Chapter

31
Ear

INTRODUCTION • It consists of a single crumpled plate of elastic

cartilage with fibrous tissue closely lined by skin.
Ear is the organ of hearing (peripheral apparatus of
• The lowest part is however, soft and consists of
hearing). It also houses receptors that help to maintain
fibrofatty tissue only. This is called lobule of the
the balance of the body. It is located in the temporal bone
ear.
and consists of three parts:
• The skin of pinna is adherant to the underlying
1. External ear
cartilage. Sebaceous glands are present in the region
2. Middle ear
of concha. Coarse hairs may be present in some
3. Internal ear
elderly males along the tragus, antitragus and

C H A P T E R-31
intertragic notch. (It is a Y-linked genetic expre-
EXTERNAL EAR (Figs 31.1 to 31.3) ssion).
It is the lateral or external part of ear and consists of two
parts namely: Anatomical Features
1. Pinna Pinna presents an external or lateral surface and a cranial
2. External auditory meatus or medial surface.
Lateral or external surface: A number of elevations and
Pinna or Auricle (Fig. 31.1) depressions are seen on this surface.
1. Concha: It is a large central depression that leads
• It is a shell like projection present one on each side into the external auditory meatus.
of the head.

Fig. 31.1: Parts of external ear

 424 Human Anatomy For Dental Students

2. Helix: The outer prominent rim of pinna is known

as helix. It passes upwards from the lobule and
curves up at the upper end. It finally descends
down and curves backwards to end as the crus of
helix at the upper part of concha. It divides the
concha into a smaller upper and larger lower part.
It presents an elevation at the postero-superior
aspect known as the Darwin’s tubercle.
3. Antihelix: The prominent margin lying in front of
and parallel to the helix is the antihelix. It encircles
the concha in a C-shaped manner being deficient
in the anterior part. Its upper end may divide into
two crura that enclose an area known as the
triangular fossa.
4. Scaphoid fossa: It is the area between helix and
antihelix.
Fig. 31.2: Nerve supply of lateral surface of auricle
5. Cymba concha: The smaller part of concha present
above the crus of helix is known as cymba concha.
It corresponds internally to the suprameatal triangle 2. Anterior auricular branches of superficial temporal
on skull. artery.
6. Tragus: It is a triangular flap of cartilage present in 3. Branches of occipital artery.
front of depression of concha. It guards the entry The veins follow arteries and drain into external
into the external auditory meatus. jugular and superficial temporal veins.
S E C T I O N-2

7. Antitragus: It is an elevation on the lower end of Lymphatic Drainage of Pinna

antihelix lying just opposite the tragus. The two are
Lymphatics from pinna drain into the following lymph
separated below by a intertragic notch.
nodes:
8. Lobule of pinna: Skin covered flap of fibro fatty
1. Parotid lymph nodes: These are present in front of
tissue that hangs below the anti-tragus is the lobule.
tragus.
Medial surface: It is also known as the cranial surface.
2. Mastoid lymph nodes: These lie behind the auricle.
It presents with few elevations that correspond to the
3. Upper group of deep cervical lymph nodes.
depressions of the lateral surface.
1. Eminentia conchae: This lies opposite the concha. Nerve Supply of Pinna (Fig. 31.2)
2. Eminentia triangularis: It lies opposite the tri- Following nerve supply the pinna.
angular fossa. 1. Great auricular nerve: It supplies the cranial
surface, helix, antihelix and lobule.
Muscles of Pinna 2. Lesser occipital nerve: It supplies the upper part
They serve minimal or no significant function in human of cranial surface.
beings. All are supplied by branches of facial nerve. 3. Auriculotemporal nerve: It supplies the anterior
1. Extrinsic muscles: Auricularis anterior, auricularis part of lateral surface, i.e., tragus, crus of helix.
posterior, auricularis superior. 4. Auricular branch of vagus nerve: It supplies the
2. Intrinsic muscles: Helicis major and minor, tragicus concha and eminentia concha.
and antitragicus etc. 5. Facial nerve: Part of antihelix and crux.

