Upload
randolph-campbell
View
220
Download
2
Tags:
Embed Size (px)
Citation preview
Auditory and Auditory and balance apparatusbalance apparatus
MorphologyMorphologyandand
embryologyembryology
AurisAuris, is, is = Us = Us, oton, oton
Auditory and vestibular Auditory and vestibular apparatusapparatus
External earExternal ear
((Auris Auris externaexterna))
Middle earMiddle ear
((Auris mediaAuris media)) Inner earInner ear
((Auris Auris internainterna))
= Organum = Organum
vestibulo-vestibulo-
cochlearecochleare
External earExternal ear ( (Auris Auris externaexterna))
EarboltEarbolt ( (AuriculaAuricula, , PinnaPinna) ) elastic cartilageelastic cartilage
External meatusExternal meatus
((Meatus acusticus Meatus acusticus externusexternus))
EardrumEardrum
((Membrana Membrana tympanica, Myrinxtympanica, Myrinx))
HelixHelix crus, spina, caudacrus, spina, cauda (tuberculum auriculare (tuberculum auriculare
Darwini,Darwini, apex auriculae) apex auriculae) AntihelixAntihelix
crura, fossa triangulariscrura, fossa triangularis ScaphaScapha Concha auriculaeConcha auriculae
cymba, cavitascymba, cavitas TragusTragus AntitragusAntitragus Incisura intertragicaIncisura intertragica LobulusLobulus auriculaeauriculae
Posterior facetPosterior facet = negative = negative ventral imageventral image
BoltecBoltec
LigamentsLigaments: lig. auriculare ant., sup., : lig. auriculare ant., sup., post.post.
Earbolt musclesEarbolt muscles - - innervationinnervation: : n. facialisn. facialis External musclesExternal muscles = mimic = mimic
mm. auriculares (ant., sup., inf.)mm. auriculares (ant., sup., inf.) m. temporoparietalism. temporoparietalis
Proper musclesProper muscles: : rudimentaryrudimentary m. tragicus + antitragicusm. tragicus + antitragicus m. helicis major+minorm. helicis major+minor m. obliquus + transversus auriculae, m. m. obliquus + transversus auriculae, m.
pyramidalis auriculaepyramidalis auriculae
CartilageCartilage:: Cartilago auriculae - Cartilago auriculae - elasticelastic
SkinSkin: : back side freeback side free, , ventrally firmly ventrally firmly attached to perichondriumattached to perichondrium - - othematomothematom
EarboltEarbolt – – supplysupply ArteriesArteries: rr. auriculares ant. : rr. auriculares ant. a. temporalis a. temporalis
superficialissuperficialis a. auricularis post. a. auricularis post. a. carotis a. carotis
externaexterna VeinsVeins: : v. jugularis ext.v. jugularis ext. LymphLymph: n.l. parotidei, mastoidei: n.l. parotidei, mastoidei NervesNerves: : sensitivesensitive
nn. auriculares ant. z nn. auriculares ant. z n. auriculotemporalis (n. auriculotemporalis (upper ventralupper ventral 2/3 2/3)) r. auricularis n. X. (r. auricularis n. X. (conchaconcha)) n. occipitalis minor (n. occipitalis minor (posterior upposterior up)) n. auricularis magnus (n. auricularis magnus (downdown))
motoric: n. VII.motoric: n. VII.
Auditory canalAuditory canal((Meatus acusticus Meatus acusticus
externusexternus)) porus acusticus externus porus acusticus externus diagonally ventromed. diagonally ventromed.
med. med. again diagonally ventromed. (totally it converges again diagonally ventromed. (totally it converges forth 160forth 160ºº and it declines convex, length approx and it declines convex, length approx.. 22 mm) 22 mm)
externalexternal 2/3 – 2/3 – hyaloid cartilage open forth and downhyaloid cartilage open forth and down (incisurae (incisurae SantoriniSantorini), lamina tragi (forth)), lamina tragi (forth)
transitiontransition – – narrowest placenarrowest place – – foreign bodiesforeign bodies !!! !!! innerinner 1/3 – 1/3 – bonybony – incisura tympanica – incisura tympanica RiviniRivini glandulae ceruminosae + sebaceaeglandulae ceruminosae + sebaceae ear waxear wax ( (cerumen) cerumen)
– – protectionprotection tragi (tragi (afterafter 30. 30. years of ageyears of age)) Skin attached to perichondrium – even small inflamation Skin attached to perichondrium – even small inflamation
very painfulvery painful !!! !!! Anterior wall: relation to gl. parotis and art. Anterior wall: relation to gl. parotis and art.
