Ear

Ear
Consists of 3 parts
External ear
Transmits airborne sound waves to fluid-filled inner ear Amplifies sound energy

Middle ear
Transmits airborne sound waves to fluid-filled inner ear Amplifies sound energy

Inner ear
Houses 2 different sensory systems
Cochlea Contains receptors for conversion of sound waves into nerve impulses which makes hearing possible Vestibular apparatus Necessary for sense of equilibrium

Hearing
Pitch (tone) of sound
Depends on frequency of air waves

Intensity (loudness)
Depends on amplitude of air waves

Timbre (quality)
Determined by overtones

Transmission of Sound Waves

Fig. 6-35a, p. 218

Fig. 6-35b, p. 218

Fig. 6-35c, p. 218

Fig. 6-37, p. 220

Fig. 6-36, p. 219

Fig. 6-36a, p. 219

Fig. 6-36b, p. 219

Fig. 6-36c, p. 219

Fig. 6-39, p. 222

Fig. 6-41a, p. 225

Hearing
Neural perception of sound energy Involves 2 aspects
Identification of the sounds (what) Localization of the sounds (where)

Sound waves
Traveling vibrations of air Consist of alternate regions of compression and rarefaction of air molecules

Sound Wave Transmission

Tympanic membrane vibrates when struck by sound waves Middle ear transfers vibrations through ossicles (malleus, incus, stapes) to oval window (entrance into fluid-filled cochlea) Waves in cochlear fluid set basilar membrane in motion Receptive hair cells are bent as basilar membrane is deflected up and down Mechanical deformation of specific hair cells is transduced into neural signals that are transmitted to auditory cortex in temporal lobe of brain for sound perception

Equilibrium
Neural signals generated in response to mechanical deformation of hair cells by specific movement of fluid and related structures

Vestibular input goes to vestibular nuclei in brain stem and to cerebellum for use in maintaining balance and posture, controlling eye movement, perceiving motion and orientation

Interesting facts
The stapes or stirrup is the smallest bone in our body.
It is roughly the size of a grain of rice ~2.5mm

Eardrum moves less than the diameter of a hydrogen atom

For minimum audible sounds

Inner ear reaches its full adult size when the fetus is 20-22 weeks old. The ears are responsible for keeping the body in balance Hearing loss is the number one disability in the world.
76.3% of people loose their hearing at age 19 and over

Specifications
Frequency range: 20Hz-20kHz Dynamic range: 0-130 dB Size of cochlea: smaller than a dime

A
N A T O M Y

Pinna /Auricle

Outer ear
Focuses sound waves (variations in pressure) into the ear canal
Pinna size: Inverse Square Law Larger pinna captures more of the wave Elephants: hear low frequency sound from up to 5 miles away Human Pinna structure: Pointed forward & has a number of curves Helps in sound localization More sensitive to sounds in front

Auditory Canal

Dogs/ Cats- Movable Pinna => focus on sounds from a particular direction

Pinna /Auricle

Outer ear

Auditory Canal

Horizontal localization
Sound Localization Vertical localization Is sound on your right or left side?

Interaural Time Difference (ITD)

Interaural Intensity Difference (IID)

Interaural differences

- The signal needs to travel further to more distant ear - More distant ear partially occluded by the head

Two types of interaural difference will emerge

- Interaural time difference (ITD) - Interaural intensity difference (IID)

Illustration of interaural differences

Left ear

Right ear time sound onset left right

Illustration of interaural differences

Left ear

Right ear time sound onset

arrival time difference

Illustration of interaural differences

Left ear

Right ear time sound onset

ongoing time difference

Illustration of interaural differences

Right ear time sound onset

intensity difference

Left ear

Thresholds
Interaural time differences (ITDs) Threshold ITD 10-20 ms (~ 0.7 cm) Interaural intensity differences (IIDs) Threshold IID 1 dB

Interaural time differences (ITDs) Low frequencies Up to around 1500 Hz; sensitivity declines rapidly above 1000 Hz

D U P L E X

Smallest phase difference corresponds to the true ITD

Interaural intensity differences (IIDs) High Frequencies The amount of attenuation varies across frequency below 500 Hz, IIDs are negligible (due to diffraction) IIDs can reach up to 20 dB at high frequencies