Ligaments of Pinna External Auditory/Acoustic Meatus (Fig. 31.3)

It is a 24 mm long canal which extends from the bottom
1. Extrinsic ligaments: These are present anteriorly
of the concha to the tympanic membrane. It consists of
and posteriorly and connect the auricle to temporal
two parts:
bone.
1. Cartilaginous part: It forms lateral 1/3rd of the
2. Intrinsic ligaments: These connect various parts of
meatus. Its cartilage is continuous with that of the
the cartilage of the auricle with themselves.
auricle. The postero-superior part usually has only
Blood Supply of Pinna fibrous tissue and no cartilage.
Arterial supply is derived from the following: 2. Bony part: Medial 2/3rd of the meatus is bony. It
1. Posterior auricular branch of external carotid artery. is formed by the following parts of temporal bone:
 Ear 425

Fig. 31.3: Different parts of the ear (coronal section)

C H A P T E R-31
a. Tympanic plate of temporal bone: It forms the Blood Supply of External Auditory Meatus
anterior wall, floor and part of posterior wall of Arterial supply is derived from the following:
the meatus. 1. Posterior auricular branch of external carotid artery.
b. Squamous part of temporal bone: It forms the 2. Anterior auricular branches of superficial temporal
postero-superior wall of the meatus. artery.
At the medial end of the bony canal a tympanic 3. Deep auricular branch of maxillary artery.
sulcus is present that lodges the tympanic membrane. The veins run along with arteries and drain into
The floor and anterior wall of meatus are longer than external jugular and maxillary veins.
the roof and posterior wall due to the obliquely placed Lymphatic drainage is same as pinna.
tympanic membrane. The meatus presents with two Nerve Supply of External Auditory Meatus
constrictions. The first is at the junction of bony and
1. Auriculotemporal nerve: It supplies the roof and
cartilaginous parts. The second is narrower and lies in
anterior wall of meatus.
the bony part, 5 mm in front of the tympanic membrane.
2. Auricular branch of vagus nerve (The only
Direction of meatus: The external auditory meatus has cutaneous branch of vagus nerve): It supplies the
a peculiar S-shaped course. From lateral to medial side floor and posterior wall of meatus.
it curves as follows :
i. Medially, upwards and forwards. Functions of External Ear
ii. Medially, upwards and backwards. • It receives the sound waves and transmits them
iii. Medially, forward and downwards. inside.
The meatus is lined by skin which is adherant to the • The wax produced by ceruminous glands keeps the
perichondrium and periosteum of the meatus. Hence, epithelium of external ear moist preventing dryness
an infection of meatus is very painful. The skin continues and also prevents maceration of epithelium due to
over the pinna laterally and on external surface of water.
tympanic membrane medially. The subcutaneous tissue
of cartilaginous part has ceruminous glands which are CLINICAL AND APPLIED ANATOMY
thought to be modified sweat glands. These produce ear • We know that external auditory meatus is
wax or cerumen. The wax prevents maceration of the S-shaped. Hence, in order to examine the canal and
lining epithelium by water and also aids in opposing view the tympanic membrane the auricle is pulled
entry of insects into the ear. upwards, backwards and laterally to straighten the
 426 Human Anatomy For Dental Students

external meatus before inserting the ear speculum. • The tympanic membrane is divided into 2 parts by
In newborn babies and young children the bony these folds:
part of meatus is poorly developed and is in the 1. Pars tensa: It is the greater part of membrane
form of a bony rim. Hence, the ear speculum should which is taut.
be inserted minimally and carefully as otherwise 2. Pars flaccida: It is the part of membrane which
the tympanic membrane can be easily damaged. is thin and lax. It is present in the small
• Ceruminosis is the excessive collection of wax in triangular area above the lateral process of
the meatus. The excess wax impedes transmission malleus between the two malleolar folds.
of sound waves and patient presents with blocked • The ear drum has two surfaces:
ear and decrease in hearing. The wax can be
1. Lateral surface: It is concave and directed
washed out by syringing with a warm jet of water.
downwards, forwards and laterally.
However, this can lead to stimulation of auricular
2. Medial surface: It is convex and is attached to
branch of vagus nerve leading to coughing and
the handle of malleus. The point of attachment
vomiting during the procedure and rarely, can even
is maximally convex and is called the umbo.
cause sudden cardiac inhibition. There is also a
high chance of injury to the tympanic membrane. Structure: The tympanic membrane is composed of
Thus, wax now a days is removed by gentle suction following three layers:
in the meatus. It is not advisable to use earbuds to a. Outer cutaneous layer: This is continuous with the
clean wax as they push the wax further inside skin of the external auditory meatus.
which gets stuck. b. Middle fibrous layer: In the pars flaccida however,
• Any infection of skin of external auditory meatus the middle layer consists of loose connective tissue
is very painful because the skin is intimately instead of fibrous tissue.
adherent to the underlying cartilage and bone. c. Inner mucous layer: It is continuous with the
S E C T I O N-2

mucus lining of middle ear.

