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For example, we have already discussed how we don t hear with our ears. The ear, as wonderful as it is, is simply a transducer--a mechanism that changes the form of energy in a message. In the case of hearing, mechanical sound waves are converted into electro-chemical impulses.8  {    So let s begin this section with a short pop quiz. Let s see how you do? Here is the multiple choice question: How many ears do you have? a. One b. Two c. Three d. Four e. Five f. None of the above.4rc   9Illustrations not to be taken as scientific replications.$:9 :    .An ear by any other name will hear differently$/. / Of course, the answer was none of the above. Semantically we have SIX ears! They include two Outer Ears; two Middle ears; and two Inner ears. Admittedly it was a bad question, and there were misleading drawings; but that s what I m paid for. Of course pragmatically we have two ears, each broken up into three sections which we call the Outer, Middle and Inner ears. But why bother with all this nomenclature at all? It is because they each contribute differently to the hearing process. [ f   /The Pinna is the most visible parts of the Ear$0/   ' Let s take a look at each segment individually and see what the boundaries are and what contribution is. uter Ear: The Pinna of the Outer ear is the most visible part. Its what many folks think of as the ear. In terms of hearing, it doesn t really contribute much. If we had Pinnas like rabbits or donkeys there might be some sound gathering and resonance benefits. dvjXi       V   LDiagram Figure A-15 from the text, page 394 of the Outer Ear (colors added).MM M HThe most critical part of the Outer Ear is the External Auditory Meatus.II A   But then try to imagine Tom Cruise with rabbit or donkey ears and the spell might be diminished a bit (my wife denies this, of course). As it is, the Pinna is suitable for piercing purposes, hanging earrings and perching glasses on. Some boxers also like to bite it! Somewhat centered in the Pinna is the ear canal. That is what we called it in CD 261; but this a 300 level course so it is now referred to as the External Auditory Meatus. X3 dL        Breath in my External Auditory Meatus one more time and you ll get five extra ossicles in yours.aa6  )     RA Conductive Hearing Loss can occur if the External Auditory Meatus is obstructed.SS =   The External Auditory Meatus functions clearly as a passageway to conduct air (sound) waves into the middle ear. Anything that interferes with this canal will hamper the hearing process. I see students in class putting their fingers in both ears quite frequently during parts of the lecture. The result for them is a reduction of the loudness of sound. This is referred to as a Conductive Hearing Loss. There are three interesting facts about a Conductive Hearing loss.XA%F     (1) It is impossible to be deaf with a conductive hearing loss. The most you could hope for under any circumstance is a 60 dB loss. Hence, if I put my mouth right next to a person with their fingers in their ears and talk reasonably loud (over 60 dB), they will still hear every word of the lecture. Not only will they hear it all but the (2) fidelity will be normal. That is, there will be no distortion of my somewhat high shrill nasal voice.X:P   PWax impacted in the External Auditory Meatus can cause a Conductive Hearing lossQQ &  % Another fact about a Conductive loss is that it is usually (3) remediable by medical and/or other means, i.e., hearing can be recovered. If I tickle a student under the armpits, they will remove their fingers from their ears and hear normally. Wax accumulation in the External Auditory Meatus can can be another common cause of a Conductive loss. Basically, wax is exuded by special cells in the ear canal as a means of cleansing the ear.8@H2     Dust particles, or parts of hapless insects if they have wandered in there, are embedded in the wax and are removed when the wax falls out. Some times the wax doesn t fall out and becomes impacted in the canal. If it occurs in both ears we can get a significant loss that can interfere with communication and social interaction. LL L hIf children put objects in their ears, they can get a conductive hearing loss that can last a long time.ii i With a conductive hearing loss, you may find listening laborious; you may find yourself asking people to repeat a lot; and you may get the unpleasant feeling of being an  outsider in a social group, if not the  butt of unkind social remarks. The good news, of course, is that the wax can be removed, and when it is, hearing is as clear as it was before. What may have been gained is a new awareness of how wonderful and important this transducer is!    XIn a more worrisome vain, show me a two year old, and I will show you a person who has a life s goal to find and place objects in very body orifice. If it happens to be something like beans in the ears, we can get a significant hearing loss. The problem here is that objects in the canal may not be easily noticed because of the zig zag shape of the canal. Nor would the child typically be able to verbalize what had happened. I  \ IThe Tympanic Membrane is the first important structure in the Middle Ear.