ANATOMY OF INTERNAL EAR

1. The internal ear (labyrinth),

which has organs of both
hearing and balance, is divided
into bony and membranous
labyrinth.
2. The membranous labyrinth is
filled with endolymph.
Perilymph is filled in the space
present between membranous
and bony labyrinths.
 BONY LABYRINTH

vestibule, semicircular canals and cochlea.

lateral wall: medial wall of middle ear.

medial wall: lateral limit of internal auditory canal (IAC).

A. VESTIBULE: This central chamber of the labyrinth

(5 mm).
1. Lateral wall: It has oval window.
i. Oval window (Fenestra vestibuli): It lies in the lateral
wall and closed by footplate of stapes surrounded by
annular ligament
2. Medial wall:
i. Spherical recess: It is situated anteriorly and
lodges the saccule. Perforations of maculae cribrosa
media provides passage for fibers of inferior
vestibular nerve.
ii. Elliptical recess: It is situated posteriorly and
lodges the utricle. The perforations of maculae
cribrosa superior (Mike’s dot) provide passage to
nerve fibers that supply to utricle and ampulla of
superior and lateral semicircular canals (SCC).
iii. Vestibular crest and cochlear recess: The
spherical and elliptical recesses are separated from
each other by vestibular crest. Inferiorly vestibular
crest splits to enclose cochlear recess for cochlear
nerve fibers.
iv. Opening of aqueduct of vestibule: It is present
below the elliptical recess. Through this passes the
endolymphatic duct.
3. Posterosuperior region:
i. Five openings of semicircular canals: They are
present in the posterosuperior part of vestibule.
4. Anterior: Cochlea opens into the anterior
region of vestibule.
B. SEMICIRCULAR CANALS: [
A. Lateral (horizontal), posterior and superior
(anterior)].
B. Each canal occupies 2/3rd of a circle and has a
diameter of 0.8 mm. They lie in planes at right
angles to one another.
C. Each canal has two ends: ampullated and
nonampullated.
D. All the three ampullated ends and
nonampullated end of lateral SCC open
independently and directly into the vestibule.
1. Superior: It is 15–20 mm long and situated
transverse to the axis of petrous part of temporal
bone. Its antero- lateral end is ampullated and opens
in the superolateral part of vestibule.
2. Lateral SCC: It is 12–15 mm long and projects
as a rounded bulge into the middle ear, aditus and
antrum.
It makes an angle of 30 degree with the horizontal
plane. Its anterior end is ampullated and opens into
the upper part of vestibule. The posterior
nonampullated end opens into the lower part of
vestibule below the orifice of crus commune.
3. Posterior SCC:
 It is 18–22 mm long and situated parallel and
close to the posterior surface of petrous part of
temporal bone.
 Its lower end is ampullated and opens into the
lower part of vestibule.
 Its upper limb joins the crus commune.
Crus commune:
The nonampullated ends of posterior and superior
canals join and form a crus commune (4 mm
length), which then opens into the medial part of
vestibule. So, the three SCCs open into the vestibule
by five openings.
C. COCHLEA: The bony cochlea, which
is a coiled tube, looks like snail. Cochlear
canal makes 2.5–2.75 turns round a
central pyramid of bone called modiolus.
The cochlear tube is 30 mm long. It is 5
mm from base to apex and 9 mm around
its base.
1. Modiolus: The base of modiolus,
which is directed towards internal acoustic
meatus, transmits vessels and nerves to
the cochlea. The apex lies medial to tensor
tympani muscle.
2. Osseous spiral lamina: A thin plate of
bone called osseous spiral lamina, winds
spirally around the modiolus like the thread
of a screw. This bony lamina gives
attachment to the basilar membrane and
divides the bony cochlear tube into three
compartments: scala vestibuli, scala
tympani and scala media (membranous
cochlea).
3. Rosenthal’s canal: The spiral ganglions
are situated in Rosenthal’s canal, which
runs along the osseous spiral lamina.
4. Scala vestibuli: This upper most channel

is continuous with vestibule and closed at

oval window by the stapes foot plate.

