The Brain and Ears Working Together

The Brain and Ears Working Together | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 September 2025 V1 Latest version Share on The Brain and Ears Working Together Author : Joe Ordia MD, FACS. 0000-0001-9799-8679 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175743619.96905496/v1 144 views 124 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Humans have five primary senses, which collect information through sensory organs and transmit it to the brain, allowing us to perceive and engage with our environment. They are hearing, sight, touch, taste and smell. The ears are the sensory organs for hearing. The ophthalmoscope is a key instrument in neurology and neurosurgery for examination of the eyes to learn about the brain. Similarly, the otoscope is an important tool particularly for pediatricians and otolaryngologists for looking into the ear canal. It can reveal problems such as ear wax, ear infection, or a perforation of the ear drum. The ears function closely with the brain, supporting not only hearing, but also speech, verbal communication, and social engagement. Children with undiagnosed hearing impairment are at risk of being misdiagnosed with intellectual disability because of delayed language development. This can lead to unwarranted stigmatization, and inappropriate placement in special education programs that do not reflect their true capabilities. Early hearing screening, starting in the newborn period, is of critical importance to prevent these outcomes. Beyond hearing, the ears play an important role in the regulation of equilibrium and balance. The eardrum vibrates in response to sound, and the middle ear ossicles amplify and transmit the vibrations to the cochlea. The cochlea converts the mechanical energy into electrical signals, which are relayed to the brain through the cochlear nerve, which is a component of the vestibulocochlear nerve (cranial nerve VIII). It extends to the cochlea nuclei of the brain stem and then to the thalamus. From there the signals are transmitted to the primary auditory cortex in the temporal lobe where frequency and intensity are analyzed to enable the recognition of speech, music, and noise. Beyond hearing, the ears play an important role in the regulation of equilibrium and balance. If a child is born with hearing impairment, it can hinder normal development of the auditory cortex resulting in delayed speech and communication skills, difficulties with social interaction, and in cognitive and academic abilities. The Centers for Disease Control (CDC) recommends “All babies should be screened for hearing loss no later than 1 month of age. It is best if they are screened before leaving the hospital after birth.” 1 Babies who do not pass the initial screening need a detailed hearing assessment by 3 months. Intervention before 6 months gives the best chance to develop language skills equal to children with typical hearing. Joint Committee on Infant Hearing (JCIH) has labeled the newborn hearing screening by 1 month, diagnosis by 3 months, and intervention by 6 months as the “1-3-6 guideline”. 2 Common Causes of Hearing Impairment The causes can be broadly divided into 2 categories, genetic, and non-genetic. Between 50 and 60 percent of hearing loss in newborns and children are due to genetic causes. Some are linked to disorders such as Down syndrome. Non-genetic (acquired) causes may arise from prenatal factors. Intrauterine infections such as CMV (cytomegalovirus), rubella, toxoplasmosis, or syphilis can damage the inner ear of the baby. Birth-related causes include prematurity with incomplete development of the auditory pathway, and hypoxia. Postnatal factors include ear infections, meningitis, head trauma, and some antibiotics. Repeated ear infections like otitis media can cause damage and scarring of the ear drum. In otitis media with effusion there is accumulation of fluid in the middle ear, and conductive hearing loss. Ear infection is one of the leading causes of brain abscess in children. Hearing challenges are even more prevalent in adults. The World Health Organization estimates that globally, disabling hearing loss affects about 430 million people, among them 34 million children. 