PHYSIOLOGY

OF
HEARING
J.P. SOUAID, M.D., C.M., FRCS(C)
QUEENSWAY-CARLETON HOSPITAL
THE OTTAWA HOSPITAL
DEPARTMENT OF OTOLARYNGOLOGY
April 10, 2014
J. G. Marsan MD FRCSC

Physics of Sound
DEFINITION
Mechanical radiant energy
Transmitted by longitudinal pressure waves
In a material medium
CHARACTERISTICS
Frequency pitch
Amplitude - loudness

Mismatch of Impedance
Air

Water

Sound pressure
energy
0.1% Energy
absorbed
99.9% Energy
reflected

Loss of sound pressure energy: 30dB

OBJECTIVES

Explain how sound travels from a source to the

temporal lobe
Explain how mechanical energy is transformed
into electrical energy in hearing
Define and differentiate between conductive
hearing loss and sensorineural hearing loss
Describe the neural pathways involved in the
stapedial reflex
Describe pure-tone audiometry and
tympanometry.
Describe the physiology of otoacoustic emissions

EXTERNAL EAR

Concha and External Auditory Canal act

as acoustic resonators
10-15 db gain in 3-5kHz region.
Concha:
Resonance of 5kHz,
Irregular surface introduces other
resonances and anti-resonances.
Ear canal acts roughly like a simple tube
resonator, open at one end
Resonant peak at a frequency of 2.5 kHz
in human ears
Effects of the ear canal resonance
contribute substantially toward an
increase in sound pressure level at the
tympanum

EXTERNAL EAR CANAL

2.5kHz

MIDDLE EAR

Purpose: Transfer sound energy

from the air space of the
external auditory meatus to
the fluid in the cochlea.
Accomplished through the
vibration of the three middleear ossicles.
Piston-like vibration of the
stapes in the oval window
results in a pressure differential
between the oval window (and
hence scala vestibuli) and the
round window (and scala
tympani). This pressure
difference between the two
scalae is critical to the
mechanical excitation of the
cochlear structures.

MIDDLE EAR
Serves as a transformer, acting to
increase the sound energy
transmitted to the cochlear fluids.
Middle-ear transformer effects:
A, The ratio of the areas of the
tympanic membrane and the
stapes footplate (A1/A2) results in
a pressure increase at the oval
window. (17:1) (25 dB)
B, The lever effect caused by the
unequal displacements of the
malleus and incus (L1/L2) about the
incudostapedial joint also
results in a pressure increase.
(1.3x) (2.5 dB)
C, Curved membrane effect.
Certain
areas of TM vibrate
more than others.
D, Phase difference between oval
and round windows (small effect)
TOTAL GAIN: 27.5 dB

17:
Hydraulic
effec
1

Lever effect
1.3x

22:1=(17x1.3):1

Combined effect

Next Step

Mechanical energy
Mechanical energy

External and middle ear

Electrical nerve impulses

Inner ear (cochlea)

COCHLEAR PHYSIOLOGY

35 mm coiled bony tube; 2.5 turns

Divided into :
1) Scala vestibuli and tympani:
Contains perilymph
ECF like : Na- 140. K- 4-10
Production of perilymph:
Unknown
Ultrafiltrate of blood?
From CSF?

COCHLEAR PHYSIOLOGY
2) Scala media:
Contains endolymph
ICF like: K- 144 meq, Na- 15-25meq
Bounded by :
Reissners membrane
Basilar membrane
Osseous spiral lamina
Lateral wall

COCHLEAR PHYSIOLOGY

Stria vascularis:
Lateral wall
Highly vascularized
Cells contain NA-K-ATPase to produce
endocochlear potential about +80mV
in the scala media
Decreases slightly from base to apex

FUNCTION: Endolymph production

ORGAN OF CORTI

HAIR CELL INNERVATION

50,000 neurons innervate cochlea:

90-95% synapse directly on inner hair cells

(type 1 neurons)
Predominantly afferent
15- 20 of these neurons innervate each hair
cell
5-10% synapse directly on outer hair cells
(type 2 neurons)
Predominantly efferent
Each type2 neuron branches to innervate 10
outer hair cells

Characteristic

Inner H.C.

Outer H.C.