TYMPANIC MEMBRANE (SYN. EAR DRUM) (Figs 31.3 Blood Supply of Tympanic Membrane
and 31.4)
Arterial supply is derived from the following:
It is a thin, semi-transparent membrane which separates 1. Deep auricular branch of maxillary artery.
the external auditory meatus from the middle ear. It is 2. Stylomastoid branch of posterior auricular artery.
oval in outline, a little less than ½ inch (12 mm) in its
3. Anterior tympanic branch of maxillary artery.
greatest or vertical diameter.
The veins runs along with arteries. From the lateral
surface they drain into the external jugular vein while
Anatomical Features from the medial surface they drain into the pterygoid
• The tympanic membrane is inclined forwards and venous plexus.
downwards. It makes an angle of 55° with the floor
of the external auditory meatus. Nerve Supply of Tympanic Membrane
• It is thickened along its margins and is attached to It is supplied by the following nerves:
the sulcus in the bony ring of tympanic plate of 1. Auriculotemporal nerve: It supplies the upper and
temporal bone. The posterosuperior part of anterior part of lateral surface.
tympanic plate does not have any sulcus and is
2. Auricular branch of vagus nerve: It supplies the
replaced by a notch. Two folds of membrane extend
from the margin of the membrane downwards from lower and posterior part of lateral surface.
the two ends of the notch and converge at the level 3. Glossopharyngeal nerve: It supplies the medial
of lateral process of malleus. They form the anterior surface.
and posterior malleolar folds.
Functions of Tympanic Membrane
The tympanic membrane vibrates in response to sound
wavesand transmits them to the middle ear ossicles. It
helps in amplification of sound.

CLINICAL AND APPLIED ANATOMY

• Normal appearance of tympanic membrane on
Fig. 31.4: Right tympanic membrane Otoscope (Fig. 31.4): Since the tympanic membrane
 Ear 427

is transluscent, on examination with otoscope, one MIDDLE EAR (SYN.: TYMPANIC CAVITY) (Figs 31.3
can see the underlying handle and lateral process and 31.5)
of malleus and the long process of incus. The The middle ear is a narrow, slit-like, air filled space in
greater part of membrane (pars tensa) is taut. the petrous part of the temporal bone between the
Above the lateral process of malleus, a small external ear and the inner ear.
triangular area of the membrane is seen which is Shape and size: It is like a cube compressed from side
thin and lax (pars flaccida). This triangular area is to side. In coronal section the cavity of middle ear
seen to be bounded by two distinct folds, anterior appears biconcave because the medial and lateral walls
and posterior malleolar folds which reach down are closer to each other in the centre of the cavity.
to the lateral process of the malleus.
The point of greatest concavity on the external Measurements:
surface of the membrane is known as umbo. This Vertical diameter : 15 mm
marks the attachment of the handle of the malleus Anteroposterior : 15 mm
to the membrane. On illumination, the normal
tympanic membrane appears pearly grey in colour Transverse diameter:
and reflects a ‘cone of light’ in its antero-inferior At roof : 6 mm
quadrant with the apex at umbo. This reflection of In the center : 2mm
light is due to the inclination of tympanic At floor : 4 mm
membrane in the external auditory canal.
• Myringotomy means incision in tympanic Boundaries (Fig. 31.5)
membrane. The incision is usually given in the
postero inferior quardant. This is the most 1. Roof: It is wider than the floor and is formed by a

C H A P T E R-31
dependent part of the middle ear, where pus thin sheet of bone called tegmen tympani. It
generally collects in acute infection. The risk of separates the tympanic cavity from the middle
injury to chorda tympani nerve is also minimal in cranial fossa and the temporal lobe of brain.
such an incision since the nerve runs on the inner 2. Floor: It is formed by a thin bony plate of petrous
aspect of tympanic membrane downwards and temporal which lodges the superior bulb of internal
forwards lateral to the long process of incus. jugular vein inferiorly.
• Myringoplasty is the repair of a perforation in the 3. Anterior wall: It is narrow due to approximation
tympanic membrane by application of a graft. The of medial and lateral walls anteriorly. The thin
graft is usually derived from temporalis fascia or lamina of bone presents with the following features
cartilage of tragus of the patient. (From above downwards):

Fig. 31.5: Middle ear cavity (lateral wall is removed)