3 Prolonged exposure to loud sounds such as industrial machinery or recreational headphones can precipitate noise-induced hearing loss. In adults, other causes of hearing loss include otitis media, and viral infection. Poorly controlled diabetes or hypertension can damage the nerves and blood vessels in the inner ear. Meniere’s disease is associated with the buildup of fluid in the inner ear and is characterized by hearing loss, dizziness (vertigo), ringing in the ear (tinnitus), and ear fullness and pain. The cause is not well understood, but it is rare in children and is most common between the ages of 40 and 60. Drug induced hearing loss have been linked to some antibiotics, chemotherapy, antimalarial agents such as chloroquine, and some vaccines. Otosclerosis is an abnormal bone growth in the middle ear, typically around the stapes, the smallest of the ear ossicles, thereby disrupting the transmission of sound to the inner ear. Age related hearing loss (presbycusis) is progressive cochlear and cochlear nerve decline, most prevalent after 65 years. High frequencies are often affected and individuals have difficulty understanding speech in noisy environments. As hearing loss advances, communication becomes increasingly impaired, raising the risk of social isolation and depression. Impacted ear wax is one of the most common causes of acute but temporary hearing loss. The commonest cause of hearing loss encountered in neurosurgery is a tumor of cranial nerve VIII known as an acoustic neuroma. Treatments for Hearing Loss When addressing medical care, starting with preventive strategies provides a strong foundation. There is evidence linking childhood vaccination to the prevention of hearing loss caused by infections such as rubella, mumps, and Streptococcus pneumoniae. 4 The American Academy of Pediatrics (AAP) has guidelines for hearing screening as part of regular wellness visits in infants, children and adolescents. 5 From a self-help standpoint, the risk of exposure to loud sounds can be mitigated by decreasing the noise intensity, limiting exposure, and utilizing protective devices. Individuals who suspect that their hearing loss is age-related, should consult their primary care provider or an otolaryngologist before purchasing an over-the-counter hearing aid. A look with an otoscope may reveal excess wax which can often be cleaned out at the office, leading to almost immediate improvement in hearing. When younger individuals notice hearing challenges in older adults, reducing or muting background noise during phone calls can make communication clearer. Some experts advocate that parents should consider learning sign language along with the child as soon as hearing impairment is detected. 6 Management of ear infections may involve the use of antibiotic, antiviral, antifungal agents, and steroids. Persistent middle ear fluid, may necessitate the placement of ear tubes, a procedure known as tympanostomy. Hearing aids make sounds louder and clearer. When hearing aids fail, cochlear implants may be considered. Symptomatic or rapidly growing acoustic neuroma may require surgical removal or shrinkage with focused radiation. Technological advances such as closed-caption displays on television and video, as well as telecommunications devices for the deaf (TDD), offer vital support to individuals with hearing impairment. Speech therapy and educational support should be started early. Elderly individuals living with hearing impairment benefit significantly from social support and engagement to protect against isolation and depression. The Ears and Balance The ears contain both the cochlear system for hearing and the vestibular system for balance. The eight cranial nerve is formed by the union of the cochlear and vestibular nerves at the pons, creating the vestibulocochlear nerve. In addition to the cochlear, the inner ear also houses the vestibular system. The balance center consists of three fluid-filled semicircular canals which detect head rotations and two sacs called otoliths which contain calcium crystals and detect the speed of linear movement. They send information to the brainstem and cerebellum through the vestibular nerve. The brain integrates the information with input from the eyes and muscles to stabilize gaze, and maintain posture and balance. Disruption of the vestibular system by infection, inflammation, ischemia, trauma, or tumor, may cause vertigo, characterized by a spinning sensation of the individual or the surroundings. These disturbances are often accompanied by loss of balance, dizziness, nausea, and vomiting. When the cochlear division is involved, hearing loss and tinnitus may occur. Benign paroxysmal positional vertigo (BPPV) is a leading cause of episodic vertigo, typically triggered by changes in head position. It arises from displacement of calcium crystals in the otolith organs. It is often idiopathic but it may result from head trauma or ear infection. Treatment involves non-invasive repositioning maneuvers performed by an otolarygologist. Medication is sometimes prescribed to control nausea and vomiting. Patients may benefit from treatment by a physical therapist who specializes in vestibular therapy, and home Epley maneuver. 