The macular organs (sacculus and utriculus) are parts of the vestibular labyrinth and register linear accelerations and gravitational influences. They contain hair-filled sensory cells whose stereocilia are embedded in a gelatinous membrane weighted with otoliths (calcium carbonate crystals). Displacements of the otoliths when the head is tilted or accelerated bend the stereocilia and thus trigger nerve impulses. This information is transmitted to the brain via the vestibular part of the VIII. cranial nerve to the brain and combined with visual and proprioceptive data to determine position. Damage to the macular organs leads to unsteadiness when standing and walking as well as pathological swaying.

A malformation syndrome of the ear includes congenital malformations of the outer ear, middle ear or inner ear, often as part of genetic syndromes such as Goldenhar or Treacher Collins syndrome. Affected individuals show auricular abnormalities (microtia, anotia), ear canal atresia or cochlear malformations. Hearing loss ranges from mild conductive hearing loss to complete deafness, depending on the extent of the malformation. Treatment includes surgical reconstruction, bone conduction hearing systems or cochlear implants. Multidisciplinary care by ENT surgeons, audiologists and plastic surgeons is crucial for functional and aesthetic results.

The mandibular reflex, also known as the chin reflex, is triggered by tapping on the lower jaw and tests the trigeminal motor function. Although primarily a neurological test, masticatory muscles influence the auditory canal through their proximity and can promote earache and tinnitus in the case of temporomandibular joint disorders. An increase or decrease in the reflex can indicate central or peripheral nerve lesions. In ENT diagnostics, it is combined with other cranial nerve reflexes in order to differentiate between headache and ear symptoms. Therapy for dysfunction is provided by craniomandibular therapy and physiotherapy.

Masking is the superimposition of a noise or sound mask on a test signal in order to prevent the non-tested ear from reacting during audiometry (cross-hearing). It is necessary if the level difference between air and bone conduction allows unwanted perception in the opposite ear. Masking levels are calculated according to standardized rules to ensure the validity of the threshold determination. Psychoacoustically, masking also refers to the suppression of quieter sounds by loud neighboring frequencies. Targeted masking is used in hearing aids to cover tinnitus or reduce background noise.

The mastoid (mastoid process) is the bony protrusion behind the pinna that contains air-filled cells and is part of the temporal bone. It serves as a buffer for middle ear infections, but can even become inflamed in chronic otitis media (mastoiditis). Clinically, the mastoid is palpated for tenderness and swelling in order to detect complications. Imaging procedures (CT) show the cell structure and extent of inflammatory processes. Surgical mastoidectomy removes diseased tissue and preserves hearing function.

The external auditory meatus is the external auditory canal that conducts sound from the auricle to the eardrum. It consists of bony and cartilaginous parts and is lined with skin and cerumen glands. Cerumen formation and exostoses can narrow the meatus and lead to sound conduction disorders. Otoscopic examination checks the width, skin condition and foreign bodies. In hearing aid fitting, a precise fit of the earmold in the meatus is crucial for attenuation and freedom from feedback.

The medial olive nucleus complexes in the brain stem are central switching stations for binaural auditory processing. They compare interaural time differences (ITD) to determine the direction of low-frequency sound sources. Neurons in these nuclei fire in phase synchronization with the sound waves and transmit information to higher auditory centers. Lesions lead to directional hearing loss and reduced speech understanding in noise. Research uses electrode recordings to analyze the precise temporal coding in the olfactory nuclei.

In audiology, the membrane usually refers to the eardrum, a three-layered structure that converts sound energy into mechanical vibrations. It separates the outer ear from the middle ear and transmits vibrations to the inner ear via the ossicular chain. Changes in thickness, tension or integrity - such as perforations - influence impedance and hearing ability. The membrane also plays a role in otoacoustic emissions, as its reflections can be measured. Surgical repairs (tympanoplasty) reconstruct damaged membranes to restore sound conduction.