H
E O

R
Y

Pinna /Auricle

Outer ear
Sound Localization

Auditory Canal

Horizontal localization
Vertical localization Is sound above or below? Pinna Directional Filtering
Pinna amplifies sound above and below differently
Curves in structure selective amplifies certain parts of the sound spectrum

Pinna /Auricle

Outer ear
Closed tube resonance: wave resonator Auditory canal length 2.7cm Resonance frequency ~3Khz Boosts energy between 2-5Khz upto 15dB

Auditory Canal

A
N A T O M Y

Eardrum

Middle Ear
Eardrum OssiclesOval Window Impedance matching Ossicles: Malleus, Incus, Stapes

Ossicles
Oval window

Pressure variations are converted to mechanical motion

Acoustic impedance of the fluid is 4000 x that of air All but 0.1% would be reflected back

Amplification
By lever action < 3x Area amplification [55mm2 3.2mm2] 15x

Stapedius reflex
Protection against low frequency loud sounds Tenses muscles stiffens vibration of Ossicles Reduces sound transmitted (20dB)

A
N A T O M Y

Inner Ear

Semicircular Canals Cochlea

Body's balance organs Accelerometers in 3 perpendicular planes Hair cells detect fluid movements Connected to the auditory nerve

Inner Ear
Cochlea is a snail-shell like structure 2.5 turns 3 fluid-filled parts: Scala tympani Scala Vestibuli Cochlear duct (Organ of Corti)

Semicircular Canals Cochlea

(1) Organ of Corti (2) Scala tympani (3) Scala vestibulli (4) Spiral ganglion (5) auditory nerve fibres

Inner Ear

Semicircular Canals Cochlea

Organ of Corti Basilar membrane Inner hair cells and outer hair cells (16,000 -20,000) IHC:100 tiny stereocilia
The body's microphone: Vibrations of the oval window causes the cochlear fluid to vibrate Basilar membrane vibration produces a traveling wave Bending of the IHC cilia produces action potentials The outer hair cells amplify vibrations of the basilar membrane

The cochlea works as a frequency analyzer

It operates on the incoming sounds frequencies

Place Theory
4mm2 1mm2

32-35 mm long

Each position along the BM has a characteristic frequency for maximum vibration Frequency of vibration depends on the place along the BM At the base, the BM is stiff and thin (more responsive to high Hz) At the apex, the BM is wide and floppy (more responsive to low Hz)

Auditory Neuron

Auditory Area of Brain

Carries impulses from both the cochlea and the semicircular canals Connections with both auditory areas of the brain Neurons encode
Steady state sounds Onsets or rapidly changing frequencies

Elephants
Sound Production

A a typical male elephants rumble is around an average minimum of 12 Hz, a female's rumble around 13 Hz and a calf's around 22 Hz. Produce sounds ranging over more than 10 octaves, from 5 Hz to over 9,000 Hz Produce very gentle, soft sounds as well as extremely powerful sounds. (112dB recorded a meter away)
Hearing Wider tympanic membranes Longer ear canals (20 cm) Spacious middle ears.

Low frequency detection

STRUCTURE OF THE HUMAN EAR

STRUCTURE OF THE HUMAN EAR:

The cartilaginous auricle and the auditory canal of the outer ear direct sound waves to the middle ear.

The eardrum, stretched across the end of the canal,

vibrates as sound waves reach it. Vibrations are transmitted via three small bones (hammer, anvil, stirrup) to the membranous oval window, which links the middle ear to the inner ear.

The cochlea is a coiled, fluid-filled tube lined with sensory

hairs.

Vibrations in the oval window cause movement of the cochlear

fluid, stimulating the hairs to initiate impulses that travel along a branch of the auditory nerve to the brain. The eustachian tube, running from the middle ear to the nasopharynx, equalizes pressure between the middle and outer

ear.
The fluid-filled semicircular canals play a role in balance, as hairs

in the canals respond to movement-induced changes in the fluid

by initiating impulses that travel to the brain.

structure of the human ear

Ear Bone: Middle Ear Figure 2: The auditory ossicles of the middle ear and the structures surrounding them.

Bony Labyrinth The two labyrinths of the inner ear. The bony labyrinth is partially cut away to show the membranous labyrinth within.