5. Scala tympani: This lowermost channel

is closed by secondary tympanic membrane

of round window (RW ).

6. Promontory: The promontory, a bony

bulge in the medial wall of middle ear,

represents the basal coil of cochlea.

7. Helicotrema: The scala

vestibuli and scala tympani, which

communicate with each other at

the apex of cochlea through an

opening called helicotrema, are

filled with perilymph.

8. Round window (fenestra cochlea): On

the lateral wall of internal ear (medial wall

of middle ear), scala vestibuli is closed by

the stapes footplate, while the scala tympani

is closed by secondary TM of RW.

9. Aqueduct of cochlea: The scala tympani

is connected with the subarachnoid space

through the aqueduct of cochlea. It is

thought to regulate perilymph and pres-

sure in bony labyrinth.

 MEMBRANOUS LABYRINTH

cochlear duct, utricle, saccule, three semicircular

ducts and endolymphatic duct and sac.

Cochlear Duct: This blind coiled tube, which

appears triangular on cross- section, is connected to
the saccule through ductus reunions. It is bounded by
the following three walls:
a. Basilar membrane: It supports the organ
of Corti. Its length increases as it proceeds
from the basal coil to the apical coil. So,
the higher frequencies of sound are heard
at the basal coil while lower tones at the
apical coil. The inner thin area is called
zona arcuata while outer thick area is
called zona pectinata.
b. Reissner’s membrane: It separates scala
media from the scala vestibuli.
c. Stria vascularis: It contains vascular
epithelium and secrets endolymph.
Utricle: The utricle, which is oblong and
irregular, has anteriorly upward slope at an
approximate angle of 30 . It lies in the posterior
part of bony vestibule and receives the five
openings of the three semicircular ducts. The
utricle (4.33 mm ) is bigger than saccule (2.4
mm ) and lies superior to saccule. The utricle is
connected with the saccule through
utriculosaccular duct. Its sensory epithelium,
which is called macula, is concerned with
linear acceleration and deceleration.
Saccule: The saccule lies anterior to the utricle
opposite the stapes footplate in the bony
vestibule. Its sensory epithelium, macula
responds to linear acceleration and
deceleration. The saccule is connected to the
cochlea through the thin reunion duct.

Semicircular Ducts: The three semicircular

ducts, which open in the utricle, correspond
exactly to the three bony canals.
The ampullated end contains a thickened ridge
of neuroepithelium, which is called crista
ampul- laris.
Endolymphatic Duct and Sac: The ducts
from utricle and saccule unite and form
utriculosaccular duct, which continues as
endolymphatic duct that passes through the
vestibular aqueduct. The terminal part of the
endolym- phatic duct is dilated and forms
endolymphatic sac that is situated between the
two layers of dura on the posterior surface of
the petrous bone. Endolymphatic sac consists
of both an intraosseous and an extraosseous
portion. The endolymphatic duct and sac are
thought to be involved in the reabsorption and
regulation of endolymph.
 INNER EAR FLUIDS
Perilymph fills the space between bony and
membranous laby- rinth.

PERILYMPH
It resembles extracellular fluid and is rich in sodium
ions. The aqueduct of cochlea provides
communication between scala tympani and
subarachnoid space. Perilymph percolates through
the arachnoid type connective tissue present in the
aqueduct of cochlea.
Source:
1. Filtrate of blood serum from the capillaries of
spiral liga- ment.
2. CSF reaching labyrinth via aqueduct of cochlea.
Endolymph fills the entire membranous labyrinth
ENDOLYMPH
It resembles intracellular fluid and is rich in potassium ions.
Protein and glucose contents are less than in perilymph.
Source:
1. Stria vascularis.
2. Dark cells of utricle and ampullated ends of semicircular
ducts.
Absorption: There are following two opinions regarding the
absorption of endolymph:
1. Endolymphatic sac: The longitudinal flow theory believes
that from cochlear duct endolymph reaches saccule, utricle
and endolymphatic duct and is then absorbed by
endolymphatic sac.
2. Stria vascularis: The radial flow theory believes that
endolymph is secreted as well as absorbed by the stria
vascularis.
 ORGAN OF CORTI
This sensory organ of the hearing, is situated on the
basilar membrane.

