nose into a paper

tissue through the one open nostril
After getting up, wait for 10 mins
before blowing the nose
Take increase OFI

Wash hands after blowing