temporomandibularistemporomandibularis
Auditory canalAuditory canal((Meatus acusticus externusMeatus acusticus externus))
supplysupply
ArteriesArteries: : same as earboltsame as earboltc + a. c + a. auricularis prof. auricularis prof. a. maxillarisa. maxillaris
veinsveins: v. temporalis superf., v. : v. temporalis superf., v. auricularis post.auricularis post.
lymphlymph: n.l. parotidei, mastoidei: n.l. parotidei, mastoidei nervesnerves: : r. auricularis n.X.r. auricularis n.X. ( (posterior posterior
caudal partcaudal part), n. auriculotemporalis ), n. auriculotemporalis r. r. meatus ac. externimeatus ac. externi
EardrumEardrum((Membrana tympanica, Membrana tympanica,
MyrinxMyrinx))
EardrumEardrum - - compositioncomposition
Sulcus tympanicus, incisura tympanica Sulcus tympanicus, incisura tympanica RiviniRivini
9x10 mm, 9x10 mm, thicknessthickness 0,1 mm, 0,1 mm, areaarea 55 mm 55 mm22
Anulus fribrocartilagineusAnulus fribrocartilagineus
External surfaceExternal surface - - weakenedweakened epidermis epidermis ((ectodermectoderm))
Layer of thick collagenous tissueLayer of thick collagenous tissue ( (mesenchymemesenchyme)) Inner surfaceInner surface – – single layer cuboid epitheliumsingle layer cuboid epithelium
((endodermendoderm))
EardrumEardrumOtoskopyOtoskopy
umbo m.t.umbo m.t. stria mallearisstria mallearis prominetia mallearisprominetia mallearis plica mallearis ant. + post.plica mallearis ant. + post. light reflexlight reflex – trigonum – trigonum WildeWilde(= cone of light, light reflex, Politzer's (= cone of light, light reflex, Politzer's luminous cone) luminous cone) Bezold triasBezold trias: prominentia + stria + reflex: prominentia + stria + reflexpars flaccida pars flaccida ShrapnelliShrapnelli (5 mm (5 mm22) x pars ) x pars tensatensa
- Declination of eardrum (50- Declination of eardrum (50ºº sagitally) sagitally)- Inclinationof eardrum (45 - Inclinationof eardrum (45 ºº
transverzally)transverzally)Paracentesis: lower posterior quadrantParacentesis: lower posterior quadrant
EardrumEardrum - - supplysupply
ArteriesArteries:: a. auricularis prof. a. auricularis prof. a. maxillaris a. maxillaris
((external surfaceexternal surface)) aa. tympanicae (aa. tympanicae (inner surfaceinner surface))
Lymph: n.l. mastoidei, parotideiLymph: n.l. mastoidei, parotidei NervNerves:es:
a. auricularis n.X.a. auricularis n.X. n. auriculotemporalis n. auriculotemporalis r. r.
membranae tympanimembranae tympani
Middle earMiddle ear ( (Auris mediaAuris media)) Middle ear cavityMiddle ear cavity
((Cavitas tympaniCavitas tympani)) Middle ear ossiclesMiddle ear ossicles
((Ossicula aditusOssicula aditus)) Middle ear jointsMiddle ear joints
((Articulationes Articulationes ossiculorum ossiculorum auditusauditus))
Middle ear musclesMiddle ear muscles ((Musculi Musculi ossiculorum ossiculorum auditusauditus))
Auditory tubeAuditory tube ( (Tuba Tuba auditivaauditiva EustachiiEustachii))
Middle ear cavityMiddle ear cavity ( (Cavitas Cavitas tympanitympani))
pariesparies tegmentalis tegmentalis paries paries jugularisjugularis: prominetia styloidea: prominetia styloidea paries paries mastoideusmastoideus: aditus ad antrum : aditus ad antrum
mastoideum, prominetia canalis mastoideum, prominetia canalis semicircularis lat. + n. VII., eminetia semicircularis lat. + n. VII., eminetia pyramidalis, fossa incudis, apertura pyramidalis, fossa incudis, apertura tympanica canaliculi chordae tympani, tympanica canaliculi chordae tympani, antrum mastoideum (cellulae m.)antrum mastoideum (cellulae m.)