It is spread like a ribbon along the entire length of

basilar membrane.

1. Tunnel of Corti: This tunnel, which is situated

between the inner and outer rods, contains a fluid
called cortilymph. The functions of the rods and
cortilymph are yet not clear.
2. Hair Cells: These important receptor cells of
hearing trans- duce sound energy into electrical
energy. There are two types of hair cells—inner and
outer. At low magnification stereocilia (evaginations
of membrane on the apical surface) appears as hairs.
The stereocilia have mechanically activated ion
channels which are opened by the sound stimuli.
With the advancement of age there is generalized
reduction in the number of hair cells.

a. Inner hair cells: Inner hair cells (IHCs) form a

single row and are richly supplied by afferent
cochlear fibers. These flask-shaped cells are very
important in the transmission of auditory impulses.
Their nerve fibers are mainly afferent.
b. Outer hair cells: Outer hair cells (OHCs) are
arranged in three or four rows and mainly receive
efferent innerva- tion from the olivary complex. These
cylindrical cells modulate the function of inner hair cells.
Their nerve fibers are mainly efferent.

Nerve supply: 95% of afferent fibers of spiral ganglion

of cochlear nerve supply the IHCs. The OHCs get only
5% of the cochlear nerve fibers. Efferent fibers, which
are mainly for the OHCs, come from the superior olivary
complex through the olivocochlear bundle. Hair cells are
innervated by dendrites of bipolar cells of spiral
ganglion. Each cochlea sends auditory information to
both sides of brain.
c. Supporting Cells: Deiter’s cells, which are situated

between the outer hair cells, provide support to OHC.

Cells of Hensen are situated outside the Dieter’s cells.

d. Tectorial Membrane: The tectorial membrane, which

overlies the organ of Corti, consists of gelatinous matrix

and delicate fibers. The shearing force between the hair

cells and tectorial membrane stimulate the hair cells.

 VESTIBULAR RECEPTORS
1. Cristae:

They lie in the ampullated ends of the three

semicircular ducts and respond to angular
acceleration.

On a crest-like mound of connective tissue lie the

sensory epithelial hair cells, which are covered by
cupula.

In the crista of lateral SCC, the polarization is

towards the utricle whereas in the cristae of superior
and posterior canals, polarization is away from the
utricle.
a. Cupula:

The cilia of epithelial hair cells project into cupula that

consists of a gelatinous mass (complex carbohydrates
or glycoproteins and proteoglycans arranged in
filamen- tous network), which extends from the
surface of crista to the ceiling of the ampulla.

The cupula, which is thought to be secreted by the

supporting cells, forms a water tight partition.

With the movements of endolymph, cupula can be

displaced to any one side like a swing door.
The gelatinous mass of cupula, which consists of
polysaccharide, contains canals into which project the
cilia of sensory hair cells.

The altered cupula mechanics may result in clinical

manifestations of peripheral vestibular disorders such
as vascular, viral or bacterial and vestibular neuronitis.

The mechanism governing caloric nystagmus under

earth gravity and zero gravity in space is not clear. It
seems that a direct thermal effect on the SCC afferents
play only a small role.
b. Sensory epithelial hair cells (Fig. 38):

The sensory hair cells are type 1 and type 2.

From the upper surface of each cell projects a kinocilium

and multiple stereocilia. The kinocilium, which is thicker
than stereo- cilia, is located on the edge of the cell.