&JI    = When children stick things in their ears the condition can last for a long time. The impact of a sustained conductive hearing loss on speech and language development in a young child could be considerable. Some children are born without a Pinna or an External Auditory Meatus. In the case of the Pinna, in the old days, long hair simply covered the loss. Today, in both cases, plastic surgery can do wonders for both appearances and hearing. "X         iddle Ear: The beginning of the Middle Ear is the Ear Drum (if this was CD 261), but seeng that this is a 300 level course we will call it the Tympanic Membrane. Some texts include this as part of the outer ear. But God confided in me that this is not the case. She said that it is really part of the middle ear system that actually increases the loudness of sound as it is conducted into the Inner Ear.j 'UB P  5     HThe three Ossicles are the second important structure in the Middle Ear.II    7 Why should sound be amplified? It s because the Inner Ear, as we shall see, is filled with fluid. When sound waves travel from one medium (like air) to another (liquid), energy is lost. This is a phenomenon called impedance. We actually lose around 50 Db, which is the sound level of a good conversation. Without some means of recovering the loss, we would have to shout at each other to hear. This is really the major contribution of the middle ear--to amplify sound.       The mechanism that does this is the Tympanic membrane and the three tiny bones (Malleus, Incus & Stapes). Naturally, because this is a 300 level course, we don t refer to them as bones but as ossicles. As a point of interest, these are the smallest bones in your body! All three would fit on your fingernail. They originated, phylogenetically, from jaw bones. Hence, we have fewer bones in our jaw than species in lower phylums that have jaw bones. >Y(T ^$   #    b    O   GUsing principles of leverage the Middle ear amplifies the sound signal.HH H The amplification mechanism works on the same principle as my car jack. Leverage is the name of the game. First of all, the Tympanic membrane, which initially receives the sound has a larger surface area than the third ossicle (Stapes) which imparts the signal to the Inner Ear. This acts to concentrate the energy at this point. Also the special arrangement of the three ossicles, which form a bridge between the tympanic membrane and the middle ear, also provides leverage. I-4  b}   V     !   7  The Tympanic membrane itself has a convex shape toward the outside, which acts to gather and concentrate the energy of the sound as it is transmitted to the first ossicle (Malleus) which is attached to the membrane. In addition to the Tympanic membrane and the three ossicles, the Middle Ear includes some other important structures. One is the Middle Ear Cavity which houses the three ossicles. This is a cavity filled with air. 8YG       7      n   ' NDiagram Figure A-16 from the text, page 395 of the Middle Ear (colors added). &ON  O    GThe major contribution of the Middle Ear is the amplification of sound.HH H ZIt sits opposite the external auditory meatus separated by the Tympanic membrane. Incidentally, the bone surrounding this cavity is very porous like a sponge. God didn t tell me why but I suspect is helps to make the skull less heavy. There are some serious draw-backs to this as you will shortly see. One problem with the Middle Ear is that the air pressures on both sides of the tympanic membrane are continually changing. L&     :   $  On the outside, changes in weather and/or changes in altitude cause the Tympanic membrane to be either sucked out or pushed in. Air on the inside (middle ear cavity) also is continually being absorbed into the body causing a partial vacuum which sucks the tympanic membrane in. This can be very painful as anyone with an earache can attest. Nature has provided a mechanism (the Eustachian Tube) to equalize the pressure in the middle far cavity. X}BH         HThe Eustachian Tube equalizes the air pressure in the Middle Ear Cavity.II I The Eustachian Tube extends from the middle ear cavity to the back of the naso-pharyngeal port (where the adenoids are). One of the problems with adenoids, if they become swollen, is that they can block the Eustachian tube and hinder the air equalization process. The tubes are usually collapsed. But the muscles that close the soft palate during eating, also open the tubes as part of the same process. 8 J  M  2That is why when you chew gum while taking off in an airplane,the tubes are open and the air is continually equalized in the middle ear cavity. In the dark ages (60 years ago) it was a popular trick, in order to get attention at a party, to force cigarette smoke from the mouth up through the Eustachian Tubes and out the ears to make smoke rings. Today, that would be considered pathetic, I m happy to say.   [The Eustachian Tube is also a passage way for germs from the nose to the Middle Ear cavity.