A cross section through one of the turns of the cochlea (inset) showing the scala tympani and scala vestibuli, which contain perilymph, and the cochlear duct, which is filled with endolymph.

Mechanism Of Hearing: 1. Sound waves enter the outer ear and travel through the external auditory canal until they reach the tympanic membrane, causing the membrane and the attached chain of auditory ossicles to vibrate.

2. The motion of the stapes against the oval window sets up

waves in the fluids of the cochlea, causing the basilar membrane to vibrate.

3. This stimulates the sensory cells of the organ of Corti, atop

the basilar membrane, to send nerve impulses to the brain.

basilar membrane: analysis of sound frequencies

The analysis of sound frequencies by the basilar membrane.

(A) The fibres of the basilar membrane become progressively wider and more flexible from the base of the cochlea to the apex. As a result, each area of the basilar membrane vibrates preferentially to a particular sound frequency. (B) High-frequency sound waves cause maximum vibration of the area of the basilar membrane nearest to the base of the cochlea, (C) medium-frequency waves affect the centre of the membrane, (D) and low-frequency waves preferentially stimulate the apex of the basilar membrane. (The locations of cochlear frequencies along the basilar membrane shown are a composite drawn from different sources.)

The absolute threshold of hearing (ATH) is the minimum sound level of a pure tone that an average ear with normal hearing can hear in a noiseless environment. Minimum audibility curve is a standardised graph of the threshold of hearing versus frequency for an average human, and is used as the reference level when measuring hearing loss with an audiometer as shown on an audiogram An equal-loudness contour is a measure of sound pressure (dB SPL), over the frequency spectrum, for which a listener perceives a constant loudness when presented with pure steady tones. The unit of measurement for loudness levels is the phon, and is arrived at by reference to equal-loudness contours

An audiogram is a standard way of representing a person's hearing loss[1]. Most audiograms cover the limited range 100Hz to 8000Hz (8kHz) which is most important for clear understanding of speech, and they plot the threshold of hearing relative to a standardised curve that represents 'normal' hearing, in dBHL. Audiograms are set out with frequency in hertz (Hz) on the horizontal axis, most commonly on a logarithmic scale, and a linear dBHL scale on the vertical axis. Normal hearing is classified as being between -10dBHL and 15dBHL, although 0dB from 250Hz to 8kHz is deemed to be 'average' normal hearing.

Audiogram

MEASUREMENT Audiograms are produced using a piece of test equipment called an audiometer, and this allows different frequencies to be presented to the subject, usually over calibrated headphones, at any specified level. The levels are, however, not absolute, but weighted with frequency relative to a standard graph known as the minimum audibility curve which is intended to represent a 'normal' hearing. This is not the best threshold found for all subjects, under ideal test conditions, which is represented by around 0 Phon or the threshold of hearing on the equal-loudness contours.

 Conductive hearing loss happens when there is a problem conducting sound waves through the outer ear, tympanic membrane (eardrum) or middle ear (ossicles) and the inner ear (oval window/ round window). This type of hearing loss may occur in conjunction with sensorineural hearing loss or alone. Sensorineural hearing loss is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve (Cranial nerve VIII), the inner ear, or central processing centers of the brain.

PURE TONE AIR & BONE CONDUCTION TESTING

During air conduction testing, small foam insert earphones are placed in your ear
canals. In some cases, headphones may be used instead. A series of tones are presented at various frequencies. You are required to respond by pressing a button or raising your hand whenever you hear a tone; even if it is very soft. Your results indicate to us the softest level at which you can hear a tone for each of ten different frequencies that make up the speech spectrum.

Bone conduction testing requires us to place a small oscillator attached to a headband behind your ear. Again you are asked to respond to the softest tone that you hear at various frequencies. By reviewing the results of the bone conduction testing, compared to the air conduction testing, the audiologist can determine if your hearing loss is the result of a problem in the outer, middle or inner ear.

PURE TONE AUDIOMETRY

Hearing is measured over a range of pure tones in each ear. Frequencies vary from low pitches (250 Hz) to high pitches (8000 Hz). Measures the threshold for air and bone conduction. Can determine whether it is due to conductive or sensorineural loss or mixed. Each ear is tested at octave intervals from 250-8,000Hz and plotted on a pure tone audiogram with the test frequency along the horizontal axis and the thresholds of hearing on the vertical axis. This is in decibels hearing level (dB HL), which ranges from minus 10 (at the top) to 120 (the loudest that most audiometers can generate). The dB HL scale uses 0dB HL as the normal threshold of hearing.

Speech audiometry Subjective test in which subject repeats a standard list of words given through headphones at various loudness. Very useful in assessing need for hearing aid provision. Word recognition tests (also known as speech discrimination tests): involves reading a list of words to see if patients can discriminate words. Inferences can be made about central processing and central hearing deficits. Tympanometry Tympanometry is a measure of the stiffness of the eardrum and thus evaluates middle ear function

HEARING AID
A hearing aid is an electroacoustic body worn apparatus which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sounds for the wearer. A hearing aid is an electronic, battery-operated device that amplifies and changes sound to allow for improved communication. Earlier devices, known as an "ear trumpet" or "ear horn", were passive funnel-like amplification cones designed to gather sound energy and direct it into the ear canal. Similar devices include the bone anchored hearing aid, and cochlear implant.

Components of Hearing Aids

Microphone: Receives sound and converts it into electrical impulses. (picks up sound) Amplifier: Intensifies electrical impulses. (makes sound louder)

Receiver: Translates those electrical impulses into louder sounds. (delivers amplified sound into ear-miniature loudspeaker)
Battery: Serves as power source for device. Some hearing aids also have earmolds (earpieces) to direct the flow of sound into the ear and enhance sound quality.

Analogue vs. Digital Hearing Aids

Analogue hearing aids amplify sound signals picked up by a microphone and convert them into small electrical signals. These signals are transmitted into the ear in real time. They can be altered according to the needs of the individual user within the limits of the analogue technology.

Digital hearing aids use a microphone, receiver, battery, and computer chip. They transform the sound, convert it into bits, and manipulate it before amplifying the signal. A digital hearing aid can be programmed. This means that digital hearing aids can be individually adjusted to suit a specific user.

3 Basic Types of Hearing Aids

Conventional: Increases volume of all incoming sound with some minor adjustments possible. Programmable Analog: These are a step up in technology from conventional hearing aids. They are programmed by computer to match your hearing loss. Has some flexibility for adjustment based on preferences and listening environment. Digital: It automatically adapts to multiple listening and sound environments. The most advanced and expensive device. There are multiple channels for personal amplification, and directional microphones for management of background noise. The signal is clearer than that of other types of hearing aids. Soft sounds are distinguished from loud sounds and clarity is enhanced.

Hearing Aid Considerations

When choosing a hearing aid, an audiologist should consider the patients hearing ability, work and home activities, physical limitations, medical conditions, and cosmetic preferences. For many people, cost is also an important factor.

Types of hearing aids

Body worn aids Behind the ear aids (BTE) In the ear aids (ITE) Receiver In the ear aids (RITE) In the canal (ITC), mini canal (MIC) and completely in the canal aids (CIC) Open-fit devices Personal programmable or consumer programmable Bone Anchored Hearing Aids (BAHA) Eyeglass aids

CONVENTIONAL ANALOG TYPE HEARING AID DIGITAL HEARING AID

Behind-the-Ear (BTE)
BTE hearing aids are worn behind the ear and are connected to a plastic earmold that fits inside the outer ear. The components are held in a case behind the ear. Sound travels from the aid through the earmold into the ear. BTE aids are used by people of all ages for mild to profound hearing loss. Poorly fitting BTE earmolds may cause feedback, a whistle sound caused by the fit of the hearing aid or by buildup of earwax or fluid.

BEHIND THE EAR AID

In-the-Ear (ITE)
ITE hearing aids fit completely in the outer ear and are used for mild to severe hearing loss. The case, which holds the components, is made of hard plastic. ITE aids can accommodate added technical mechanisms such as a telecoil, a small magnetic coil contained in the hearing aid that improves sound transmission during telephone calls. ITE aids can be damaged by earwax and ear drainage, and their small size can cause adjustment problems and feedback. They are not usually worn by children because the casings need to be replaced as the ear grows.

