ANATOMY OF EAR

The ear consists of 3 parts : External Middle internal

External ear
Composed of : the shell-like auricle (pinna) : which collects sound the external acoustic meatus (canal) : conducts sound to the tympanic membrane.

Tympanic membrane
a thin, oval semitransparent membrane at the medial end of the external acoustic meatus forms a partition between the meatus and the tympanic cavity of the middle ear

Middle ear
The cavity of the middle ear or tympanic consists of : Auditory ossicles (malleus, incus, and stapes). Stapedius and tensor tympani muscles. Chorda tympani nerve, a branch of CN VII. connected anteromedially Tympanic plexus of with the nasopharynx by nerves. the pharyngotympanic tube

Internal ear
contains the vestibulocochlear organ concerned with the reception of sound and the maintenance of balance The internal ear consists of bony labyrinth and membranous labyrinth. The bony labyrinth divided into 3 areas: (1) the semicircular canals; (2) the vestibule; (3) the cochlea. The bony labyrinth is lined with periosteum and contains perilymph The membranous labyrinth, containing endolymph, is suspended within the perilymph-filled bony labyrinth

PHYSIOLOGY OF HEARING

1. Auricle directs external auditory canal 2. Sound waves strike tympanic membrane vibrate 3. Malleus starts to vibrate transmitted to incus stapes 4. Stapes push membrane of oval window in & out sets up fluid pressure waves in the perilymph in cochlea 5. Oval window bulge inward pushes perilymph of scala vestibuli transmitted to scala tympani round window bulge outward into middle ear

6. Pressure waves on the wall of scala vestibuli & scala tympani also push the vestibular membrane back & forth creating pressure waves in endolymph inside cochlear duct cause vibration of basilar membrane moves the hair cells of spiral organ against tectorial membrane bending of hair cells stereocilia produces receptor potential generate nerve impulses

Immunology in AOM
1. Production of antibodies clearance of middle ear effusion 2. Previous exposure / immunization suppress colonization by pathogens 3. Nasopharyngeal IgA antibodies to pneumolysin toxin released by pneumococcal autolysis protect against invasion by healthy pneumococci

DIAGNOSIS OF AOM:
History : patients complaint Physical : - otoscopy - audiometry - nasopharyngoscopy Lab studies : - Culture - tympanocentesis Imaging studies : - CT scanning - MRI

PROGNOSIS
depends on it stage, therapy, and wether there is complication occur An inadequate therapy can cause AOM developed into chronic suppurative otitis media.