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INTRODUCTION

Hearing loss can present at any age and is one of the most common sensory disorders in humans. Nearly 10% of the adult population has some hearing loss, and one-third of individuals age >65 years have a hearing loss of sufficient magnitude to require a hearing aid.

PHYSIOLOGY OF HEARING

The function of the external and middle ear is to amplify sound to facilitate conversion of the mechanical energy of the sound wave into an electrical signal by the inner ear hair cells, a process called mechanotransduction (Fig. 30-1). Sound waves enter the external auditory canal and set the tympanic membrane (eardrum) in motion, which in turn moves the malleus, incus, and stapes of the middle ear. Movement of the footplate of the stapes causes pressure changes in the fluid-filled inner ear, eliciting a traveling wave in the basilar membrane of the cochlea. The tympanic membrane and the ossicular chain in the middle ear serve as an impedance-matching mechanism, improving the efficiency of energy transfer from air to the fluid-filled inner ear. In its absence, nearly 99.9% of the acoustical energy would be reflected and thus not heard. Instead, the ear drum and the ossicles boost the sound energy nearly 200-fold by the time it reaches the inner ear.

FIGURE 30-1

Ear anatomy. A. Drawing of modified coronal section through external ear and temporal bone, with structures of the middle and inner ear demonstrated. B. High-resolution view of inner ear.

Within the cochlea of the inner ear, there are two types of hair cells that aid in hearing: inner and outer. The inner and outer hair cells of the organ of Corti have different innervation patterns, but both are mechanoreceptors; they detect the mechanical energy of the acoustical signal and aid its conversion to an electrical signal that travels by the auditory nerve. The afferent innervation relates principally to the inner hair cells while the efferent innervation relates principally to the outer hair cells. The outer hair cells outnumber the inner hair cells by nearly 6:1 (20,000 vs 3500). The motility of the outer hair cells alters the micromechanics of the inner hair cells, creating a cochlear amplifier, which explains the exquisite sensitivity and frequency selectivity of the cochlea.

Stereocilia of the hair cells of the organ of Corti, which rests on the basilar membrane, are in contact with the tectorial membrane and are deformed by the traveling wave. The deformation stretches tiny filamentous connections (tip links) between stereocilia, leading to opening of ion channels, influx of potassium, and hair cell depolarization and subsequent neurotransmission. A point of maximal displacement of the basilar membrane is determined by the frequency of the stimulating tone. High-frequency tones cause maximal displacement of the basilar membrane near the base of the cochlea, whereas for ...

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