The membrana tectoria is a gelatinous covering membrane in the organ of Corti that lies over the hair cells and brushes their stereocilia when sound is induced. It transmits traveling waves of the basilar membrane into lateral movements of the hair cell stereocilia, which triggers mechano-electrical transduction. Differences in stiffness and mass of the membrana tectoria along the cochlea influence frequency selectivity. Damage or detachment of this membrane leads to hearing loss and impaired tonotopy. Research approaches are testing biomaterials to regenerate the membrana tectoria after noise damage.

Meniere's disease is an inner ear disease characterized by attacks of rotary vertigo, fluctuations in hearing, tinnitus and ear pressure. Pathophysiologically, there is an endolymphatic hydrops, i.e. an overfilling of the cochlear duct and the semicircular canals with endolymph. The diagnosis is based on clinical criteria, audiograms and exclusion of other causes. Treatment includes diuretics, intratympanic administration of gentamicin for vestibular ablation and vestibular training. Despite the chronic course, symptom control can significantly improve the quality of life.

The mesotympanum is the middle section of the tympanic cavity in the middle ear between the epitympanum and hypotympanum. It contains the ossicular chain and the stapes attachment at the oval window. Pathologies such as effusion or cholesteatoma often manifest themselves in the mesotympanum and impair sound conduction. Surgical interventions (tympanotomy) are aimed at cleaning and ventilating this area. Tympanometry can indirectly estimate the pressure and volume in the mesotympanum.

Misophonia is a neurological-psychiatric disorder in which certain everyday sounds (e.g. chewing, typing) trigger intense negative emotions such as anger or disgust. Those affected react with an increased stress response, which severely restricts social interaction and quality of life. The exact mechanisms are still unclear; a misconnection between auditory areas and the limbic system is suspected. Therapeutic approaches include cognitive behavioural therapy, tinnitus desensitization and mindfulness exercises. Audiological examinations rule out organic hearing disorders in order to confirm the diagnosis.

The middle ear is an air-filled cavity containing the eardrum, ossicular chain (malleus, incus, stapes) and the Eustachian tube. It adapts sound pressure from air conduction to the fluid conduction of the cochlea and protects against loud noises through reflexes. Diseases such as otitis media, otosclerosis or cholesteatoma impair sound conduction and lead to hearing loss. Diagnosis is carried out using otoscopy, tympanometry and audiometry. Surgical procedures such as stapedotomy or tympanostomy tubes improve ventilation and conductivity.

Otitis media is an inflammatory disease of the tympanic cavity, often caused by viruses or bacteria. It causes earache, fever, hearing loss and can lead to effusion formation. Chronic otitis media can lead to complications such as perforation of the eardrum or cholesteatoma. Treatment includes antibiotics, pain therapy and tympanostomy tubes if an effusion forms. Prevention through vaccination (pneumococci) and treatment of throat infections reduces the incidence.

The modiolus is the central, bony axis of the cochlea around which the convolutions of the cochlea wind. It contains nerve fibers of the auditory nerve that run from the hair cells to the brain stem. The close spatial arrangement in the modiolus facilitates electrical stimulation during cochlear implantation. Pathologies such as fibrosis of the modiolus can impair implant function. In imaging, the modiolus is measured for planning surgical approaches.

Monaural hearing refers to hearing with only one ear, which eliminates binaural advantages such as localization and noise suppression. Those affected often compensate with head movements and visual cues. Audiologically, a monaural audiogram is shown; masking is not required. Monaural fitting with only one hearing aid can preserve speech understanding in quiet environments, but can be severely limited in noise. Strategies for support include FM systems and room acoustic optimization.

Mondini dysplasia is a congenital malformation of the cochlea with reduced convolutions (usually 1-1.5 instead of 2.5). It belongs to the spectrum of inner ear malformations and leads to varying degrees of sensorineural hearing loss. Vestibular structures are also frequently affected, which can cause vertigo. Diagnosis includes high-resolution CT and hearing tests, treatment often involves cochlear implantation. Early intervention improves speech development and balance function.