 428 Human Anatomy For Dental Students

a. It has an opening for bony part of pharyngo- 2. Posteriorly, it communicates with mastoid
tympanic tube which is directed forwards, (tympanic) antrum and mastoid air cells through
downwards and medially. aditus to antrum.
b. A smaller opening for tensor tympani muscle is
present below. Contents of the Middle Ear
c. The lowest part is formed by a thin plate of bone
which is the posterior wall of the bony carotid 1. Three small bones known as ear ossicles: malleus,
canal. This separates the cavity from the internal incus and stapes.
carotid artery and the sympathetic plexus of 2. Two muscles: tensor tympani and stapedius.
nerves around it. 3. 2 nerves: chorda tympani and tympanic plexus.
4. Posterior wall: The bony wall presents with: 4. Vessels supplying and draining the middle ear.
a. A large opening in the upper part which The mucus membrane lining the middle ear forms
communicates with mastoid antrum. It is called folds which project into the cavity, giving it a honey-
as aditus and antrum. It lies above the level of combed appearance.
tympanic membrane.
b. Lower part has bone which separates the middle POINT TO REMEMBER
ear from mastoid air cells. It presents vertical
part of bony canal for facial nerve in lower part, Strictly speaking the middle ear contains only air.
medially.
c. A pyramidal prominence which contains the Ear Ossicles
stapedius muscle. It is present in front of the
Malleus (Fig. 31.6)
upper part of facial canal.
5. Medial wall: This bony wall separates the tympanic It is the largest ossicle which is situated just medial to
S E C T I O N-2

cavity from the internal ear. It presents with the tympanic membrane. Malleus is shaped like a mallet
following features: and consists of the following parts:
a. Promontory: It is a large rounded elevation 1. Head is the larger, rounded upper end of malleus.
formed by the first (basal) turn of the cochlea. It It lies in the epitympanic part and articulates with
is covered by the tympanic plexus. the incus.
b. Fenestra vestibuli (oval window): It is a 2. Neck: It is the constricted part present just below
fenestration present behind the promontory in the head.
upper part that is closed by the base of stapes. 3. Three processes:
c. Fenestra cochleae (round window): It lies below a. Handle of malleus: It is the longest process
and behind the promontory. It is closed by the which is directed downwards and is embedded
mucus membrane of middle ear also called in the medial surface of the tympanic mem-
secondary tympanic membrane. brane.
d. A bony prominence representing the oblique b. Anterior process: It is a small projection.
part of facial nerve canal is seen above the oval
c. Lateral process: It is a conical projection which
window and passes posteriorly.
is attached to the tympanic membrane at the
e. A bony prominence of lateral semicircular canal
convergence of anterior and posterior malleolar
is seen behind the facial canal.
folds.
f. Processus trochleariformis: It is a bony
prominence present above and in front of the
oval window. The tendon of tensor tympani
hooks around it before inserting into the handle
of malleus.
6. Lateral wall: It is mainly formed by the tympanic
membrane. The portion situated above the
tympanic membrane is called as epitympanic
recess. It is formed by the squamous part of
temporal bone and opens posteriorly into aditus ad
antrum.
Communications of Middle Ear
1. Anteriorly, it communicates with nasopharynx,
through pharyngotympanic tube. Fig. 31.6: Ear ossicles
 Ear 429

Incus (Fig. 31.6) tympanic membrane, ossicles, posterior wall and

mastoid antrum.
It lies between malleus and stapes and presents with a
body and two processes. Blood Supply of Middle Ear
1. Body: It is cubical in shape. It articulates with head Arterial supply is derived from the following:
of malleus anteriorly. It forms saddle joint.
1. Stylomastoid branch of occipital artery.
2. Short process: It is a conical projection towards the
2. Anterior tympanic and deep auricular branch of
epitympanic recess posteriorly.
3. Long process: It extends downwards from the body maxillary artery.
and lies parallel to handle of malleus. The lower 3. Petrosal branch and superior tympanic branch of
end is curved medially and articulates with head middle meningeal artery.
of stapes and form ball and socket joint. 4. Inferior tympanic branch of ascending pharyngeal
artery.
Stapes (Fig. 31.6) 5. Branch of internal carotid artery.
It is smallest and the medial most ossicle. Its shape Veins from middle ear terminate into pterygoid
resembles a stirrup and consists of the following parts: plexus of veins and superior petrosal sinus.
1. Head: It is small and is directed laterally to articulate Lymphatic Supply of Middle Ear
with incus.
2. Neck: It is seen as a small constricted part under Lymphatics from middle ear pass into the parotid and
the head. It receives insertion of stapedius muscle upper deep cervical lymph nodes.
on the posterior surface. Nerve Supply of Middle Ear
3. Anterior and posterior limbs: These arise from

