Flexibility within the middle ears of vertebrates

Introduction and aims: Tympanic middle ears have evolved multiple times independently among vertebrates, and share common features. We review flexibility within tympanic middle ears and consider its physiological and clinical implications. Comparative anatomy: The chain of conducting elements is flexible: even the 'single ossicle' ears of most non-mammalian tetrapods are functionally 'double ossicle' ears due to mobile articulations between the stapes and extrastapes; there may also be bending within individual elements. Simple models: Simple models suggest that flexibility will generally reduce the transmission of sound energy through the middle ear, although in certain theoretical situations flexibility within or between conducting elements might improve transmission. The most obvious role of middle-ear flexibility is to protect the inner ear from high-amplitude displacements. Clinical implications: Inter-ossicular joint dysfunction is associated with a number of pathologies in humans. We examine attempts to improve prosthesis design by incorporating flexible components.