Meniere's disease is a chronic, recurrent disease of the inner ear in which endolymphatic hydrops is accompanied by periodic attacks of rotary vertigo, ear pressure, tinnitus and fluctuating hearing loss. It is also referred to as "Meniere's syndrome" if the symptoms are incomplete or secondary to other diseases. The diagnosis is based on clinical criteria and the exclusion of other causes of dizziness using audiometry and balance tests. Therapeutic approaches include a low-salt diet, diuretics, intratympanic gentamicin injections and vestibular rehabilitation training. In the long term, irreversible hearing loss in the affected frequency ranges can occur despite treatment.

The stapedius muscle is the smallest striated skeletal muscle in the body and originates from the pyramidal bone of the petrous bone. It is connected to the stapes via a tendon and reflexively retracts the stapes when a high level contrast occurs. This contraction - the stapedius reflex - reduces the transmission of sound to the inner ear and protects it from harmful loud noises. Its function is tested in tympanometry by measuring the change in middle ear impedance in response to acoustic stimulation. Impairment of the stapedius muscle, for example due to nerve lesions, leads to increased sensitivity to noise and hearing disorders.

The stapedius reflex is an acoustically triggered muscle reflex in which the stapedius muscle contracts at levels above around 70-90 dB SPL. This stiffening of the ossicular chain dampens loud impulses and protects the sensitive hair cells in the inner ear. The reflex is measured diagnostically with tympanometry devices that record changes in impedance and reflex latency. An absent or asymmetrical reflex can indicate otosclerosis, facial nerve lesions or central auditory pathway disorders. Reflex parameters provide important information for the differential diagnosis of middle ear and neural pathologies.

Myoelectric stimulation uses electrical impulses to activate muscles in a targeted manner and to train or relax them therapeutically. In ENT practice, it can be used to treat tinnitus, chronic muscle tension in the maxillofacial region and to improve tube function. Electrodes apply weak direct or alternating currents through the skin, which trigger muscle contractions. Patients report pain relief and improved functionality after regular sessions. Scientific studies are currently examining optimal stimulation parameters and long-term effects.

Myringitis is an inflammation of the eardrum that can be triggered by a viral or bacterial infection, excessive heat or chemical stimuli. Those affected complain of acute earache, redness and swelling of the eardrum and occasional fluid leakage. Clinically, myringitis can be recognized otoscopically by a clouded or hyperemic membrane. Treatment includes analgesics, topical antibiotics if necessary and avoidance of other irritating factors. Complications such as perforation or chronic inflammation are rare but possible.

Myringoplasty is a surgical procedure to reconstruct the eardrum in the case of perforations, usually with the aid of a connective tissue graft (e.g. fascia or perichondrium). The aim is to restore sound conduction and prevent recurrent otorrhea. The approach is often retroauricular or endaural, followed by microsurgical suturing and covering of the defect. Success rates for permanent eardrum closure are over 85%. Postoperative audiometry checks the hearing gain, and hygiene measures reduce the risk of infection.

Myringoscopy is the visual inspection of the eardrum and tympanic cavity using an otoscope or operating microscope. It allows assessment of color, permeability, perforations and other pathologies of the membrane. If necessary, samples can be taken via an instrument channel for microbacteriological or histological examination. Myringoscopy is routine in ENT outpatient clinics and forms the basis of all middle ear diagnostics. Clinical findings guide further treatment decisions, such as tympanostomy tube implantation or myringoplasty.

Myringotomy is a small incision in the eardrum to drain acute effusion or pus from the middle ear. It is often performed in combination with the insertion of a tympanostomy tube to ensure permanent ventilation. It is indicated for acute middle ear surgery, chronic effusions and pressure pain. The procedure is performed on an outpatient basis under local anesthesia and takes just a few minutes. Rapid relief usually leads to an immediate reduction in pressure and improvement in hearing.