IN THE EAR AID

In-the-Canal (ITC)
ITC hearing aids are customized to fit the size and shape of the ear canal and are used for mild or moderately severe hearing loss. Small one-piece hearing aid All components contained in a custom-fit, hard-molded plastic shell Fits outside the ear canal Slightly visible in the ear

Completely-in-Canal (CIC)
CIC hearing aids are mostly concealed in the ear canal and are used for mild to moderately severe hearing loss. Not suitable for people with severe hearing losses. Because of their small size, canal aids may be difficult for the user to adjust and remove, and may not be able to hold additional devices, such as a telecoil. Canal aids can also be damaged by earwax and ear drainage. They are not recommended for children. All components contained in a custom-fit, hard-molded plastic shell

Cochlear implant
A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. The cochlear implant is often referred to as a bionic ear. Unlike hearing aids, the cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the cochlea with an electric field. External components of the cochlear implant include a microphone, speech processor and an RF transducer or primary headpiece coil.

A secondary coil is implanted beneath the skull's skin and inductively

coupled to the primary headpiece coil.

Cochlear Implants

COCHLEAR IMPLANT

 The headpiece coil has a magnet by which it attaches to another magnet placed on the secondary coil often beside the cochlear implant. The implant relays the incoming signal to the implanted electrodes in the cochlea. The speech processor allows an individual to adjust the sensitivity of the device. The implant gives recipients additional auditory information, which may include sound discrimination fine enough to understand speech in quiet environments. Post-implantation rehabilitative therapy is often critical to ensuring successful outcomes.

Parts of the cochlear implant

The implant is surgically placed under the skin behind the ear. The basic parts of the device include:
EXTERNAL:

a microphone which picks up sound from the environment a speech processor which selectively filters sound to prioritize audible speech and sends the electrical sound signals through a thin cable to the transmitter, a transmitter, which is a coil held in position by a magnet placed behind the external ear, and transmits the processed sound signals to the internal device by electromagnetic induction,
INTERNAL:

a receiver and stimulator secured in bone beneath the skin, which converts the signals into electric impulses and sends them through an internal cable to electrodes,

 an array of up to 22 electrodes wound through the cochlea, which send the impulses to the nerves in the scala tympani and then directly to the brain through the auditory nerve system. There are 4 manufacturers for Cochlear implants, and each one produces a different implant with different number of electrodes. Cochlear produces implants with 22 electrodes, Advanced Bionics produces implants with 16 electrodes and the use a technique called current stearing in which two electrodes are stimulated simulatenously with different current level to produce intermediate virtual channels. The number of channels is not a primary factor upon which an manufacturer is chosen, but the signal processing

algorithm is also another important block.

The device is surgically implanted under a general anaesthetic, and the operation usually
takes from 1 to 5 hours. First a small area of the scalp directly behind the ear is shaven and cleaned. Then a small incision is made in the skin just behind the ear and the surgeon drills into the mastoid bone and the inner ear where the electrode array is inserted into the cochlea. The patient normally goes home the same day as the surgery, although some cochlear implant recipients stay in the hospital for 1 to 2 days. It is considered outpatient surgery. As with every medical procedure, the surgery involves a certain amount of risk; in

this case, the risks include skin infection, onset of tinnitus, damage to the vestibular
system, and damage to facial nerves that can cause muscle weakness, impaired facial sensation, or, in the worst cases, disfiguring facial paralysis.

 There is also the risk of device failure, usually where the incision does not heal properly. This occurs in 2% of cases and

the device must be removed.

After 14 weeks of healing (the wait is usually longer for children than adults), the implant is turned on or activated. Results are typically not immediate, and post-implantation therapy is required as well as time for the brain to adapt to hearing new sounds

Cochlear Implants
Definition:
A device that electrically stimulates the auditory nerve of patients with severe-toprofound hearing loss to provide them with sound and speech information The first fully functional Brain Machine Interface (BMI)

Who is a candidate?
Severe-to profound sensorineural hearing loss Hearing loss did not reach severe-to-profound level until after acquiring oral speech and language skills Limited benefit from hearing aids

Example: New Freedom

CI characteristics
1. Electrode design

Number of electrodes, electrode configuration

Analog or pulsatile Transcutaneous or percutaneous

2. Type of stimulation

3. Transmission link
4. Signal processing
Waveform representation or feature extraction

Auditory Brainstem Implant

Approved October 20, 2000 Uses the Nucleus 24 system processors Plate array with 21 electrodes