Sensory cells are surrounded by supporting cells which have

microvilli on their upper surface.

Hair cells of both types may have contact with the same
nerve calyce.
i. Type 1 cells: These cells are found only in birds and
mammals. They are flask-shaped and correspond to the IHC of
organ of Corti. Each cell has a single large cup-like nerve
terminal that surrounds the base.

ii. Type 2 cells: They are cylindrical and have multiple nerve
terminals at the base. They resemble OHC of organ of Corti.
2. Maculae:

They lie in otolith organs (utricle and saccule).

Macula of the utricle is situated in its floor in a

horizontal plane in the dilated superior portion of
the utricle.

Macula of saccule is situated in its medial wall in a

vertical plane.

The macula utriculi (approximately 33,000 hair

cells) are larger than saccular macula
(approximately 18,000 hair cells). The striola,
which is a narrow curved line in center, divides the
macula into two areas.
a. Sensory neuroepithelium:

It is made up of type1 and type 2 cells, which are similar

to the hair cells of the crista.

Type I cells are in higher concentration in the area of

striola and change orientation (mirror-shaped) along the
line of striola with opposite polarity.

The kinocilia face striola in the utricular macula,

whereas in saccule, they face away from the striola.
The polarity and curvilinear shape of striola offer CNS
wide range of neural information of angles in all the
three dimensions for optimal perception and
compensatory correction.

During tilt, translational head movements and posi-

tioning, visual stimuli combined with receptors of neck
muscles, joint and ligaments play an important part.
b. Otolithic membrane:

The otoconial membrane consists of a gelatinous mass, a

subgelatinous space and the crystals of calcium carbonate
called otoliths (otoconia or statoconia).

The otoconia, which are multitude of small cylindrical and

hexagonally shaped bodies with pointed ends, consists of an
organic protein matrix together with crystallized calcium
carbonate.

The otoconia (3–19 μm long) lie on the top of the gelatinous

mass. The cilia of hair cells project into the gelatinous layer.

The linear, gravitational and head tilt movements result into

the displacement of otolithic membrane, which stimulate the
hair cells lying in different planes.
b. Otolithic membrane:

The otoconial membrane consists of a gelatinous mass, a

subgelatinous space and the crystals of calcium carbonate
called otoliths (otoconia or statoconia).

The otoconia, which are multitude of small cylindrical and

hexagonally shaped bodies with pointed ends, consists of an
organic protein matrix together with crystallized calcium
carbonate.

The otoconia (3–19 μm long) lie on the top of the gelatinous

mass. The cilia of hair cells project into the gelatinous layer.

The linear, gravitational and head tilt movements result into

the displacement of otolithic membrane, which stimulate the
hair cells lying in different planes.
Blood supply of labyrinth

„Internal Auditory (Labyrinthine) Artery: Labyrinth is

supplied by internal auditory artery which is a branch of
anterior inferior cerebellar artery that arises from basilar
artery. The labyrinthine artery may directly arise from the
basilar artery.

Branches: Internal auditory artery divides into two following

branches:

i. Anterior vestibular artery: It supplies to utricle and

lateral and superior SCC.
ii. Common cochlear artery: It further divides into two
following branches:

1. Main cochlear artery: It supplies to cochlea (80%)

2. Vestibulocochlear artery: It again divides into two

following branches:

a. Posterior vestibular artery: It supplies to saccule and

posterior SCC.

b. Cochlear branch: It supplies to cochlea (20%).

Venous Drainage: It is through internal auditory vein, vein
of cochlear aqueduct and vein of vestibular aqueduct. These
veins drain into the inferior petrosal and sigmoid sinuses.
 INTERNAL AUDITORY CANAL

Internal auditory canal (IAC)

Is about 1 cm long and passes into petrous part of temporal

bone in a lateral direction. It is lined by dura.

At its lateral end (fundus) IAC is closed by a vertical

cribriform plate of bone that separates it from labyrinth.