7 The Ears and Chronic Pain Ear pain may arise primarily from the ear itself or be referred from another source. The most frequent primary causes of chronic ear pain include chronic otitis media and Meniere’s disease. In Meniere’s disease, ear pain often occurs alongside hearing loss, vertigo, and tinnitus. Because the temporomandibular joint (TMJ) lies directly in front of the ear, TMJ dysfunction frequently produces referred pain in this region. In trigeminal neuralgia, irritation of the branches of the fifth cranial nerve that supply sensation to the face can transmit sharp, stabbing pain to the ear. The spinal trigeminal nucleus extends from the midbrain to the upper cervical spinal cord. Consequently, disorders of the neck or upper cervical spine, including arthritic changes, can produce referred pain to the head and ear, a condition known as cervicogenic headache. Migraine headache with sensitivity to sound may give ear pain. Conclusion The five primary senses, consisting of hearing, sight, touch, taste and smell, collect information through sensory organs and transmit it to the brain where it is processed and interpreted, allowing us to perceive and interact with our environment. The ears function in close partnership with the brain, supporting not only hearing, but also speech, verbal communication, social engagement, and enhancing the overall quality of life. They also play an essential role in maintaining balance, and coordinating gait. References 1. Centers for Disease Control and Prevention. Screening for hearing loss [Internet]. Atlanta (GA): CDC; 2024 [updated 2024 Oct 8; cited 2025 Sep 6]. Available from: https://www.cdc.gov/hearing-loss-children/screening/index.html 2. Joint Committee on Infant Hearing. Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs [Internet]. Logan (UT): National Center for Hearing Assessment and Management; 2019 [cited 2025 Sep 6]. Available from: https://www.infanthearing.org/nhstc/docs/Year%202019%20JCIH%20Position%20Statement.pdf 3. World Health Organization. Deafness and hearing loss [Internet]. Geneva: WHO; 2025 [cited 2025 Sep 6]. Available from: https://www.who.int/health-topics/hearing-loss 4. Johri M, Téhinian S, Pérez Osorio MC, Barış E, Wahl B. Vaccination for prevention of hearing loss: a scoping review. Commun Med (Lond) . 2025;5(1):85. Published 2025 Mar 24. doi:10.1038/s43856-025-00795-w. https://pubmed.ncbi.nlm.nih.gov/40128310/ 5. Bower C, Reilly BK, Richerson J, Hecht JL; COMMITTEE ON PRACTICE & AMBULATORY MEDICINE; SECTION ON OTOLARYNGOLOGY–HEAD AND NECK SURGERY. Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening. Pediatrics . 2023;152(3):e2023063288. doi:10.1542/peds.2023-063288. https://pubmed.ncbi.nlm.nih.gov/37635686/ 6. Humphries T, Mathur G, Napoli DJ, Padden C, Rathmann C. Deaf Children Need Rich Language Input from the Start: Support in Advising Parents. Children (Basel) . 2022;9(11):1609. Published 2022 Oct 22. doi:10.3390/children9111609. https://pubmed.ncbi.nlm.nih.gov/36360337/ 7. Imai T, Inohara H. Benign paroxysmal positional vertigo. Auris Nasus Larynx . 2022;49(5):737-747. doi:10.1016/j.anl.2022.03.012. https://pubmed.ncbi.nlm.nih.gov/35387740/ Information & Authors Information Version history V1 Version 1 09 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords brain and ears cochlear nerve cranial nerve viii deafness. hearing impairment hearing screening nonverbal communication vertigo vestibular nerve vestibulocochlear nerve Authors Affiliations Joe Ordia MD, FACS. 0000-0001-9799-8679 [email protected] View all articles by this author Metrics & Citations Metrics Article Usage 144 views 124 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Joe Ordia MD, FACS.. The Brain and Ears Working Together. Authorea . 09 September 2025. DOI: https://doi.org/10.22541/au.175743619.96905496/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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