paries paries caroticuscaroticus paries paries membranaceusmembranaceus paries labyrinthicusparies labyrinthicus
promontorium promontorium – first coil of – first coil of cochleacochlea
sulcus sulcus promontorii – promontorii – plexus plexus tympanicustympanicus
fenestra fenestra vestibulivestibuli (= (= ovalis) – basis of ovalis) – basis of stapesstapes + + membrana membrana stapediastapedia
fenestra fenestra cochlaecochlae (= (= rotunda) – rotunda) – membrana membrana tympani tympani secundariasecundaria
Middle ear cavityMiddle ear cavityparies labyrinthicusparies labyrinthicus
Middle ear cavityMiddle ear cavity - - supplysupply ArteriesArteries: 4 aa. tympanicae, rr. : 4 aa. tympanicae, rr.
caroticotympanicicaroticotympanici VeinsVeins: do plexus pterygoideus + sinus : do plexus pterygoideus + sinus
petrosus sup.petrosus sup. LymphLymph: n.l. parotidei, mastoidei, : n.l. parotidei, mastoidei,
cervicales profundi, retropharyngeicervicales profundi, retropharyngei NervesNerves: :
n. tympanicus (n.IX) – sensitive + n. tympanicus (n.IX) – sensitive + parasympatic (ganglion tympanicum)parasympatic (ganglion tympanicum)
r. pharyngeus (n.V2) for cartilagenous part r. pharyngeus (n.V2) for cartilagenous part of auditory tubeof auditory tube
nn. caroticotympanici (sympatic)nn. caroticotympanici (sympatic)
Middle ear ossiclesMiddle ear ossicles ( (Ossicula Ossicula aditusaditus))
MalleusMalleus ( (Malleus, Malleus, HammerHammer))
caputcaput collumcollum manubriummanubrium processus lateralisprocessus lateralis processus anteriorprocessus anterior
Middle ear ossiclesMiddle ear ossicles ( (Ossicula Ossicula aditusaditus))
IncusIncus ( (IncusIncus, , AnvilAnvil)) corpuscorpus crus longumcrus longum
processus lenticularisprocessus lenticularis crus brevecrus breve
StapesStapes ( (StapesStapes,, StirrupStirrup)) caputcaput (collum)(collum) crus ant. + post.crus ant. + post. basisbasis
Middle ear joints and ligamentsMiddle ear joints and ligaments((Articulationes ossiculorum Articulationes ossiculorum
auditusauditus))
art. incudomallearis art. incudomallearis ((seddle bagseddle bag))
art. incudostapedia (art. incudostapedia (ball ball shape likeshape like))
syndesmosis syndesmosis tympanostapedialistympanostapedialis
otosclerosis – ossification otosclerosis – ossification
Sometimes both joints Sometimes both joints are replaced by are replaced by syndesmosissyndesmosis
Middle ear ligamentsMiddle ear ligaments ((Ligg. Ligg. ossiculorum auditusossiculorum auditus))
lig. mallei antlig. mallei ant. (spina . (spina o.s.)+ o.s.)+ supsup.+ .+ latlat..
lig. incudis suplig. incudis sup. (fossa . (fossa i.) + i.) + postpost..
membrana stapedialismembrana stapedialis (fenestra vestibuli)(fenestra vestibuli)
lig. anulare stapedialelig. anulare stapediale (fenestra vestibuli)(fenestra vestibuli)
membrana tympani membrana tympani secundariasecundaria = = secondary eardrumsecondary eardrum (fenestra cochleae)(fenestra cochleae)
Middle ear Middle ear musclesmuscles
m. tensor tympanim. tensor tympani semicanalis m.t.t.semicanalis m.t.t. processus cochleariformisprocessus cochleariformis manubrium malleimanubrium mallei
innervationinnervation:: n.V3 n.V3
m. stapediusm. stapedius eminetia pyramidaliseminetia pyramidalis collum stapediscollum stapedis
innervationinnervation:: n.VII n.VIIn. stapedius fromn. stapedius from pars pars
mastoidea canalis nervi mastoidea canalis nervi facialisfacialis
Middle earMiddle ear Shape of sand clock – 2 mm narrow by eardrum Shape of sand clock – 2 mm narrow by eardrum
(= mesotympanon)(= mesotympanon) recessus epitympanicus (= recessus epitympanicus (= atticusatticus, ,
epitympanon, epitympanum) – 6 mmepitympanon, epitympanum) – 6 mm recessus hypotympanicus (hypotympanon)– 4 mmrecessus hypotympanicus (hypotympanon)– 4 mm plicae malleares ant., post.plicae malleares ant., post. recessus ant., sup., recessus ant., sup.,
post. (= post. (= Prussak Prussak space)space) plica chordae tympani, incudialis, stapedialisplica chordae tympani, incudialis, stapedialis mucosa – single layer cuboid epithelium mucosa – single layer cuboid epithelium
(different height)(different height) Cup cells only by opening of auditory tubeCup cells only by opening of auditory tube !!!!!! No glandsNo glands !!! !!!
