If there are uneven pressures, the eardrum can not vibrate normally and thus hearing may become impaired to various degrees, depending on the degree of pressure discrepancy. It is (in normal circumstances) closed at rest, as it’s being compressed by the surrounding structures, as well as due to being recoiled by the distal cartilaginous part ( Bluestone & Klein, Otitis media in infants and children, 2001). The eustachian tube’s main role is to equalize the pressure between the in- and outside of the ear, i.e on both sides of the eardrum. This is important to remember because we will be talking about this more. Louder sounds will cause greater contraction, and vice versa. When they contract, vibration and thus also sound is dampened, which should occur when loud sounds enter the auditory canal (i.e the acoustic reflex).
Two muscles control the tension between the hammer and tympanic membrane, as well as between the oval window and stirrup, namely the stapedius and tensor tympani muscles. These three bones are the hammer (malleus), anvil (incus), and the stirrup (stapes), where the latter connects with the oval window, which is a membrane that covers the entrance to the cochlea. The ossicles are the three smallest bones in the human body, and their job is to transfer but also modulate the strength of vibratory energy (sound wave vibrations) into the cochlea.
This transport mechanism (i.e the mucociliary transport mechanism) drains mucus away from the middle ear, and into the nasopharynx via the eustachian tube, thus preventing infection from occurring in the middle ear. These walls of these compartments have mucosal membranes, which are used for clearing out waste products. It is a space that has three named segments, called the epitympanic, mesotympanic, and hypotympanic recesses. This area mainly consist of the ossicles, eustachian tube and the tympanic plexus. The middle ear involves the parts between the ear drum and the oval window of the cochlea. It has a natural secretion of cerumen (ear wax) that protects the canal and prevents unwanted entities or particles to enter it, thus protecting the eardrum and middle & inner ear segments. The external auditory canal is an approximately one inch long tubular structure that the sound waves travel through, ultimately hitting the eardrum and causing its vibration. The design of the ear’s lobes make it perfect to collect waves and funnel them to the eardrum, which is also known as the tympanic membrane, via the external auditory canal. The external ear, also called the ‘pinna’ or ‘auricle’, is designed mainly to capture the sound waves. There are three main segments of the ear, namely the external, middle and inner portions. The ear is a very complex network of structures which contribute both to our sense of hearing as well as balance, i.e the vestibular system.
To understand why the neck and jaw may influence our hearing, we first need to look at how sound signals are generated and sent to the brain for interpretation, as well as get acquainted with the relevant anatomy. The principles in this article are also applicable when treating vestibular and other otic disorders who have MSK (musculoskeletal) components.
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This article will be addressing the lesser known causes of tinnitus, relating to jaw and neck disorders, how to identify them, and how to treat them. Less known, is the notion that temporomandibular joint, and neck disorders also may cause tinnitus. It is known that the cause of tinnitus and similar disorders may have many causes, such as being exposed to excessive sounds, otitis, otosclerosis, MS, atherosclerosis, tumors, aneurysms and so on. Although, in general, only about 2,5% of the affected people are experiencing severe, continuous tinnitus symptoms (Møller, Textbook of tinnitus, 2010) Tinnitus is a common hearing disorder that affects up to 80% of the population at one time in their life, whilst approximately 5-20% of the younger (than 50 years of age) population are experiencing it in a prolonged manner.
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