\\ \ There is a down side to the Eustachian Tube. In adults, it is sloped downward (no pun intended) from the ear to the mouth. But in very young children, whose faces have not yet developed downward, it is almost parallel. Children in addition, have immune systems that are not as well developed as adults, but like many professors, they are continually putting their hands in their mouths (in my case its usually my foot). {  *  sThis is a perfect formula for the development of a nose cold. If you want to see a dozen or more, go to any kindergarten class. The problem is that the germs causing the cold have direct access to the Middle Ear through the Eustachian tubes. Aside from the serious pain, the ears may fill up with fluid which hampers the movement of the tympanic membrane and ossicles.tt6T        JA Middle Ear infection can cause a Conductive hearing called Otitis Media.KK =   DThe constriction of the movement of the Tympanic Membrand and/or ossicles frequently causes a socially significant conductive hearing loss. By socially significant, I mean it interferes with social interaction, and for children it retards the development of language. An infection in the middle ear is called Otitis Media. 8E5 n(             If it persists, the fluid in the middle ear cavity can become laden with dead white corpuscles. It then becomes viscous, and interferes with hearing even more severely. It can actually erode the ossicles and break into the inner ear which would be potentially a major disaster. To make matters worse, the germs become lodged in the porous bone surrounding the middle ear cavity. Here, conditions for germ survival are paramount. ,    bA Middle Ear infection can last for months and retard language development in very young children.cc c }Long after the nose cold has abated the middle ear infection will continue, fueled by the germs multiplying and dropping down from the surrounding porous bone. It can last for week and for months. For young children the impact on language and speech development can be considerable. Swift diagnosis by an audiologist and/or an otolaryngologist and medical treatment is warranted. X~2  & H  &  Children with a history of colds and ear infections should have their hearing monitored frequently to insure that the infection has not returned and lodged in the middle ear. As with most conductive losses, medical remediation will return the hearing to where it was before the infection. Incidentally, middle ear infection accounts for the highest incidence of socially significant hearing loss in the United States today. ,     LOtosclerosis is a conductive hearing loss caused by plague on the ossicles.MM,  7   Another type of conductive hearing loss that occurs more in girls than boys around the early twenties is otosclerosis. This is a condition in which a sort of plaque covers the ossicles to the point where they become immobilized. This can create a severe conductive hearing loss. If it is not rectified, a person would probably have to learn speech reading and/or sign language to communicate.8i 6h   ;    VMedical intervention can, fortunately, usually restore hearing to its former level. A doctor will simply peel back the eardrum (excuse me, Tympanic membrane) and insert a probe to jostle the ossicles. This will free them and restore hearing. If otosclerosis is not treated, it can cause complications which will make treatment more complex.WWL   +  /   T :The Inner Ear (Cochlea) is where transduction takes place.;; !    nner Ear: The function of the out and Middle ear was to conduct sound energy to the Inner Ear where the actual transduction takes place. The Inner Ear is usually referred to as the Cochlea (in dark green in the picture on the next screen). It is basically a tube filled with fluid and embedded in the Temporal bone. Unlike the porous bone surrounding the Middle Ear Cavity, the Temporal bone has the highest density of any bone matter in the body. h ' W#N l        hThis is probably a testimony to the delicate nature of this mechanism and its need for protection. The tube is wound around a central core so that it would resemble a snail shell. At its base are three other tubes, which we have discussed before. These are the Semi Circular Canals of the Vestibular sense (in light green in the picture on the next screen). i 1 < #   ; XDiagram Figure A-17 from the text, page 396 of the Inner Ear or Cochlea (colors added). &YX  Y   6The Cochlea is a double layered tube filled with fluid77 7 The Cochlear tube is actually divided in half, length wise. If it is visualized as being straight, a large scale model would resemble a long classroom on the second floor, with a classroom of equal size directly beneath it. At the back of the room (which would be the top of the snail shell) is a stairway leading down into the room beneath. The room beneath is empty except, that it is filled with fluid.    }Fluid also fills the classroom above. There is, in addition, at the front of the room below, a round window which is covered with a membrane. This serves as a pressure release when sound waves enter the fluid in the room. At the front of the room on the second floor, is an oval window covered by a membrane through which the third ossicle (the Stapes) punches in its vibrations. X~_  a,L  )  WThe floor of the Cochlea has the Basilar Membrane on which are four rows of hair cells.XX !  / The vibrations, generated by the third ossicle, set up waves in the fluid which proceed to the back of the room (top of the snail shell), down the stairs, and to the front oval window of the room below. The floor that separates these rooms is hard (bone tissue) except for a long strip that runs lengthwise up the side. The consistency of this strip is reminiscent of a trampoline. It is called the Basilar Membrane.x!A 6'  c     In the top classroom, there are four rows a chairs that occupy the area we are calling the Basilar membrane. If you imagine students sitting in these chairs (with scuba gear, of course), these would be analogous to the four rows of hair cells in the Cochlea. In our model there might be space for each row to be 40 chairs deep each. In the Cochlea, however, the depth would number in the thousands.86[     gThe celia on some hair-cells on the Basilar Membrane are bent by each sound wave that enters the fluid.hh6    < There are other cells in the Cochlea, but their function is to support the hair-cells and the transduction process. It s a pretty nice life for a hair-cell except for one inconvenience. Their celia (hairs) are embedded in another membrane called the Tectorial membrane. In our classroom model, this would be analogous to a large role of fly-paper stretched from the front to the back of the room across the heads of everyone sitting on the Basilar Membrane. x  b^   W  4        Hence, when a sound wave is transmitted into the room by the Stapes, the cells on the Basilar membrane rock back and forth like tourists on a raft. BUT...because their hairs are embedded in the fly paper (Tectoral Membrane) the hair cells receive a wrenching with each wave movement. Because of the structure of the air cells and the composition of the fluid around them, each wrenching generates an electrical potential in the hair-cell.XtALV  6  :     cDiagram Figure A-18 from the text, page 397 showing a cross section of the Cochlea (colors added). dd d   !VThe hair-cells along the Basilar membrane respond selectively to specific frequencies.WW   6 The physical wrenching of the hair-cells, and the corresponding generation of an electrical potential is the actual instance of transduction. Not all of the hair cells, however, are stimulated by a sound wave. Two factors account for this. One is that the Basilar membrane is actually thicker (more mass) towards the back of the room (top of the snail shell). Hence, it resonates more for low frequency vibrations.  w  4 6   w    pThe Base of the Cochlea resonates more for high frequency sounds. The other is that low frequency sound waves tend to be longer and more penetrating, whereas high frequency waves are short. The result is that the hair-cells along the Basilar membrane perform much like the keys to a piano. That is, hair-cells at specific locations respond to specific frequencies.Xq#8   | "IA hair-cell and the nerve connected to it is called a Basic Sensory Unit.JJ J A hair-cell and the nerve that connects with it is called the Basic Sensory Unit. If either of these is damaged, a sensory-neural hearing loss will result. This is quite a different kind of loss than the conductive loss which we discussed earlier. Here are three differences. 1) Although a sensory neural loss may be so mild that people do not even know that they have it, it can also, unlike a conductive loss, be total, with no residual hearing remaining at all.  %$$   tGranted this is rare, and there is usually some residual hearing. However, this often goes undeveloped and unused by deaf individuals. 2) Unlike a conductive loss which is generally equal across all frequencies, a sensory neural loss typically effects some frequencies more than others. And almost always, it is the higher frequencies that are typically effected first.8u?4 u #UA sensory neural loss usually begins in the higher frequencies and works it way down.VV V A significant high frequency loss of 6000 Hz and higher would probably not be noticed by a person even if it occurred in both ears. If would be of medical significance, however, because it is a  red flag heralding a probable progressive hearing loss. A doctor would want to explore the possible agents that might be contributing to the loss; to consider medication or changes that might be made in the environment to stop the progression of the loss; %?   to set up a schedule of re-tests to monitor any changes in the loss that occur over time; and to prepare individuals how to cope with a hearing loss. As the loss dips down into the speech range, the individual progressively loses the ability to hear consonants. For young children developing language, this is particularly insidious. Because they can hear the lower frequencies very well, they respond to sounds& even soft ones. Hence, no one ever guesses they have a major loss.  ,%+An Audiogram is a chart of hearing ability.,,      A profile of hearing ability is recorded on a chart called an Audiogram. Typically, an audiogram has numbers across the top which show each frequency (pure tone) that will be sampled. For example they might include: 125, 250, 500, 1000, 2000, 4000 and 8000 Hz. On the left, going down the side, would be the intensity, marked off in decibels relative to threshold, required for a person to hear each pure tone at threshold. " F nJUB>      K   These might include: -10, 0, 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100 dB. A series of pure tone are presented with increasing intensity. The individual raises his hand when he finally hears it. Most audiograms use an  X to she the threshold for the right ear and an  O for the left ear. If one connects the points with a line, a profile of hearing is apparent. In the following audiograms you can see the high frequency loss in the profile. 8Jy6      5 $xAn audiogram showing a significant loss above 4000 Hz. Speech is still intelligible but many fricatives are not heard. (yx     m   -&yAn audiogram showing a significant loss above 2000 Hz. Speech is almost unintelligible. Most consonants are not heard. (zy     n   .'|An audiogram showing a significant loss above 1000 Hz. Speech is not intelligible because no consonants can be differented.(}| 6   d      /(An audiogram showing a significant loss above 500 Hz. Only some prosodic features of speech are discriminable like rhythm and stress.( 6   U      %^Amplification will not always improve speech discrimination affected by a sensory neural loss.__ _ There are many causes of sensory neural loss in infants an children. This includes viral infections of the mother before birth or the baby after; blood incompatibilities between the baby and the mother; medical or pleasure drug a effects; oxygen deprivation; physical trauma; genetic inheritance; and noise pollution to mention a few. Young teenagers who play in rock concert bands are particularly at risk for noise pollution. U/6s   A consequence of the unevenness the a sensory neural hearing loss is that one cannot guarantee that amplification will be beneficial in every case. In some cases it lowers the threshold level so that consonants can be discriminated and speech discrimination improves. In others, consonant discrimination remains poor and the person is blasted in the lower frequencies by the amplification. In some cases the discomfort must be weighed against the gains.  &nIt is important to identify a hearing loss as early as possible and to develop a program of auditory training.oo o Even when the sensory neural loss is relatively flat across the board, discrimination of consonants my not improve do to distortion caused by an imbalance in transduction and/or discharge by the damaged hair cells. The best way to know if a hearing aid will be of benefit is to be tested with different makes and models by an agency which is not trying to sell one. Many major universities have Speech and Hearing Clinics. 8y &,      These will provide hearing aid evaluations at reduced cost as a public service. It is important to identify hearing loss among children as early as possible and to, if necessary, establish a program of amplification and training. This is so that a neural network to support whatever residual hearing may remain can be developed to its maximum capacity. Even  deaf persons who rely on sign language can benefit from the ability to perceive sound.   ' (A sensory neural loss is not reversible.)) ) 3) A third major difference between a conductive and a sensory neural hearing loss, is that the latter is not reversible. A doctor may be able to check the advance of the loss but he cannot recover what has been lost. There are two exceptions to this. One is the Temporary Threshold Shift and the other is the Cochlear Implant. You may notice when, you have been in a very noisy environment such as a rock concert... 8%]   ...that when you come out everything is somewhat hushed. The cells of the sensory neural unit are depleted of the materials they need to function. In a matter of hours, they will regenerate and you can hear normally again. You have experienced a Temporary Threshold shift. You can experience similar phenomenon if you try to hold two books out at arms length for 15 minutes. For most of us our arms will sink despite our best efforts far short of the goal.  (!dThe Cochlear Implant is an artificial cochlea that has considerable promise for adults and children.ee e A Temporary Threshold shift is, at best, a red flag warning that the sound level in the environment is unsafe. A recent development in the treatment of a sensory neural loss is the Cochlear Implant. In essence, this is an artificial cochlea that is connected directly to the hearing nerve. In its present stage, is would be to the cochlea what the Model-T-Ford is to the Space Shuttle. Yet the promise of things to come is impressive. 8    Even in its primitive state, I have seen it help a deafened adult, whose loss was severe enough to preclude any normal face to face conversation. With an implant, he was able to talk on the telephone! The quality of the sound is poor but useful. And, of course, each year brings improvements. For deaf children who grow u،ؿp with the Cochlear Implant, the capacity to develop listening skills may bring surprising results. I foresee a future in which deaf children can be truly bi-lingual, in both speech and Sign Language.      - )"XNerves connecting with hair cells emerge from the Cochlea as the VIII (Acoustic) nerve. YY Y I would not anticipate, however, that an adult who has been deaf all his/her life would benefit much from a cochlear implant. Such individuals would not have developed, nor would they be able to as adults, the necessary perceptual neural network to utilize any sound that was received. The cochlear implant feeds directly into the VIII nerve, the nerve of hearing. But how does the normal cochlea relay information to the brain?    We described the Sensory Neural Unit as a hair cell and the nerve that connects to it. In principle this is true, but in reality, the system is more complex than that. Many nerves connect with one hair cell, and a nerve will connect with more than one hair cell. These nerves connect with the base of the hair cells and then transverse down the core of the cochlea were they emerge in a single bundle (trunk) called the VIII th (Acoustic) nerve.X    *#JConnecting nerves never touch but are separated by a gap called a Synapse.KK K :The word  connect requires some explanation here. The extensions of the nerves (dendrites and axons) never touch the hair cells or the other nerves in the pathways to and in the brain. There is always a tiny gap. And what occurs in this gap is truly amazing. This gap is as wide as the ink on a page of print. In the fluid of the gap are ions of various kinds. This gap, incidentally is called a synapse. R b   zWhen the celia of the hair cell is wrenched, an electrical potential in the cell is produced. Molecules (neural transmitters) are emitted from the base of the cell. These cross the gap and embed themselves in special receptacles in the  connecting nerve. After another quick exchange of molecules the membrane of the cell is altered so that ions in the surrounding fluid may enter the cell. When they do, they change the valence of the cell.8jA6   O  _ +$lThe chemistry of the Synapse creates a vital switch which provides inhibition or control of neural pathways.mm m The change of valence at the point of entry of the ions creates an electrical gradient (potential) that moves through the cell like a wave. When it reaches the end, the process is repeated for the next connecting neuron. Several things must be noted about this process. The specific neural transmitter emitted by a cell determines whether or not ions will enter the next connecting cell. ,     This makes the synapse, in essence, a switch which can turn on or off a particular neural pathway. This mechanism is critical to the function of the brain. It provides for inhibition, or the ability to turn off a pathway. When these switches fail, electrical storms are free to wander unchecked through the brain wreaking havoc with normal neurological processes. These are called seizures.    1)SNeural function is more a chemical reaction than it is an electrical transmission.TT T FThe synapse, then, is the  guts of the perceptual processes (to be discussed next), which involve the control and structuring of these neural impulse wave patterns created through transduction. The importance and mode of operation of the synapse underscores the role of chemicals in the thought processes; and in my mind the need for good nutrition to keep these processes functioning correctly is worth consideration.      jAlthough the hair cells can generate electrical potentials that mirror in number the frequency of a sound wave, the connecting nerve cells are relatively limited. A nerve cell can fire (replenish its nutrients to create and carry a potential) no more than 1000 per second and then no more than for a second. If many cells are involved in such a massive operation, they simply  poop out and we experience a Temporary Threshold Shift.  2*eThe Acoustic Nerves enter the brain stem in the Medulla where most nerves cross to the opposite side.ff f In order that neural transmissions can mirror high frequency sounds, neurons work in complicated units or banks and fire in volleys. The Acoustic (VIII th) nerve from each ear enters the brain stem at the level of the top of the Medulla. Here, curiously, most of the nerve fibers cross to the opposite side and proceed up through the Pons, Midbrain and Thalamus to the Temporal Lobe of the Cerebral Cortex. 8,    3+jThe Lateral Lemniscus carries the input and the Reticular formation alerts the Cerebrum that it is coming.kk    U These neural pathways which carry this auditory input up the sides of the brainstem are called the Lateral Lemniscus. There is one more wrinkle in the process of hearing, however. There is another neural network which is located in the core of the brain stem, called the Reticular Formation. This network does many thing, and one of them is to alert the Cerbral Cortex when information is incoming from the transducer.Xc6k     9  If the Cerebral Cortex is not alerted, the information will still arrive but it will not be processed. 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