C H A P T E R-31
neck and diverge to attach to the base. It is derived from the tympanic plexus of nerves which
4. Base: It is also called foot plate of stapes. It consists is situated over the promontory on medial wall of
of a plate of bone which is reniform in shape. The tympanic cavity. The plexus is made of:
foot plate is connected to the fenestra vestibuli by 1. Superior and inferior carotico-tympanic nerves -
an annular ligament. these consists of post-ganglionic fibers derived from
sympathetic plexus around internal carotid artery.
Muscles of Middle Ear 2. Tympanic branch of glossopharyngeal nerve.
Tensor Tympani
Origin: Cartilaginous part of auditory tube and CLINICAL AND APPLIED ANATOMY
adjoining part of greater wing of sphenoid.
Insertion: Root of handle of malleus • Middle ear infections may spread to mastoid
Nerve supply: Mandibular nerve antrum and mastoid air cells through aditus-ad-
antrum. Since the mastoid antrum is intimately
Stapedius related posteriorly to the sigmoid sinus and
cerebellum, both these structures may also be
Origin: Pyramidal eminence in posterior wall of involved in severe cases.
tympanic cavity. • In children, upper respiratory tract infections (URI)
Insertion: Posterior surface of neck of stapes. are fairly common. The infection spreads easily
Nerve supply: Facial nerve. from nasopharynx to the middle ear via the
Action of muscles: The tensor tympani makes the eustachian tube because the tube is short and more
tympanic membrane taut while the stapedius draws the horizontal in position. Hence, examination of ear
stapes laterally. This exerts a dampening effect on sound is important in all children with URI.
vibrations. This helps to prevent damage to the internal • The pharyngotympanic tube connects naso-
ear in the presence of loud noise. pharynx to the middle ear cavity and helps to
equalize the pressure on either side of tympanic
membrane. The tubal opening in nasopharynx is
Mucosa of Tympanic Cavity slit like and normally remains closed except while
The mucosal lining of tympanic cavity consists of ciliated yawning or swallowing. When it opens, the air in
columnar epithelium which continues into the pharynx middle ear escapes and equalizes with atmosphere
along the pharyngo tympanic tube. It is pale and thin. pressure. The pressure of air at higher altitudes is
Non-ciliated low columnar epithelium is present over less. Hence, when ascending up a mountain in a
 430 Human Anatomy For Dental Students

vehicle or travelling by aeroplane, the pressure Relations of vestibule:

changes can lead to ear ache. This is because on a. Its lateral wall opens into the tympanic cavity by
ascent the middle ear pressure (internal) will an oval aperture called fenestra vestibuli which is
exceed the pressure in external ear (external). The closed by the foot-plate of the stapes.
tympanic membrane as a consequence is pushed b. Its medial wall is related to the internal acoustic
outwards leading to pain. This is relieved normally meatus. The interior of the medial wall presents
by constant swallowing. However, in people with a vestibular crest, an oblique ridge which
suffering from common cold, the tubal opening divides the medial wall into two recess namely:
may be blocked due to swelling and the pain cannot i. A spherical recess, below and in front. It
be relieved as the escape of air is prevented. During presents various foramina for transmission of
descent, the pressure changes are reversed and air lower divisions of the vestibular nerve to the
is sucked into the middle ear cavity via the tube. saccule.
Pain during descent is more because the slit like ii. An elliptical recess, above and behind. The floor
tubal opening allows easy escape of air during of this recess presents a foramen for upper
ascent while the sucking in of air during descent division of vestibular nerve and lodges the
via the opening is more difficult. utricle.
c. Posteriorly, it receives the opening of three
INTERNAL EAR semicircular canals.
d. Anteriorly, it is continuous with the cochlea.
It is the inner most part of the ear and is located within
the petrous part of the temporal bone.
POINT TO REMEMBER
Structure: It consists of a complex series of fluid filled
S E C T I O N-2

spaces called the membranous labyrinth. This The vestibular crest splits in its lower part to enclose
membranous labyrinth is loged within similarily an recess called cochlear recess.
arranged bony cavities forming the ‘bony labyrinth’. The
membranous labyrinth is filled with endolymph and Cochlea
bony labyrinth with perilymph. • The cochlea is a helical tube of about 2½ to 23/4
turns. It is named cochlea due to its resemblance to
Bony Labyrinth (Fig 31.7) the shell of a snail.
The bony labyrinth consists of a complex series of bony • It forms the anterior part of the bony labyrinth.
canals in the petrous part of temporal bone. It is made • Its basal coil forms the promontory of the middle
up of three parts namely vestibule, cochlea and ear and opens into the vestibuli posteriorly.
semicircular canals which communicate with each other. • The cochlea possesses a bony core or central bony
pillar called modiolus which contains the spiral
Vestibule ganglion and transmits the cochlear nerve.
• The vestibule is the middle part of the bony • A spiral ridge of the bone projects from the
labyrinth and is located immediately medial to the modiolus which partly divides the cochlear canal
tympanic cavity. into two parts:
• It lodges the utricle and saccule of the membranous a. Scala vestibuli, above
labyrinth. b. Scala tympani, below
• The partition between scala vestibuli and scala
tympani is completed by the basilar membrane
which extends from the tip of spiral lamina to lateral
wall of cochlea.
• The scala vestibuli communicates with the scala
tympani at the apex of the cochlea by a small
opening called helicotrema.
• Both scala have perilymph.
• The scala tympani is closed by a bony lamina at the
end of the basal turn while the scala vestibuli opens
Fig. 31.7: Bony labyrinth into the anterior wall of vestibule.
 Ear 431

Semicircular Canals
• There are three semicircular canals situated behind
the vestibule. These are superior or anterior,
posterior, and lateral.
• Each canal is 15 to 20 mm long and forms 2/3rd of
a circle.
• Each canal is dilated at both the ends to form
ampullae.
• Both ends of the canals (6 in number) open into the
vestibule by 5 openings.
• The three canals are set at a right angle to each other.
Fig. 31.8: Membranous labyrinth
Anterior Semicircular Canal
• It lies in a vertical plane at right angle to the long Cochlear Duct (also known as, scala media)
axis of the petrous temporal bone.
• Its convexity faces upwards which produces an • It is a spiral-shaped duct consisting of 2 and 3/4th
arcuate eminence on the anterior surface of the turns. It lies in the bony cochlear canal between the
scala vestibuli and scala tympani.
petrous temporal bone.
• The cochlear duct contains the spiral organ of Corti.
• Its ampulla is located anterolaterally and its
• Structure: On cross section, the cochlear duct is
posterior end unites with the upper end of the
triangular in shape. Its boundaries are as follows:
posterior semicircular canal to form the crus
— Floor is formed by the osseous spiral lamina

C H A P T E R-31
commune which forms a single opening into the
medially and basilar membrane laterally.
vestibule. — Medially it is bounded by the vestibular or
Posterior Semicircular Canal Reissener’s membrane which passes from upper
• It lies in a vertical plane parallel to the long axis of surface of spiral lamina to the lateral wall of
petrous temporal bone. cochlear canal.
• Its convexity faces backwards. — Laterally, it is bounded by outer wall of the
• Ampulla lies at its lower end. cochlear canal.
• Its upper end forms the crus commune.
Spiral Organ of Corti (Fig. 31.9)
Lateral Semicircular Canal
• It lies in a horizontal plane. • It is the peripheral organ of hearing present in the
• Its convexity faces posterolaterally. cochlear duct. It rests on the basilar membrane.
• Its ampulla lies anteriorly close to the ampulla of
the anterior semicircular canal.

POINT TO REMEMBER
The lateral semicircular canals of both ears lie in the
same plane. The anterior semicircular canal of one side
is parallel to the plane of the posterior semicircular
canal of the other side.

Membranous Labyrinth (Fig. 31.8)

The membranous labyrinth, as mentioned earlier,
consists of closed membranous sacs and ducts
intercommunicating with each other. It lies within the
bony labyrinth. The membranous labyrinth consists of
3 parts:
1. Cochlear duct, within the bony cochlea.
2. Saccule and utricle, within the vestibule.
3. Three semicircular ducts, within the respective
semicircular canals. Fig. 31.9: Spiral organ of Corti
 432 Human Anatomy For Dental Students

