Snow JB, Wackym PA.

Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
TELINGA LUAR

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
KOKLEA

Guyton AC, Hall JE. Textbook of medical physiology.

Philadelphia: Saunders Elsevier; 2006.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
N.FASIALIS (N. VII)

http://studyblue.com
http://openi.nlm.nih.gov
http://yale.edu
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
Silverthorn DU. Human physiology: an integrated approach. 6th ed. Illinois: Pearson Education Inc.; 2013.
Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Saunders Elsevier; 2006.
• Across the deep end of the external acoustic meatus lies a thin,
somewhat transparent sheet called the tympanic membrane or
eardrum.
• is membrane consists of fibroelastic connective tissue
• covered externally with epidermis and
• internally by the simple cuboidal epithelium of the mucosa that
lines the middle ear cavity.
• Sound waves cause vibrations of the tympanic membrane, which
transmit energy to the middle ear
Mediating the functions of the inner ear, each of these structures contains in its epithelial lining large areas with
columnar mechanoreceptor cells, called hair cells, in specialized sensory regions:
• Two maculae of the utricle and saccule,
• Three cristae ampullares in the enlarged ampullary regions of each semicircular duct,
• The long spiral organ of Corti in the cochlear duct.
The entire membranous labyrinth is within the bony labyrinth, which includes the following regions:
• An irregular central cavity, the vestibule (L.vestibulum, area for entering) houses the saccule and the utricle.
• Behind this, three osseous semicircular canals enclose the semicircular ducts.
• On the other side of the vestibule, the cochlea (L.snail, screw) contains the cochlear duct
• The cochlea Is about 35mm long and makes 2 3⁄4 turns around a bony core called the modiolus (L. hub of
wheel).
• The modiolus contains blood vessels and surrounds the cell bodies and processes of the acoustic branch
of the eighth cranial nerve in the large spiral or cochlear ganglion.
the organ of Corti, or spiral organ, where sound vibrations of different
frequencies are detected,
consists of hair cells and other epithelial structures supported by
the basilar membrane
• Here the sensory hair cells have precisely arranged V-shaped bundles of
rigid stereocilia
• Two major types hair cells:
• Outer hair cells,
• About 12,000 intotal
• Occur in three rows near the saccule, increasing to five rows
near the apex of the cochlea.
• Each columnar outer hair cell bears a V-shaped bundle of
stereocilia
• Inner hair cells
• Are shorter and form a single row of about 3500 cells,
• each with a single more linear array of shorter stereocilia
FIGURE 6-36 Transmission of sound waves. (a)
Fluid movement within the cochlea set up by
vibration of the oval window follows two
pathways, one dissipating sound energy and the
other initiating the receptor potential.
• ROLE OF THE INNER HAIR CELLS
• The inner and outer hair cells differ in function.
• The inner hair cells are the ones that “hear”:
• they transform the mechanical forces of sound (cochlear fluid
vibration) into the electrical impulses of hearing (action
potentials propagating auditory messages to the cerebral
cortex).
• Because the stereocilia of these receptor cells contact the stiff,
stationary tectorial membrane, they are bent back and forth
when the oscillating basilar membrane shifts their position in
relationship to the tectorial membrane
• this back-and-forth mechanical deformation of the hairs
alternately opens and closes mechanically gated cation
channels in the hair cell, resulting in alternating depolarizing
and hyperpolarizing potential changes—the receptor
potential—at the same frequency as the original sound
stimulus.
ROLE OF THE OTOLITH ORGANS
• the otolith organs provide information about the position of
the head relative to gravity (that is, static head tilt) and also
• detect changes in the rate of linear motion (moving in a
straight line regardless of direction).