Shape

Flask

Cylindrical

Number

3500

12000

No.of hair cells

Few

Many

Arrangement

3-4 rows, slightly

curved

6-7 rows, rows

arranged in V or W
shape

Attachement to
tectorial membrane

None or loosely

Long stereocilia firmly

embedded

Intracellular electric
potential

-40mV

-70mV

Stereocilia

COCHLEAR MECHANICS
1. Motion is a traveling wave moving
longitudinally from the base to the apex
of the cochlea.
2. Each point along the cochlear partition
vibrates at a frequency equal to that of the
stimulus. Tonotopic organization:
This means that specific areas of the basilar
membrane respond to specific frequencies
3. High frequency- base of cochlea
4. Low frequency- apex of cochlea

COCHLEAR TONOTOPIC
ORGANIZATION

PHYSIOLOGY ORGAN OF CORTI

Stereocilia-Hair Cell complex:

Deflection of Stereocilia of outer hair cells
By travelling wave
Opens and closes non-specific ion channels
Influx of K, depolarizing of cell
Ca mediated K channels -intracellular
cascade
Release of chemical transmitters (Glutamate)
Activate afferent neurons

HAIR CELL DEPOLARIZATION

KINOCILIUM (longest
cilium)

DEFLECTION TOWARDS KINOCILIUM=EXCITATION

DEFLECTION AWAY FROM KINOCILIUM=INHIBITION

Auditory CNS

Cochlea
Cochlear Nerve
Cochlear Nucleus (CN)
Superior Olivary
Complex (SOC)
Lateral Lemniscus (B)
Inferior Colliculus (IC)
Medial Geniculate Body
(MGB)
Trapezoid body
Auditory Cortex
(Temporal lobe,
Brodman area 41)

Extensive crossover
Tonotopicity of Cortex also.

MNEMONIC: N.N.S.L.I.M.

CONDUCTIVE HEARING LOSS

SENSORINEURAL HEARING
LOSS
Conductive HL:
Related to sound
conduction travelling
through air via Pinna,
External Ear Canal,
TM, Ossicles and
Middle Ear up to the
oval window.
Sensorineural HL:
Related to the
electrical signal that
is travelling via the
cochlea, nerve and
onwards.

AUDIOMETRY

AIR CONDUCTION TESTING

BONE CONDUCTION
TESTING

NORMAL AUDIOGRAM

CONDUCTIVE HEARING
LOSS

SENSORINEURAL HEARING
LOSS

TYMPANOMETRY

Not a hearing test.

Objective test of
middle-ear
function. It is a
measure of energy
transmission
through the
middle ear.

TYMPANOMETRY

A tone of 226Hz is generated

by the tympanometer into
the ear canal, where the
sound strikes the tympanic
membrane, causing vibration.
This is done for different air
pressures.
Some of this sound is
reflected back and picked up
by the instrument.
Admittance is how energy is
transmitted through the
middle ear. The instrument
measures the reflected sound
and expresses it as an
admittance or compliance,
plotting the results on a chart
known as a tympanogram.

TYMPANOGRAMS

Under normal conditions,

the air pressure in the
middle ear is
approximately the same
as ambient pressure
since the eustachian
tube opens periodically
to ventilate the middle
ear and to equalize
pressure. In a healthy
individual, the maximum
sound is transmitted
through the middle ear
when the ambient air
pressure in the ear canal
is equal to the pressure
in the middle ear.

TYMPANOGRAMS

Type A: normal ear

Type As: stiff
TM/ossicles
Type Ad: flaccid TM or
discontinuity of ossicles
Type B: fluid in ear,
mass in ear
Type C: negative
pressure means ET
dysfunction.

MIDDLE EAR MUSCLES

5= STAPEDIUS MUSCLE
9= TENSOR TYMPANI MUSCLE
STAPEDIUS INNERVATION: CN7
TENSOR TYMPANI INNERVATION:
V3

STAPEDIAL REFLEX ARC

Otoacoustic Emissions,
OAEs

Sounds given off by the inner ear, 0-15dB

Triggered by sound stimuli to the cochlea
Usual emitted with sound pressure level at 25-30 dB
Generated by the outer hair cell
Can be measured by sound probe in ear canal
Completely objective measure
Important part of newborn hearing screening
Diagnosis of auditory dysfunction in adults

Mechanism of Otoacoustic
Emissions

Types of OAEs

Spontaneous otoacoustic emissions

Transient otoacoustic emissions

Distortion product otoacoustic emissions

Sustained frequency otoacoustic emissions

(Evoked OAEs)

Otoacoustic

CURVED MEMBRANE EFFECT

Certain
areas of TM
vibrate
more than
others.

Ultrastructure

Inner HC

Outer HC

Position of nucleus

Center

Base

Cytoplasmic
organelles

Scattered

Adjacent to cell
membrane

Presynaptic
specializations

Large

Small or absent

Glycogen content

Low

High

Relation to
supporting cells

Completely
surrounded

Only at base and

surface

Afferent
innervation

Inner HC

Outer HC

Ganglion cells
Number of
ganglion cells

TYPE 1
27000

TYPE 2
2100

Hair cell to
gangion cell ratio

1.8:1

5.7:1

Source

Lateral superior
olivary complex

Medial superior
olivary complex

Postsynaptic
target

Afferent dendrites

Base of hair cell

Efferent innerv.