• Structure: It consists of: supplied by the peripheral processes of the neurons

a. Inner and outer rod cells. of vestibular nerve.
b. Inner and outer hair cells: These respond to
vibrations induced in the endolymph by the Semicircular Ducts
sound waves. • Three semicircular ducts are present within the
c. Supporting cells (Deiter’s and Hensen’s cells). corresponding bony semicircular canals along their
d. Tunnel of Corti, an interval between the inner outer walls.
and outer rod cells which contains corti-lymph. • Each duct is dilated at both its ends forming an
ampulla lodged in the corresponding bony
e. Membrana tectoria: It is made up of a gelatinous
ampulla.
substance and covers the hair cells. Medially, it • The three ducts open into the utricle at both their
is attached to the vestibular lip of osseous spiral ends by five openings.
lamina. • The inner aspect of the medial wall of the ampulla
• The organ of Corti is innervated by the peripheral of each duct possesses sensory end organs called
processes of bipolar neurones located in the spiral crista ampullaris or ampullary crests.
ganglion which is located in the spiral canal. • Crista ampullaris consists of hair cells, supporting
cells and a gelatinous mass called cupula covering
• The spiral canal is located within the modiolus at
the sterocilia and kinocilia of hair cells.
the base of the spiral lamina. • The semicircular ducts are responsible for sensing
• The central process of these ganglion cells forms the rotatory movements of the head and help to
the cochlear nerve. maintain the kinetic balance of the body.
Blood Supply of Internal Ear
POINT TO REMEMBER
Arterial supply is derived from the following:
S E C T I O N-2

Note that the scala tympani containing perilymph lies 1. Labyrinthine artery, branch of basilar artery.
below the basilar membrane and scala vestibuli 2. Stylomastoid branch of occipital artery.
containing perilymph lies above the vestibular The organ of Corti has no blood vessels but
membrane. Thus cochlear duct containing endo- receives oxygen via the cortilymph.
lymph is bathed above and below by the perilymph The veins accompany arteries and form labyrin-
of the two scalae. thine vein which end in the superior petrosal sinus.
Nerve Supply of Internal Ear
Saccule and Utricle
Internal ear is supplied by the following nerves:
• The saccule is a globular membranous sac which 1. The utricle, saccule and semicircular ducts receive
lies in the anteroinferior part of the vestibule. fibres from vestibular nerve.
• It is connected in front to the basal turn of the 2. The cochlear duct (organ of Corti) receives fibres
cochlear duct by the ductus reuniens and behind from cochlear nerve.
with the utricle by a Y-shaped utriculo-saccular
duct. This duct forms the saccus endolymphaticus.
• The utricle an oblong membranous sac that lies VESTIBULO-COCHLEAR NERVE (Fig. 31.10)
behind and above the saccule in the posterosuperior The vestibulo-cochlear is the 8th cranial nerve. It is a
part of the vestibule. sensory nerve consisting of two components:
• It is connected in front to the saccule by a Y-shaped 1. The cochlear nerve, the nerve of hearing.
utriclo saccular duct and behind with the 3 2. The vestibular nerve, the nerve of balance (equili-
semicircular ducts by 5 openings. brium).
• The wall of utricle and saccule consists of an outer
layer of perilymphatic cells and an inner layer of
single row of epithelial cells separated by a tunica Functional Components
propria. 1. Special somatic afferent: Conveys the sensation of
• The inner aspect of medial wall of saccule and hearing from hair cells organ of Corti
anterior wall of utricle possess the sensory end 2. Special visceral afferent: For maintaining static and
organs called maculae. They contain hair cells, kinetic equilibrium.
supporting cells and a covering gelatinous mass
impregnated with calcium salts called the otolithic
membrane Nuclear Origin
• The maculae are also called the static balance 1. Dorsal and ventral cochlear nuclei: They are
receptors and give infromation about the position present in pons and receive fibres from cochlear
of head. They respond to movement of fluid when nerve.
there is linear acceleration of head. They are
 Ear 433

person if there is excessive stimulation of semi-

circular ducts.
• Motion sickness: It is characterized by vertigo,
headache, nausea and vomiting. It is primarily due
to excessive stimulation of the utricle and saccule
during motion like travelling in fast moving
vehicle.
Infants do not get motion sickness, since the labyrinth
is not functioning during the first year of life.

Auditory Pathway (Fig. 31.11)

Transmission of Sound Waves
Fig. 31.10: Vestibulo-cochlear nerve • The sound waves are received by the pinna and
passed to tympanic membrane via the external
auditory canal.
2. Vestibular nuclei: They receive fibres from • This sets up vibrations in tympanic membrane
vestibular nerve and are also present in the pons. which are transmitted to the ossicles of middle ear.
They are four in number namely superior, inferior, • The movements are passed successfully from
medial and lateral. malleus, incus to the foot of stapes that sets up
vibrations in the cochlea fluid in scala vestibule.
Intracranial Course • The pressure of sound waves is increased 22 times
as it passes from the tympanic membrane to foot
• The vestibular and cochlear components of the 8th of stapes.