• otolith organs, the utricle and the saccule, are saclike

structures housed within a bony chamber situated
between the semicircular canals and the cochlea
• the hairs (kinocilium and stereocilia) of the receptor hair cells
in these sense organs also protrude into an overlying
gelatinous sheet, whose movement displaces the hairs and
results in changes in hair cell potential.
Chronic Otitis Media
[Diagnosis & Assessment]
• SITE OF PATHOLOGY
• Anatomically the pars tensa can be divided into four quadrants
• pathology, such as perforations, tend to be anterior, posterior or inferior 
Hence division into thirds rather that quarters is preferred

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
[Diagnosis & Assessment]

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
[Diagnosis & Assessment]
• ACTIVE OR INACTIVE?
• A decision as to whether an ear is currently active, i.e. inflamed with the
production of inflammatory products including pus, is primarily based on
visualization of an inflamed mucosa and secretions.
• In squamous epithelial disease that is active with a cholesteatoma, there is
almost invariably associated mucosal disease that can be seen and produces
the secretions, perhaps along with squamous epithelial debris.
• Secretions, and in particular mucopus, can dry and be mistaken for wax. Once
removed, the underlying disease may still be active or have become inactive

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
[Diagnosis & Assessment]

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
• Pathology of Subtypes of COM
3. Inactive Squamous COM (Retraction, Atelectasis and Epidermization)
• Negative static middle ear pressure  can result in retraction (atelectasis) of the
tympanic membrane
• A ‘retraction pocket’  invagination into the middle ear space of a part of the eardrum,
• may be fixed  when it is adherent to structures in the middle ear
• free  when it can move medially or laterally depending on the state of inflation of the
middle ear.
• ‘Epidermization’ (more advanced type of retraction)  refers to replacement of middle
ear mucosa by keratinizing squamous epithelium without retention of keratin debris.
• The area of epidermization may involve part or all of the middle ear cavity
• Epidermization often remains quiescent  does not progress to cholesteatoma or
active suppuration.
• epidermization  not an indication for surgical intervention

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
• Pathology of Subtypes of COM
4. Active Squamous COM (Cholesteatoma)
• The hallmark of a cholesteatoma  its retention of keratinous debris
• Histologically, the squamous epithelial lining or ‘matrix’ of a cholesteatoma is similar to
that of skin.
• The matrix is usually surrounded by a layer of inflamed, vascular, subepithelial
connective tissue.
• A cholesteatoma can be filled with keratin and be quite dry, or be associated with active
bacterial infection leading to profuse malodorous otorrhoea
• inflammatory changes  very similar to those in active mucosal COM  present
throughout the mucosal and submucosal regions of the middle ear cleft in an ear with
cholesteatoma.
• Cholesteatomas  potentially dangerous because of their potential to incite resorption
of bone, leading to intratemporal or intracranial complications.

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
• Pathology of Subtypes of COM
5. Healed COM
1. HEALED PERFORATION (DIMERIC MEMBRANE)
• Loss of the lamina propria of the tympanic
membrane due to atrophy or failure to reform
during healing of a perforation leads to a ‘dimeric’
membrane that consists of epidermis and mucosa.
• Such a thin membrane is prone to retraction if
there is negative static middle ear pressure.

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media
• Pathology of Subtypes of COM
5. Healed COM
3. FIBROCYSTIC AND FIBRO-OSSEOUS SCLEROSIS
• Some cases of healed COM  result in end-stage pathology characterized by fibrosis and cyst
formation (‘fibrocystic sclerosis’), that obliterates large portions of the middle ear cleft
• The cystic spaces become lined by mucosal epithelium that has been overrun by proliferation
of connective tissue.
• There is often deposition of new bone in the mastoid antrum and surrounding mastoid cell
tracts (‘fibro-osseous sclerosis’), eventually resulting in a sclerotic mastoid
• The neo-osteogenesis can also involve the spaces around the ossicles, such as the
epitympanum  leading to conductive hearing loss
• Fibrocystic and fibro-osseous sclerosis represent nonprogressive, end-stage pathology that is
a contraindication to tympanoplasty surgery, since it is very difficult or impossible to reverse
these cicatricial changes by operative intervention.

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Chronic Otitis
Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Chronic Otitis Media

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Otosclerosis [Pathology]

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery

Otosclerosis [Pathology]

Source: Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery