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Dr. Rabia Inam Gandapore
Assistant Professor
Head of Department Anatomy
(Dentistry-BKCD)
B.D.S (SBDC), M.Phil. Anatomy (KMU),
Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR
(KMU), Dip. Arts (Florence, Italy)
EAR ANATOMY & CLINICAL
FEATURES
Teaching Methodology
 LGF (Long Group Format)
SGF (Short Group Format)
LGD (Long Group Discussion, Interactive discussion with the
use of models or diagrams)
SGD (Short Group)
SDL (Self-Directed Learning)
DSL (Directed-Self Learning)
PBL (Problem- Based Learning)
Online Teaching Method
Role Play
Demonstrations
Laboratory
Museum
Library (Computed Assisted Learning or E-Learning)
Assignments
Video tutorial method
Goal/Aim (main objective)
BY THE END OF THIS PRESENTATION ANATOMY
SCHOLARS SHALL BE ABLE TO:
 Discuss parts of external ear.
 Describe features of external acoustic meatus.
 Describe structure of tympanic membrane.
 Describe features of middle ear.
 Explain boundaries of middle ear.
 Briefly explain functions of middle ear.
 Briefly explain mastoid air cells.
 Explain bony and membranous labyrinth.
Specific Learning Objectives
(cognitive)
At the end of the lecture the student will able to:
 Explain External Ear, Middle ear & Internal Ear.
Psychomotor Objective:
(Guided response)
 A student to draw parts of Ear (External, Middle and
Internal )
Affective domain
 To be able to display a good code of conduct and moral values in
the class.
To cooperate with the teacher and in groups with the colleagues.
To demonstrate a responsible behavior in the class and be
punctual, regular, attentive and on time in the class.
To be able to perform well in the class under the guidance and
supervision of the teacher.
Study the topic before entering the class.
Discuss among colleagues the topic under discussion in SGDs.
Participate in group activities and museum classes and follow the
rules.
Volunteer to participate in psychomotor activities.
Listen to the teacher's instructions carefully and follow the
guidelines.
Ask questions in the class by raising hand and avoid creating a
disturbance.
To be able to submit all assignments on time and get your sketch
logbooks checked.
Lesson contents
 Clinical chair side question: Students will be asked if
they know what is the function of Ear (External, Middle
and Internal)
 Outline:
Activity 1 Describe features of Ear (External, Middle &
Internal Ear).
Recommendations
 Students assessment: MCQs, Flashcards, Diagrams
labeling.
Learning resources: Langman’s T.W. Sadler, Laiq
Hussain Siddiqui, Snell Clinical Anatomy, Netter’s Atlas,
BD Chaurasia’s Human anatomy, Internet sources links.
CONTENT
 LANDMARKS
 EXTERNAL EAR:
Auricle or Pinna
External Acoustic (Auditory) Meatus
Ear Drum (Tympanic Membrane)
 MIDDLE EAR CLEFT OR
TYMPANIC CAVITY:
Auditory ossicles
Eustachian (Auditory) Tube
Mastoid Air Cell System
 INTERNAL EAR OR LABYRINTH:
Bony Labyrinth
Membranous Labyrinth
EXTERNAL EAR
The external ear consists
of 3 parts:
 Auricle (Pinna)
 External Acoustic
Meatus:
 Tympanic Membrane
(Ear Drum or Myringa)
1. ANATOMY OF AURICLE
(PINNA)
 Helix : Outside Large rim.
Inferiorly: lobule
Anteriorly: crus of helix.
 Antihelix smaller curved rim.
 Concha or Cymba Cavity.
Hollow center
 External acoustic meatus
depths of Cymba
 Tragus : an elevation
 Antitragus : Opposite the tragus.
 Inter-tragic notch: Between
Tragus & Anti tragus
 Triangular or Navicular Fossa:
Between the Crura of Anti helix.
 Scapha or scaphoid fossa:
longitudinal furrow between the
helix and the anthelix.
AURICLE (PINNA)
 Thin cartilage
 Covered with skin
 Both Extrinsic &
Intrinsic muscles.
Function: Collects
Air Vibration.
MUSCLES OF AURICLE
(PINNA)
Extrinsic Muscle
(Changes Position)
Intrinsic Muscle
(Changes Shape)
Superior Auricular Helicis Major
Muscle
Anterior Auricular Helicis Minor
Muscle
Posterior Auricular Tragicus Muscle
Transverse Muscle Anti-Tragicus
Muscle
MUSCLES:
Anterior
auricular
Superior
auricular
Posterior
auricular
EXTRINSIC
INTRINSIC
MUSCLE
Helicis
Major
Helicis
Minor
Tragic
us
Anti-
Ttagic
us
Tail of
Helix
EXTRINSIC
MUSCLE
Posteri
or
auricula
r
Superio
r
auricula
r
Transvers
e
auricular
Oblique
auricula
r
External
Acoustic
meatus
A
B
BLOOD SUPPLY:
 ARTERIES.
 VEINS.
SENSORY INNERVATION:
Anterior &
Superiorly Auricular
Temporal nerve
Branch of facial
nerve
(DEEP)
Lesser
occipital nerve
Auricular
Temporal
nerve
( Branch of
vagus which
send branch to
auricular
branch of
facial nerve)
(DEEP)
Great Auricular
nerve
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
SENSORY
INNERVATION:
LYMPHATIC DRAINAGE:
CLINICAL FEATURE:
 From piercings
the ear.
A small round
bumps around the
piercing site.
KELOIDS: FRANK’S SIGN:
 Diagonal crease in
lobe more
susceptible to
Cardiovascular
diseases especially
in men.
CONGENITAL
CONDITION:
 Darwin Tubercle is
a congenital ear
condition which
often presents as a
thickening on the
helix at the junction
of the upper and
middle thirds.
RAMSAY-HUNT
SYNDROME:
CAULIFLOWER EAR:
2. LANDMARKS EXTERNAL
ACOUSTIC MEATUS:
 Middle cranial fossa
 Styloid process
 Mastoid process
 Mandibular fossa
 Zygomatic process
External Acoustic (Auditory)
Meatus
Extends from the deepest part
of the concha to the
tympanic membrane
(eardrum).
A curved tube :1 inch (2.5
cm).
 ELASTIC CARTILAGENEOUS
PART:
Lateral one-third :
cartilaginous extensions from
some of the auricular
cartilages.
 BONY PART:
Medial two-thirds is a bony
External Acoustic (Auditory)
Meatus
FUNCTION:
Conducts sound waves from auricle to the tympanic
membrane.
External Acoustic (Auditory)
Meatus
 Covered with skin.
 Outer Third contains
hair , sebaceous &
modified sweat
glands called
ceruminous glands
producing cerumen
(earwax).
BLOOD SUPPLY:
ARTERIAL SUPPLY:
ANTERIOR PART:
Anterior Auricular
Artery (Superficial
Temporal Artery) .
POSTERIOR PART:
Posterior Auricular
Artery( ECA).
Deep Auricular Artery
(Maxillary)
BLOOD SUPPLY:
Venous Drainage:
 External jugular
vein
 Maxillary vein
 Pterygoid plexus
SENSORY INNERVATION:
ANTERIOR & SUPERIOR
WALLS:
Auriculotemporal
nerve, a branch of the
mandibular nerve [V3]
POSTERIOR & INFERIOR
WALLS:
Auricular branch of the
vagus nerve [X]
ALDERMAN’S NERVE Also
receive sensory fibers of
Facial Nerve.
LYMPHATICS:
LYMPHATIC
DRAINAGE:
ANTERIORLY: Pre-
Auricular Lymph
Nodes.
POSTERIORLY:
Post-Auricular Lymph
Nodes.
INFERIORLY:
Upper deep cervical
Lymph Nodes.
CLINICAL FEATURES:
IMPACTED WAX:
Deafness & discomfort
Clinical Examination:
Yellowish,brownish, black
or
Grayish.
COMPICATIONS DUE TO USE
OF COTTON BUDS:
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
5812304/ (2017)
 https://www.khaleejtimes.com/news/uae-
health/dangers-of-using-ear-buds (2018)
FURUNCLOSIS EAR:
BOIL:
 Staphylococal
Infection hair follicle.
OTITIS EXTERNA:
 Otitis externa
(swimmers ear):
Inflammation of the
skin of the auditory
canal.
EXTERNAL ACOUSTIC
MEATUS:
3. Tympanic Membrane ( Ear
Drum or Myringa)
A thin, cone-
shaped membrane.
Separates the external
acoustic
meatus from the middle
ear.
Tympanic Membrane ( Ear
Drum or Myringa)
FEATURES:
 Thin,Fibrous,circular
pearly gray
membrane about 1cm
in diameter &
0.1mm thick
 Connective tissue
core lined with:
Skin: on the outside
Mucous membrane:
on the inside.
 Angle: Obliquely
placed.
FUNCTION:
It converts and amplifies vibration in air to vibration
in fluid.
Tympanic Membrane ( Ear
Drum or Myringa)
 Periphery:
fibrocartilaginous
ring attaches it to
the tympanic part of
the temporal bone.
 Center: Umbo
concavity produced
by handle of
malleus
Tympanic Membrane ( Ear
Drum or Myringa)
 Superior to umbo in an
anterior direction is
handle of malleus.
 At the most superior
extent of this line of
attachment is lateral
process of the malleus.
 Extending away from this
elevation are the anterior
& posterior malleolar
folds.
 Superior to these folds
are:
Pars flaccida: thin and
OTOSCOPE
EXAMINATION:
Anteroinferior to the
umbo,a bright
reflection
of light, referred to as
the cone of light.
ARTERIAL SUPPLY:
OUTER SURFACE:
 Deep auricular
artery of maxillary
artery.
INNER SURFACE:
 Anterior Tympanic
of V3.
 Posterior
Tympanic of
posterior auricular
artery.
VENOUS SUPPLY:
OUTER SURFACE:
 External jugular
vein.
INNER SURFACE:
 Transverse sinus
 Pterygoid plexus
SENSORY
INNERVATION:
1). TYMPANIC NERVE
Branch of
Glossopharyngeal nerve
(passes through floor of
middle ear onto promontry
gives :
 Tympanic plexus
(associates
caroticotympanic plexus &
supply mucous membrane
of middle ear.
 Lesser petrosal nerve to
otic ganglion.
2). Skin: auriculotemporal
nerve, a branch of the
mandibular nerve [V3]
with auricular branch of
the vagus nerve [X]
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
SENSORY INNERVATION:
LYMPHATICH DRAINAGE:
MUCOSA OF
TYMPHANIC
MEMBRANE & ANTRUM:
Drain into:
Parotid or upper deep
cervical lymph nodes.
CLINICAL APPROACH:
 Extremely sensitive to
pain.
 To avoid perforation of
tympanic cavity:
Pars Tensa :
Central/tubotympanic,
safe approach
Pars Flaccida : Attic/
unsafe approach (with
or without retraction
pocket.
COMPLICATIONS:
EXTRA-CRANIAL INTRACRANIAL
Hearing loss Meningitis
Tympanic
membrane
perforation
Extradural
Abscess
Mastoiditis Sudural empyema
Cholestatoma Brain Abscess
Labyrinthitis
IF YOU LOOSE THIS SMALLEST BONE LOCATED IN THE
MIDDLE EAR,YOU WILL LOOSE THE ABILITY TO HEAR &
WILL LOOSE YOUR BALANCE.
َ‫م‬ُ‫ك‬ِِّ‫ب‬ َ‫ر‬ ِ‫آالء‬ ِِّ‫ي‬َ‫أ‬ِ‫ب‬َ‫ف‬
ِِ‫ ا‬َ‫ب‬َِِِّّ‫ك‬ُُ ‫ ا‬
SO WHICH OF THE FAVORS OF YOUR ALLAH WOULD
YOU DENY?
Surah Ar-Rahman (55)
MIDDLE EAR
MIDDLE EAR:
Two parts
 Tympanic cavity
Proper immediately
adjacent to the
tympanic membrane
 SUPERIORLY:
Epitympanic recess.
 3 interconnected &
movable bones:
Malleus (Hammer)
Incus (Anvil)
Stapes(Stirrup)
INCU
S
STAPE
S
FUNCTION:
 Transfers acoustic
energy from
compression
waves in air to fluid–
membrane waves
within the
cochlea.
BOUNDARIES:
 ANTERIORLY:
Nasopharynx (via
pharyngotympanic
tube).
 POSTERIORLY:
Mastoid area
 ROOF:Tegmental wall
(petrous part of
temporal bone).
 FLOOR: Jugular wall.
 MEDIAL WALL:
Labyrinthine wall.
 LATERAL WALL:
Membranous wall.
BOUNDARIES:
MIDDLE EAR:
ROOF :
(Tegmental wall)
 Formed by thin layer
of bone the Tegmen
tympani (petrous
part of temporal
bone).
 Separates the middle
ear from the
meninges of temporal
lobe in the middle
MIDDLE EAR:
FLOOR: (Jugular wall)
 Thin layer of bone
(partly replaced by
fibrous tissue).
 Separates it from the
superior bulb Internal
jugular vein.
 Medial border of the
floor Tympanic branch
(Jacobson nerve) via
glossopharyngeal nerve
Glossopharyngeal
nerve
Superior bulb of
Internal Jugular
Vein
Jacobson
nerve
Interna
carotid
artery
MIDDLE EAR:
POSTERIOR WALL:
(Mastoid wall)
 UPPER PART : Aditus of
the mastoid antrum
 SUPERIORLY: the
epitympanic recess
 LOWER PART: bony
partition between the
tympanic cavity and
mastoid air cells.
 pyramidal eminence:
tendon of the stapedius
muscle.
 the opening through which
the chorda tympani nerve
PYRAMIDA
L
EMINENCE
TENDON OF
STAPEDIUS
MUSCLE
MASTOI
D
CELLS
MASTOID
ANTRUM
MIDDLE EAR:
Anterior wall:
(CAROTID WALL)
 UPPER PART: 2 canals
separated by thin bony septum:
Upper & Small canal
Tensor tympani muscle.
Lower & Large canal:
Pharyngotympanic tube
 LOWER PART: Processus
Cochleariformis (thin bone)
separates the tympanic cavity
from the Internal carotid
artery.
 Foramen: chorda tympani
nerve.
Auditory
tube
MIDDLE EAR:
LATERAL WALL:
(Membranous wall)
 Tympanic membrane.
(does not extend superiorly
into bony epitympanic
recess).
MIDDLE EAR:
MEDIAL WALL:
(Labyrinthine wall)
 Formed by: lateral wall of
the internal ear.
 Rounded bulge :
promontory (1st turn of
cochlea)
 2 openings:
 POSTEROSUPERIOR :
Fenestra vestibuli (oval
window) Closed by base of
stapes (footplate).
 POSTEROINFERIOR:
Fenestra cochleae (round
window) Closed by
PROMONTORY
STAPES
(OVAL WINDOW)
COCHLEAE (ROUND
WINDOW)
CONTI….
MEDIAL WALL:
(Labyrinthine wall)
 PROMINENCE OF FACIAL
CANAL: Rounded ridge,
posterosuperior to
Promontoty & Fenestra
vestibule (produced by the
facial nerve).
 PROCESSUS
COCHLEARIFORMIS: Bony
shelf forms pulley, supports
tensor tympani muscle
Prominence of
facial canal
Processus
cochleariform
is
Tensor
Tympa
ni
Prominence of
facial canal
Tensor
Tympa
ni
Processus
cochleariform
is
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
MIDDLE EAR:
CONTENTS:
 Auditory ossicles
 Muscles
 Air
 Nerves: Tympanic branch of Glosspharyngeal
nerve IX, Tympanic plexus, Chorda tympani
and lesser petrosal nerve
 Vessels: Deep auricular, Anterior tympanic
artery & stylomastoid artery.
MIDDLE EAR:
 OSSICELS:
Malleus
Incus
Stapes
 Muscles:
Tensor tampani
muscle
Stapedius muscle
(modulate movement
during the
transmission of
AUDITORY OSSICLES:
 MALLEUS: (Largest)
Attached to tympanic membrane.
PARTS:
Head of malleus
Neck of malleus
Anterior & Lateral processes
Handle of malleus
 Incus:
Body of incus
Long & Short limbs
 Stapes
Attached to the oval window.
head of stapes
anterior & posterior limbs
base.
TENSOR TYMPANI:
ORIGIN: Cartilaginous part
of the pharyngotympanic
tube & greater wing of the
sphenoid
INSERTION: upper part of
the handle of the malleus.
INNERVATION: Branch
from the mandibular nerve
[V3].
ACTION:
Contraction of the tensor
tympani pulls the handle of
the malleus medially. This
tenses the tympanic
membrane, reducing the
STAPEDIUS: (SMALLEST
MUSCLE)
ORIGIN: Pyramidal
eminence
INSERTION: Posterior
surface of the neck of
stapes.
INNERVATION: Branch
from the facial nerve [VII]
ACTION:
Contraction of the
stapedius muscle, usually
in response to loud
noises, pulls the stapes
BLOOD SUPPLY OF MIDDLE
EAR:
ARTERIA SUPPLY:
MAJOR ARTERIES:
 Anterior tympanic (Branch of
Maxillaty artery)
 Stylomastoid (Branch of
posterior auricular artery)
MINOR ARTERIES:
 Petrosal (Branch of middle
meningeal artery)
 Superior tympanic (Branch of
middle meningeal artery)
 Tympanic (Branch of internal
carotid artery).
 Vidian artery (Branch of
external carotid artery)
VENOUS SUPPLY:
 Pterygoid venous
plexus
 Superior petrosal
sinus.
SENSORY & MOTOR
SUPPLY:
SENSORY
SUPPLY OF
MIDDLE EAR
MUCOSA
MOTOR
SUPPLY OF
MIDDLE EAR
MUSCLE
TYMPANIC
(BRANCH OF
GLOSSPHARYN
GEAL NERVE)
STAPEDIUS
MUSCLE :
STAPEDIAL
BRANCH OF
FACIAL NERVE
AURICULOTEM
PORAL
(BRANCH OF
TRIGEMINAL
NERVE)
TENSOR
TYMPANI:
MANDIBULAR
DIVISION OF
TRIGEMINAL
NERVE
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
MIDDLE EAR
INNERVATION:
TYMPANIC PLEXUS:
Formed by: Tympanic
nerve, (a branch of the
glossopharyngeal nerve
[IX]) & branches of Internal
carotid plexus.
 The tympanic plexus also
gives off a major branch the
lesser petrosal nerve,
which supplies
preganglionic
parasympathetic fibers to
the otic ganglion.
 INNERVATES: mucous
membrane & contents of the
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
LYMPHATIC DRAINAGE:
TYMPANIC END OF
AUDITORY TUBE :
Drains into the deep
cervical lymph nodes.
SUPERIOR VESSELS:
Upper deep cervical
lymph nodes.
INFERIOR VESSELS:
Inferior deep cervical
lymph nodes or
pretracheal &
prelaryngeal nodes
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
OTITIS MEDIA:
OTITIS MEDIA:
Inflammatory disease.
The two main types:
 Acute otitis
media (AOM)
 Otitis media with
effusion (OME)
Common : Children
 CLINICAL FEATURES:
 Opaque &reduced
mobality of Tympanic
membrane.
MASTOIDITIS:
OTITIS MEDIA
EFFUSION(OME):
The inner ear is responsible for balance.
However,1400 years ago the Quran described
people who got knocked out by blows to their ears:
"Darabna ala Athanihim ْ‫م‬ِ‫ه‬ِ‫ن‬‫ا‬َ‫ذ‬‫آ‬ ٰ
‫ى‬َ‫ل‬َ‫ع‬ ‫ا‬َ‫ن‬ْ‫ب‬َ‫ر‬َ‫ض‬َ‫ف‬
"
Means: “We hit them on their ears.”
INTERNAL EAR
SURFACE LANDMARKS
THE TEMPORAL
BONE:
Internal Acoustic Meatus:
 Petrous part of the
temporal bone
(Posterior cranial fossa).
Tegmen Tympani
Jugular Foramen Jugular
Foramen
INTERNAL EAR:
(LABYRINTH)
LOCATION:
 Petrous part of the
temporal bone
 medial to the middle ear
.
CONTENTS:
 BONY LABYRINTH:
Cavities within the bone.
 MEMBRNOUS
LABYRINTH:
BONY LABYRINTH:
These are cavities
situated in
the substance of dense
bone.
 3 parts:
Vestibule
Semicircular canals
Cochlea
 Lined by endosteum
 Contain a clear
BONY LABYRINTH:
VESTIBULE:
Central part of the bony
labyrinth.
LOCATION:
 Posterior: Cochlea
 Anterior: Semicircular canals.
 Lateral wall:
Fenestra vestibuli(closed by
the base of the stapes & its
anular ligament)
Fenestra cochleae(closed by
the secondary tympanic
membrane).
 Lodged within the vestibule are
Cochlea
(Posterior
)
Semi-Circular
canals
(Anterior)
Fanestra
Cochleae
(Lateral
Wall)
Fenestr
a
Vestibuli
(Lateral
wall)
UTRIC
LE
Saccule
BONY LABYRINTH:
SEMI-CIRCULAR
CANALS:
3 semi-circular canals open
into the posterior part of the
vestibule.
 Superior: vertical & right
angles to the long axis of the
petrous bone.
 Posterior : vertical but
&parallel with the long axis of the
petrous bone.
 Lateral: horizontal position & it
lies in the medial wall of the aditus
to the mastoid antrum, (above the
Conti…. (Semi-circular
canals)
The canals open into the
vestibule by 5 orifices, one
of which is common to two
of the canals.
It has :
 AMPULLA: Each canal
has a swelling at one
end.
 SEMI-CIRCULAR
DUCTS: Lodged within
Ampulla
(Posterior
& Anterior)
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
BONY LABYRINTH:
COCHLEA:
SHAPE: Snail shell.
OPENS: into the anterior part of the
vestibule.
It has:
MODIOLUS: Central pillar,around
which a hollow bony tube makes 2.5
spiral turns.
Each successive turn is of decreasing
radius
Anterolaterally : Apex
Posteromedially: Base (Bottom of
internal acaustic meatus)
Promontory:
The first basal turn of the cochlea
(medial wall of the middle ear)
APE
X
BONY
LABYRINTH:MODIOLUS:
NERVE: Branch of Cochlear
nerve.
SPIRAL LAMINA: winds
around the modiolus & projects
into the interior of the canal &
partially divides it. BASILAR
MEMBRANE: Of the spiral
lamina divides the cochlear
canal into:
ABOVE: Scala vestibuli
(perilymph seperated from
middle ear by base of stapes
& anular ligamement at
Fenestra Vestibule)
BELOW: Scala tympani
(perilymph separated from
Spiral nerve
SPIRAL ORGAN OF CORTI:
 The highly
specialized
epithelium that lies
on the Basilar
membrane
 Contains the
sensory receptors
for hearing.
HISTOLOGICAL LEVEL:
MODIOLUS
PHYSIOLOGICAL LEVEL:
MODIOLUS
K
K NA
NA
K
N
A
MEMBRANOUS
LABYRINTH:
LOCATION: within the bony labyrinth
CONTAINS: Endolymph & surrounded by
perilymph.
It consists of:
 UTRICLE: Larger of the two vestibular
sacs.
 SACCULE: Globular & is connected to
the utricle.
 3 SEMI CIRCULAR DUCTS: lies within
the bony semicircular canals (Same
configuration).
 DUCT OF COCHLEA: lies within the
bony cochlea.
All these structures freely communicate
with one another
DUCTUS
UTRICULOSACCULARIS:
Connects Utricle to saccule & ductus
endolymphaticus.
SACCUS
ENDOLYMPHATICUS:
 Ductus endolymphaticus joined by the ductus
utriculosaccularis, passes on to end in a small blind pouch.
This lies beneath the dura.
DUCTUS REUNIENS:
 The duct of the cochlea is connected to the saccule
by the ductus reuniens.
Ductus
Reuniens
Cochlear
Duct
FUNCTION:
 BALANCE: Utricle and saccule(specialized sensory
receptors)
 ACCELARATION & DECELATATION: Semicircular
ducts This change is detected by ampullae(sensory
receptors).
 HEARING: Ducts of cochlea (Spiral organ of corti).