A transverse crest divides this plate into smaller upper and

larger lower parts.

Upper part is further divided into anterior and posterior

quadrant by a vertical crest called Bill’s bar.
contents

1. Vestibulocochlear nerve.

2. Facial nerve including nervous intermedius.

3. Internal auditory artery and vein.

 VESTIBULOCOCHLEAR (AUDITORY) NERVE

The vestibulocochlear nerve, also known as the 8th cranial

nerve (CN VIII) is a sensory nerve that consists of two

divisions: the vestibular and\ cochlear nerves. The

function of the vestibulocochlear nerve is to provide special

somatic afferent (SSA) innervation of the internal ear,

with each division serving a specific role.

The vestibular nerve conveys information from the
vestibular apparatus of the internal ear to the vestibular
nuclei in the pons and brainstem in order to maintain
balance, spacial orientation and coordination

The cochlear nerve is part of the auditory pathway,

conveying auditory information from the cochlea of the
internal ear to the cochlear nuclei in the brainstem in order
to enable the sense of hearing

Both sets of fibres combine in the pons to form the

vestibulocochlear nerve. The nerve emerges from the
brain at the cerebellopontine angle and exits the cranium
via the internal acoustic meatus of the temporal bone.
Vestibulocochlear nerve

The vestibulocochlear nerve (CN VIII) arises from the

brainstem at the pontomedullary junction/cerebellopontine

angle.

It exits the cranium via the internal acoustic meatus of the

temporal bone, where it divides into the vestibular and

cochlear nerves.
The vestibular nerve contains the axons of neurons whose cell bodies are found in the vestibular ganglion,

found at the lateral end/fundus of the internal acoustic meatus.

The vestibular ganglion consists of superior and inferior parts, from which the superior and inferior branches

of vestibular nerve arise and proceed to innervate the vestibular apparatus (utricle, saccule and semicircular

ducts).

The anterior ampullary, lateral ampullary and utricular nerves arise from the superior branch, while the

posterior ampullary and saccular nerves are given off from the inferior component.

These nerves collect information related to motion and position of the head and transmit it to the vestibular

nuclei (the superior, inferior, medial and lateral vestibular nuclei) in the lower pons/upper medulla oblongata in

order to maintain balance and equilibrium.

The cochlear nerve contains the axons of neurons
whose cell bodies are located in
the cochlear/spiral ganglion that lies in the spiral
canal of the modiolus of the cochlea.

Peripheral processes of these neurons send terminal

endings to receptors in the spiral organ (of Corti),
that collect auditory information and transmit it via
the cochlear nerve to the cochlear nuclei (anterior
and posterior cochlear nuclei) in the brainstem,
and ultimately to the primary auditory cortex of the
temporal lobe.
 FACIAL NERVE

Facial nerve runs from pons to parotid. It is a mixed nerve

having motor and a sensory root. The latter is also called the
nerve of Wrisberg and carries secretomotor fibres to the
lacrimal gland and salivary glands, and brings fibres of taste
and general sensation. Thus there are two efferent and two
afferent pathways. Components of the facial nerve include:
 FACIAL NERVE

1. Special visceral efferent forms the motor root and supplies

all the muscles derived from the second branchial arch, i.e.
all the muscles of facial expression, auricular muscles (now
vestigial), stylohyoid, posterior belly of digastric and the
stapedius.

2. General visceral efferent supplies secretomotor fibres to

lacrimal, submandibular and sublingual glands and the
smaller secretory glands in the nasal mucosa and the palate.
 FACIAL NERVE

1. Special visceral efferent forms the motor root and supplies

all the muscles derived from the second branchial arch, i.e.
all the muscles of facial expression, auricular muscles (now
vestigial), stylohyoid, posterior belly of digastric and the
stapedius.

2. General visceral efferent supplies secretomotor fibres to

lacrimal, submandibular and sublingual glands and the
smaller secretory glands in the nasal mucosa and the palate.