C H A P T E R-31
cranial nerve are attached from the brain stem at • The movement of fluid in inner ear sets up pressure
the junction of pons and medulla, in the region of changes on inner hair cells which initiates action
cerebello-pontine angle. They lie lateral and potentials in them and hence in auditory nerves.
posterior to the facial nerve at this point. • Loudness of sound is proportional to amplitude of
• The two components then pass forwards and sound waves while pitch of sound is proportional
laterally to enter the internal auditory meatus along to frequency of sound waves striking the ear.
with the facial nerve and run in the petrous • Intensity of sound is measured on decibel scale. The
temporal bone to the inner ear. human ear can hear sound waves with frequencies
ranging from 20 to 20,000 Hertz (Hz) only.
Connections and Distribution The primary receptor cells of hearing are inner hair
cells in organ of Corti which initiate action potentials in
1. The cochlear nerve consists of afferent fibres and is
the auditory nerve fibers.
formed primarily by the central processes of bipolar
neurons which have their cell bodies in the spiral
ganglion located in the petrous temporal bone at Auditory Pathway
the modiolus. The peripheral processes of these cells • The organ of Corti is the peripheral receptor of
end in relation to the inner and outer hair cells of auditory pathway. Hair cells of organ of Corti are
the spiral organ of Corti. They are responsible for the receptor cells which are innervated by the
perception of sound waves. dedrites of bipolar cells located in spiral ganglion
2. The vestibular nerve also consists of afferent fibres of modiolus.
which are formed by the central processes of bipolar • Afferents impulses are transmitted via axons of the
neurons of the vestibular ganglion situated at the bipolar cells which form the cochlear division of
bottom of the internal acoustic meatus. The vestibulocochlear nerve (8th cranial nerve).
peripheral processes of these cells end in the macula • These relay in the dorsal and ventral cochlear nuclei
of the saccule and utricle which are responsible for located at the upper part of medulla and lower part
the static balance or equilibrium of the body and of pons.
the ampullary cristae of semicircular canals which • The fibres from ventral cochlear nuclei decussate
are involved in maintaining the kinetic balance of to opposite side forming trapezoid body at basilar
the body. part of pons.
• Fibres from ipsilateral dorsal cochlear nucleus and
contra-lateral ventral cochlear nucleus pass through
CLINICAL AND APPLIED ANATOMY superior olivary nucleus (some fibres relay here)
• Vertigo: Is the feeling of giddiness with subjective and ascend up as lateral lemniscus successively
sense of rotation either of the surroundings or of through inferior colliculus of midbrain, medial
oneself. It is a cardinal sign of labyrinthine geniculate body, auditory radiation to the auditory
dysfunction. Vertigo may also occurs in a normal cortex on superior temporal gyrus.
S E C T I O N-2 434 Human Anatomy For Dental Students

Fig. 31.11: Auditory pathway

Masking: Masking is the phenomenon in which • The afferent impluses are transmitted from the
presence of one sound decreases the ability to hear receptors to the proximal processes of bipolar cells
which form the vestibular division of vestibulo-
another sound. Example, we cannot hear clearly human
cochlear nerve.
voice if loud music is playing. • The fibres relay in vestibular nuclei located in upper
Localization of direction of sound depends upon part of medulla and lower part of pons. Further
the differences in the time of sound waves reaching the transmission is complex and fibres go along various
pathways.
two ears and the variation in the intensity of sound
1. Ascend to cerebellum via inferior cerebellar
waves reaching the two ears. This is integrated at level peduncle.
of auditory cortex and any diseases of the cortex can 2. Descend in spinal cord as the vestibulospinal
affect sound localization. tract.
3. Cross to vestibular nuclei of opposite side.
4. Have to and from connection with reticular
Vestibular Pathway
formation.
Peripheral receptors for vestibular pathway are the 5. Ascend to cerebral cortex of temporal lobe.
cristae ampularis of the semicircular canals and the 6. Have connection with nuclei of 3rd 4th and 6th
cranial nerves via medial longitudnal bundle.
macular located in saccule and utricle of vestibule. They Function of vestibular pathway: This pathway
are innervated by the distal processess of bipolar cells intergrates multiple inputs and helps to co-ordinates
of vestibular ganglion situated in the lateral part of movements of head, neck and body to maintanance of
internal acoustic meatus. balance and provides subjective awareness of motion.