ARTERIAL SUPPLY:
VENOUS SUPPLY:
 Internal auditory
vein
 Veins of cochlear
aquaduct
 Veins of Vestibular
aquaduct
DRAINAGE:
 Inferior petrosal
sinus
 Sigmoid sinus
INNER EAR & LYMPHATIC
SYSTEM:
https://www.ncbi.nlm.nih.gov/pubmed/11568618
(2001)
VESTIBULOCOCHLEAR
NERVE:
Internal acoustic meatus
Vestibularcochlear
 vestibular nerve-----
vestibular ganglion :
Supply membranous
labyrinth (utricle,saccule
&ampullae)
 cochlear nerve------
spiral ganglion
branches base of the
modiolus :Supply: spiral
TINNITUS:
PRESBYCUSIS:
SIGMOID SINUS
THROMBOSIS:
MENIERE’S DISEASE:
LABYRINTHITIS:
VERTIGO:
ْ‫ف‬َ ْ
‫اْل‬ َ‫و‬ َ‫ ار‬َ‫ص‬ْ‫ب‬َ ْ
‫اْل‬ َ‫و‬ َ‫ع‬ْ‫م‬َّ‫س‬‫ال‬ ُ‫م‬ُ‫ك‬َ‫ل‬ َ‫أ‬َ‫ش‬ْ‫ن‬َ‫أ‬ ‫ي‬َِِّّ‫ال‬ َ‫و‬ُ‫ه‬ َ‫و‬
َِ‫و‬ُ‫ر‬ُ‫ك‬ْ‫ش‬َُ ‫ ا‬َ‫م‬ ‫ا‬
‫يًل‬ِ‫ل‬َ‫ق‬ ۚ َ‫ة‬َ‫د‬ِ‫ئ‬
[Quran 23.78] It is He who produced for you the hearing,
and the eyesight, and the feelings. But little gratitude you
show.
The Quran always refers to the "hearing" before the
"seeing" which turned out to be their actual order of
creation.
How could an illiterate man who lived 1400 years
THANK YOU

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Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx

  • 1. Dr. Rabia Inam Gandapore Assistant Professor Head of Department Anatomy (Dentistry-BKCD) B.D.S (SBDC), M.Phil. Anatomy (KMU), Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE (KMU),CHR (KMU), Dip. Arts (Florence, Italy) EAR ANATOMY & CLINICAL FEATURES
  • 2. Teaching Methodology  LGF (Long Group Format) SGF (Short Group Format) LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams) SGD (Short Group) SDL (Self-Directed Learning) DSL (Directed-Self Learning) PBL (Problem- Based Learning) Online Teaching Method Role Play Demonstrations Laboratory Museum Library (Computed Assisted Learning or E-Learning) Assignments Video tutorial method
  • 3. Goal/Aim (main objective) BY THE END OF THIS PRESENTATION ANATOMY SCHOLARS SHALL BE ABLE TO:  Discuss parts of external ear.  Describe features of external acoustic meatus.  Describe structure of tympanic membrane.  Describe features of middle ear.  Explain boundaries of middle ear.  Briefly explain functions of middle ear.  Briefly explain mastoid air cells.  Explain bony and membranous labyrinth.
  • 4. Specific Learning Objectives (cognitive) At the end of the lecture the student will able to:  Explain External Ear, Middle ear & Internal Ear.
  • 5. Psychomotor Objective: (Guided response)  A student to draw parts of Ear (External, Middle and Internal )
  • 6. Affective domain  To be able to display a good code of conduct and moral values in the class. To cooperate with the teacher and in groups with the colleagues. To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on time in the class. To be able to perform well in the class under the guidance and supervision of the teacher. Study the topic before entering the class. Discuss among colleagues the topic under discussion in SGDs. Participate in group activities and museum classes and follow the rules. Volunteer to participate in psychomotor activities. Listen to the teacher's instructions carefully and follow the guidelines. Ask questions in the class by raising hand and avoid creating a disturbance. To be able to submit all assignments on time and get your sketch logbooks checked.
  • 7. Lesson contents  Clinical chair side question: Students will be asked if they know what is the function of Ear (External, Middle and Internal)  Outline: Activity 1 Describe features of Ear (External, Middle & Internal Ear).
  • 8. Recommendations  Students assessment: MCQs, Flashcards, Diagrams labeling. Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy, Netter’s Atlas, BD Chaurasia’s Human anatomy, Internet sources links.
  • 9. CONTENT  LANDMARKS  EXTERNAL EAR: Auricle or Pinna External Acoustic (Auditory) Meatus Ear Drum (Tympanic Membrane)  MIDDLE EAR CLEFT OR TYMPANIC CAVITY: Auditory ossicles Eustachian (Auditory) Tube Mastoid Air Cell System  INTERNAL EAR OR LABYRINTH: Bony Labyrinth Membranous Labyrinth
  • 10. EXTERNAL EAR The external ear consists of 3 parts:  Auricle (Pinna)  External Acoustic Meatus:  Tympanic Membrane (Ear Drum or Myringa)
  • 11. 1. ANATOMY OF AURICLE (PINNA)  Helix : Outside Large rim. Inferiorly: lobule Anteriorly: crus of helix.  Antihelix smaller curved rim.  Concha or Cymba Cavity. Hollow center  External acoustic meatus depths of Cymba  Tragus : an elevation  Antitragus : Opposite the tragus.  Inter-tragic notch: Between Tragus & Anti tragus  Triangular or Navicular Fossa: Between the Crura of Anti helix.  Scapha or scaphoid fossa: longitudinal furrow between the helix and the anthelix.
  • 12. AURICLE (PINNA)  Thin cartilage  Covered with skin  Both Extrinsic & Intrinsic muscles. Function: Collects Air Vibration.
  • 13. MUSCLES OF AURICLE (PINNA) Extrinsic Muscle (Changes Position) Intrinsic Muscle (Changes Shape) Superior Auricular Helicis Major Muscle Anterior Auricular Helicis Minor Muscle Posterior Auricular Tragicus Muscle Transverse Muscle Anti-Tragicus Muscle
  • 16. SENSORY INNERVATION: Anterior & Superiorly Auricular Temporal nerve Branch of facial nerve (DEEP) Lesser occipital nerve Auricular Temporal nerve ( Branch of vagus which send branch to auricular branch of facial nerve) (DEEP) Great Auricular nerve
  • 20. CLINICAL FEATURE:  From piercings the ear. A small round bumps around the piercing site. KELOIDS: FRANK’S SIGN:  Diagonal crease in lobe more susceptible to Cardiovascular diseases especially in men.
  • 21. CONGENITAL CONDITION:  Darwin Tubercle is a congenital ear condition which often presents as a thickening on the helix at the junction of the upper and middle thirds.
  • 24. 2. LANDMARKS EXTERNAL ACOUSTIC MEATUS:  Middle cranial fossa  Styloid process  Mastoid process  Mandibular fossa  Zygomatic process
  • 25. External Acoustic (Auditory) Meatus Extends from the deepest part of the concha to the tympanic membrane (eardrum). A curved tube :1 inch (2.5 cm).  ELASTIC CARTILAGENEOUS PART: Lateral one-third : cartilaginous extensions from some of the auricular cartilages.  BONY PART: Medial two-thirds is a bony
  • 26. External Acoustic (Auditory) Meatus FUNCTION: Conducts sound waves from auricle to the tympanic membrane.
  • 27. External Acoustic (Auditory) Meatus  Covered with skin.  Outer Third contains hair , sebaceous & modified sweat glands called ceruminous glands producing cerumen (earwax).
  • 28. BLOOD SUPPLY: ARTERIAL SUPPLY: ANTERIOR PART: Anterior Auricular Artery (Superficial Temporal Artery) . POSTERIOR PART: Posterior Auricular Artery( ECA). Deep Auricular Artery (Maxillary)
  • 29. BLOOD SUPPLY: Venous Drainage:  External jugular vein  Maxillary vein  Pterygoid plexus
  • 30. SENSORY INNERVATION: ANTERIOR & SUPERIOR WALLS: Auriculotemporal nerve, a branch of the mandibular nerve [V3] POSTERIOR & INFERIOR WALLS: Auricular branch of the vagus nerve [X] ALDERMAN’S NERVE Also receive sensory fibers of Facial Nerve.
  • 32. CLINICAL FEATURES: IMPACTED WAX: Deafness & discomfort Clinical Examination: Yellowish,brownish, black or Grayish.
  • 33. COMPICATIONS DUE TO USE OF COTTON BUDS:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 5812304/ (2017)  https://www.khaleejtimes.com/news/uae- health/dangers-of-using-ear-buds (2018)
  • 35. OTITIS EXTERNA:  Otitis externa (swimmers ear): Inflammation of the skin of the auditory canal.
  • 37. 3. Tympanic Membrane ( Ear Drum or Myringa) A thin, cone- shaped membrane. Separates the external acoustic meatus from the middle ear.
  • 38. Tympanic Membrane ( Ear Drum or Myringa) FEATURES:  Thin,Fibrous,circular pearly gray membrane about 1cm in diameter & 0.1mm thick  Connective tissue core lined with: Skin: on the outside Mucous membrane: on the inside.  Angle: Obliquely placed.
  • 39. FUNCTION: It converts and amplifies vibration in air to vibration in fluid.
  • 40. Tympanic Membrane ( Ear Drum or Myringa)  Periphery: fibrocartilaginous ring attaches it to the tympanic part of the temporal bone.  Center: Umbo concavity produced by handle of malleus
  • 41. Tympanic Membrane ( Ear Drum or Myringa)  Superior to umbo in an anterior direction is handle of malleus.  At the most superior extent of this line of attachment is lateral process of the malleus.  Extending away from this elevation are the anterior & posterior malleolar folds.  Superior to these folds are: Pars flaccida: thin and
  • 42. OTOSCOPE EXAMINATION: Anteroinferior to the umbo,a bright reflection of light, referred to as the cone of light.
  • 43. ARTERIAL SUPPLY: OUTER SURFACE:  Deep auricular artery of maxillary artery. INNER SURFACE:  Anterior Tympanic of V3.  Posterior Tympanic of posterior auricular artery.
  • 44. VENOUS SUPPLY: OUTER SURFACE:  External jugular vein. INNER SURFACE:  Transverse sinus  Pterygoid plexus
  • 45. SENSORY INNERVATION: 1). TYMPANIC NERVE Branch of Glossopharyngeal nerve (passes through floor of middle ear onto promontry gives :  Tympanic plexus (associates caroticotympanic plexus & supply mucous membrane of middle ear.  Lesser petrosal nerve to otic ganglion. 2). Skin: auriculotemporal nerve, a branch of the mandibular nerve [V3] with auricular branch of the vagus nerve [X]
  • 48. LYMPHATICH DRAINAGE: MUCOSA OF TYMPHANIC MEMBRANE & ANTRUM: Drain into: Parotid or upper deep cervical lymph nodes.
  • 49. CLINICAL APPROACH:  Extremely sensitive to pain.  To avoid perforation of tympanic cavity: Pars Tensa : Central/tubotympanic, safe approach Pars Flaccida : Attic/ unsafe approach (with or without retraction pocket.
  • 50. COMPLICATIONS: EXTRA-CRANIAL INTRACRANIAL Hearing loss Meningitis Tympanic membrane perforation Extradural Abscess Mastoiditis Sudural empyema Cholestatoma Brain Abscess Labyrinthitis
  • 51. IF YOU LOOSE THIS SMALLEST BONE LOCATED IN THE MIDDLE EAR,YOU WILL LOOSE THE ABILITY TO HEAR & WILL LOOSE YOUR BALANCE. َ‫م‬ُ‫ك‬ِِّ‫ب‬ َ‫ر‬ ِ‫آالء‬ ِِّ‫ي‬َ‫أ‬ِ‫ب‬َ‫ف‬ ِِ‫ ا‬َ‫ب‬َِِِّّ‫ك‬ُُ ‫ ا‬ SO WHICH OF THE FAVORS OF YOUR ALLAH WOULD YOU DENY? Surah Ar-Rahman (55) MIDDLE EAR
  • 52. MIDDLE EAR: Two parts  Tympanic cavity Proper immediately adjacent to the tympanic membrane  SUPERIORLY: Epitympanic recess.  3 interconnected & movable bones: Malleus (Hammer) Incus (Anvil) Stapes(Stirrup) INCU S STAPE S
  • 53. FUNCTION:  Transfers acoustic energy from compression waves in air to fluid– membrane waves within the cochlea.
  • 54. BOUNDARIES:  ANTERIORLY: Nasopharynx (via pharyngotympanic tube).  POSTERIORLY: Mastoid area  ROOF:Tegmental wall (petrous part of temporal bone).  FLOOR: Jugular wall.  MEDIAL WALL: Labyrinthine wall.  LATERAL WALL: Membranous wall.
  • 56. MIDDLE EAR: ROOF : (Tegmental wall)  Formed by thin layer of bone the Tegmen tympani (petrous part of temporal bone).  Separates the middle ear from the meninges of temporal lobe in the middle
  • 57. MIDDLE EAR: FLOOR: (Jugular wall)  Thin layer of bone (partly replaced by fibrous tissue).  Separates it from the superior bulb Internal jugular vein.  Medial border of the floor Tympanic branch (Jacobson nerve) via glossopharyngeal nerve Glossopharyngeal nerve Superior bulb of Internal Jugular Vein Jacobson nerve Interna carotid artery
  • 58. MIDDLE EAR: POSTERIOR WALL: (Mastoid wall)  UPPER PART : Aditus of the mastoid antrum  SUPERIORLY: the epitympanic recess  LOWER PART: bony partition between the tympanic cavity and mastoid air cells.  pyramidal eminence: tendon of the stapedius muscle.  the opening through which the chorda tympani nerve PYRAMIDA L EMINENCE TENDON OF STAPEDIUS MUSCLE MASTOI D CELLS MASTOID ANTRUM
  • 59. MIDDLE EAR: Anterior wall: (CAROTID WALL)  UPPER PART: 2 canals separated by thin bony septum: Upper & Small canal Tensor tympani muscle. Lower & Large canal: Pharyngotympanic tube  LOWER PART: Processus Cochleariformis (thin bone) separates the tympanic cavity from the Internal carotid artery.  Foramen: chorda tympani nerve. Auditory tube
  • 60. MIDDLE EAR: LATERAL WALL: (Membranous wall)  Tympanic membrane. (does not extend superiorly into bony epitympanic recess).
  • 61. MIDDLE EAR: MEDIAL WALL: (Labyrinthine wall)  Formed by: lateral wall of the internal ear.  Rounded bulge : promontory (1st turn of cochlea)  2 openings:  POSTEROSUPERIOR : Fenestra vestibuli (oval window) Closed by base of stapes (footplate).  POSTEROINFERIOR: Fenestra cochleae (round window) Closed by PROMONTORY STAPES (OVAL WINDOW) COCHLEAE (ROUND WINDOW)
  • 62. CONTI…. MEDIAL WALL: (Labyrinthine wall)  PROMINENCE OF FACIAL CANAL: Rounded ridge, posterosuperior to Promontoty & Fenestra vestibule (produced by the facial nerve).  PROCESSUS COCHLEARIFORMIS: Bony shelf forms pulley, supports tensor tympani muscle Prominence of facial canal Processus cochleariform is Tensor Tympa ni
  • 65. MIDDLE EAR: CONTENTS:  Auditory ossicles  Muscles  Air  Nerves: Tympanic branch of Glosspharyngeal nerve IX, Tympanic plexus, Chorda tympani and lesser petrosal nerve  Vessels: Deep auricular, Anterior tympanic artery & stylomastoid artery.
  • 66. MIDDLE EAR:  OSSICELS: Malleus Incus Stapes  Muscles: Tensor tampani muscle Stapedius muscle (modulate movement during the transmission of
  • 67. AUDITORY OSSICLES:  MALLEUS: (Largest) Attached to tympanic membrane. PARTS: Head of malleus Neck of malleus Anterior & Lateral processes Handle of malleus  Incus: Body of incus Long & Short limbs  Stapes Attached to the oval window. head of stapes anterior & posterior limbs base.
  • 68. TENSOR TYMPANI: ORIGIN: Cartilaginous part of the pharyngotympanic tube & greater wing of the sphenoid INSERTION: upper part of the handle of the malleus. INNERVATION: Branch from the mandibular nerve [V3]. ACTION: Contraction of the tensor tympani pulls the handle of the malleus medially. This tenses the tympanic membrane, reducing the
  • 69. STAPEDIUS: (SMALLEST MUSCLE) ORIGIN: Pyramidal eminence INSERTION: Posterior surface of the neck of stapes. INNERVATION: Branch from the facial nerve [VII] ACTION: Contraction of the stapedius muscle, usually in response to loud noises, pulls the stapes
  • 70. BLOOD SUPPLY OF MIDDLE EAR: ARTERIA SUPPLY: MAJOR ARTERIES:  Anterior tympanic (Branch of Maxillaty artery)  Stylomastoid (Branch of posterior auricular artery) MINOR ARTERIES:  Petrosal (Branch of middle meningeal artery)  Superior tympanic (Branch of middle meningeal artery)  Tympanic (Branch of internal carotid artery).  Vidian artery (Branch of external carotid artery)
  • 71. VENOUS SUPPLY:  Pterygoid venous plexus  Superior petrosal sinus.
  • 72. SENSORY & MOTOR SUPPLY: SENSORY SUPPLY OF MIDDLE EAR MUCOSA MOTOR SUPPLY OF MIDDLE EAR MUSCLE TYMPANIC (BRANCH OF GLOSSPHARYN GEAL NERVE) STAPEDIUS MUSCLE : STAPEDIAL BRANCH OF FACIAL NERVE AURICULOTEM PORAL (BRANCH OF TRIGEMINAL NERVE) TENSOR TYMPANI: MANDIBULAR DIVISION OF TRIGEMINAL NERVE
  • 74. MIDDLE EAR INNERVATION: TYMPANIC PLEXUS: Formed by: Tympanic nerve, (a branch of the glossopharyngeal nerve [IX]) & branches of Internal carotid plexus.  The tympanic plexus also gives off a major branch the lesser petrosal nerve, which supplies preganglionic parasympathetic fibers to the otic ganglion.  INNERVATES: mucous membrane & contents of the
  • 76. LYMPHATIC DRAINAGE: TYMPANIC END OF AUDITORY TUBE : Drains into the deep cervical lymph nodes. SUPERIOR VESSELS: Upper deep cervical lymph nodes. INFERIOR VESSELS: Inferior deep cervical lymph nodes or pretracheal & prelaryngeal nodes
  • 79. OTITIS MEDIA: Inflammatory disease. The two main types:  Acute otitis media (AOM)  Otitis media with effusion (OME) Common : Children  CLINICAL FEATURES:  Opaque &reduced mobality of Tympanic membrane.
  • 82. The inner ear is responsible for balance. However,1400 years ago the Quran described people who got knocked out by blows to their ears: "Darabna ala Athanihim ْ‫م‬ِ‫ه‬ِ‫ن‬‫ا‬َ‫ذ‬‫آ‬ ٰ ‫ى‬َ‫ل‬َ‫ع‬ ‫ا‬َ‫ن‬ْ‫ب‬َ‫ر‬َ‫ض‬َ‫ف‬ " Means: “We hit them on their ears.” INTERNAL EAR
  • 83. SURFACE LANDMARKS THE TEMPORAL BONE: Internal Acoustic Meatus:  Petrous part of the temporal bone (Posterior cranial fossa). Tegmen Tympani Jugular Foramen Jugular Foramen
  • 84. INTERNAL EAR: (LABYRINTH) LOCATION:  Petrous part of the temporal bone  medial to the middle ear . CONTENTS:  BONY LABYRINTH: Cavities within the bone.  MEMBRNOUS LABYRINTH:
  • 85. BONY LABYRINTH: These are cavities situated in the substance of dense bone.  3 parts: Vestibule Semicircular canals Cochlea  Lined by endosteum  Contain a clear
  • 86. BONY LABYRINTH: VESTIBULE: Central part of the bony labyrinth. LOCATION:  Posterior: Cochlea  Anterior: Semicircular canals.  Lateral wall: Fenestra vestibuli(closed by the base of the stapes & its anular ligament) Fenestra cochleae(closed by the secondary tympanic membrane).  Lodged within the vestibule are Cochlea (Posterior ) Semi-Circular canals (Anterior) Fanestra Cochleae (Lateral Wall) Fenestr a Vestibuli (Lateral wall) UTRIC LE Saccule
  • 87. BONY LABYRINTH: SEMI-CIRCULAR CANALS: 3 semi-circular canals open into the posterior part of the vestibule.  Superior: vertical & right angles to the long axis of the petrous bone.  Posterior : vertical but &parallel with the long axis of the petrous bone.  Lateral: horizontal position & it lies in the medial wall of the aditus to the mastoid antrum, (above the
  • 88. Conti…. (Semi-circular canals) The canals open into the vestibule by 5 orifices, one of which is common to two of the canals. It has :  AMPULLA: Each canal has a swelling at one end.  SEMI-CIRCULAR DUCTS: Lodged within Ampulla (Posterior & Anterior)
  • 90. BONY LABYRINTH: COCHLEA: SHAPE: Snail shell. OPENS: into the anterior part of the vestibule. It has: MODIOLUS: Central pillar,around which a hollow bony tube makes 2.5 spiral turns. Each successive turn is of decreasing radius Anterolaterally : Apex Posteromedially: Base (Bottom of internal acaustic meatus) Promontory: The first basal turn of the cochlea (medial wall of the middle ear) APE X
  • 91. BONY LABYRINTH:MODIOLUS: NERVE: Branch of Cochlear nerve. SPIRAL LAMINA: winds around the modiolus & projects into the interior of the canal & partially divides it. BASILAR MEMBRANE: Of the spiral lamina divides the cochlear canal into: ABOVE: Scala vestibuli (perilymph seperated from middle ear by base of stapes & anular ligamement at Fenestra Vestibule) BELOW: Scala tympani (perilymph separated from
  • 93. SPIRAL ORGAN OF CORTI:  The highly specialized epithelium that lies on the Basilar membrane  Contains the sensory receptors for hearing.
  • 96. MEMBRANOUS LABYRINTH: LOCATION: within the bony labyrinth CONTAINS: Endolymph & surrounded by perilymph. It consists of:  UTRICLE: Larger of the two vestibular sacs.  SACCULE: Globular & is connected to the utricle.  3 SEMI CIRCULAR DUCTS: lies within the bony semicircular canals (Same configuration).  DUCT OF COCHLEA: lies within the bony cochlea. All these structures freely communicate with one another
  • 97. DUCTUS UTRICULOSACCULARIS: Connects Utricle to saccule & ductus endolymphaticus.
  • 98. SACCUS ENDOLYMPHATICUS:  Ductus endolymphaticus joined by the ductus utriculosaccularis, passes on to end in a small blind pouch. This lies beneath the dura.
  • 99. DUCTUS REUNIENS:  The duct of the cochlea is connected to the saccule by the ductus reuniens.
  • 101. FUNCTION:  BALANCE: Utricle and saccule(specialized sensory receptors)  ACCELARATION & DECELATATION: Semicircular ducts This change is detected by ampullae(sensory receptors).  HEARING: Ducts of cochlea (Spiral organ of corti).
  • 103. VENOUS SUPPLY:  Internal auditory vein  Veins of cochlear aquaduct  Veins of Vestibular aquaduct DRAINAGE:  Inferior petrosal sinus  Sigmoid sinus
  • 104. INNER EAR & LYMPHATIC SYSTEM: https://www.ncbi.nlm.nih.gov/pubmed/11568618 (2001)
  • 105. VESTIBULOCOCHLEAR NERVE: Internal acoustic meatus Vestibularcochlear  vestibular nerve----- vestibular ganglion : Supply membranous labyrinth (utricle,saccule &ampullae)  cochlear nerve------ spiral ganglion branches base of the modiolus :Supply: spiral
  • 112. ْ‫ف‬َ ْ ‫اْل‬ َ‫و‬ َ‫ ار‬َ‫ص‬ْ‫ب‬َ ْ ‫اْل‬ َ‫و‬ َ‫ع‬ْ‫م‬َّ‫س‬‫ال‬ ُ‫م‬ُ‫ك‬َ‫ل‬ َ‫أ‬َ‫ش‬ْ‫ن‬َ‫أ‬ ‫ي‬َِِّّ‫ال‬ َ‫و‬ُ‫ه‬ َ‫و‬ َِ‫و‬ُ‫ر‬ُ‫ك‬ْ‫ش‬َُ ‫ ا‬َ‫م‬ ‫ا‬ ‫يًل‬ِ‫ل‬َ‫ق‬ ۚ َ‫ة‬َ‫د‬ِ‫ئ‬ [Quran 23.78] It is He who produced for you the hearing, and the eyesight, and the feelings. But little gratitude you show. The Quran always refers to the "hearing" before the "seeing" which turned out to be their actual order of creation. How could an illiterate man who lived 1400 years THANK YOU