Mastoid cavityMastoid cavity ((Antrum Antrum
mastoideummastoideum))
aditus ad antrum aditus ad antrum mastoideummastoideum
cellulae mastoideaecellulae mastoideae ((development development
postnatally postnatally – – 6th year6th year)) Type pneumaticType pneumatic Type diploicType diploic Type scleroticType sclerotic
cellulae cellulae tympanicaetympanicae
Flat 1 layer Flat 1 layer epitheliumepithelium
Close to Close to sinus sinus sigmoideussigmoideus
mastoidectomymastoidectomy
Auditory tubeAuditory tube ( (Tuba Tuba auditivaauditiva))
Tuba auditoria, tuba Tuba auditoria, tuba pharyngotympanica, salpinx, tuba pharyngotympanica, salpinx, tuba
EustachiiEustachii ostium tympanicumostium tympanicum pars ossea (= semicanalis t.a.) – cellulae pars ossea (= semicanalis t.a.) – cellulae
pneumaticaepneumaticae pars cartilaginea – cartilago (lamina med.pars cartilaginea – cartilago (lamina med.
+ lat., lamina membranacea) – under + lat., lamina membranacea) – under mucosa of tonsilla tubaria mucosa of tonsilla tubaria GerlachiGerlachi When enlarged tonsilla – lesion of When enlarged tonsilla – lesion of
ventilation (especially in kids) ventilation (especially in kids) inflammation of midlle ear cavityinflammation of midlle ear cavity
ostium pharyngeum (v úrovni meatus nasi ostium pharyngeum (v úrovni meatus nasi inf.)inf.)
Auditory tubeAuditory tube((Tuba auditivaTuba auditiva))
Auditory tube Auditory tube ((Tuba Tuba auditivaauditiva))
Tuba auditoria, tuba Tuba auditoria, tuba pharyngotympanica, salpinx, tuba pharyngotympanica, salpinx, tuba
EustachiiEustachii Equilibrates pressure in pharynx and middle ear Equilibrates pressure in pharynx and middle ear cavitycavity
thicknessthickness 2 mm, 2 mm, lengthlength 40 mm 40 mm Transition of multilayer cylindrical epithelium in Transition of multilayer cylindrical epithelium in
single layer cylindricalsingle layer cylindrical glandulae tubariae, cup cells – in glandulae tubariae, cup cells – in
cartilagenous partcartilagenous part In kids more horizontal, shorter and widerIn kids more horizontal, shorter and wider Catetrization via nasal cavityCatetrization via nasal cavity
openingopening: : • m. tensor m. tensor tympanitympani• m. m. salpingopharynsalpingopharyngeusgeus
? role ? role of of m. m. levator velilevator veli palatini palatini not clearnot clear ? ?
• Ostmann Ostmann adipose bodyadipose body
Auditory tubeAuditory tube ( (Tuba Tuba auditivaauditiva))
Inner earInner ear ( (Auris internaAuris interna)) organum vestibulocochleareorganum vestibulocochleare Bony Bony labyrintlabyrint ( (labyrinhtus osseuslabyrinhtus osseus))
forechamberforechamber ( (vestibulumvestibulum)) Semicircular canalsSemicircular canals ( (canales semicircularescanales semicirculares)) snailsnail ( (cochleacochlea)) Inner acustic meatus Inner acustic meatus ((meatus acusticus internusmeatus acusticus internus)) spatium perilymphaticumspatium perilymphaticum
Membranous labyrinthMembranous labyrinth ( (labyrinthus labyrinthus membranaceusmembranaceus)) labyrinthus vestibularislabyrinthus vestibularis labyrinthus cochlearislabyrinthus cochlearis spatium endolymphaticumspatium endolymphaticum
Bony labyrinthBony labyrinth ( (labyrinthus labyrinthus osseusosseus))
forechamberforechamber ( (vestibulumvestibulum)) recessus ellipticusrecessus ellipticus
(utricularis)(utricularis) apertura int. apertura int.
canaliculi vestibulicanaliculi vestibuli macula cribrosa macula cribrosa
superiorsuperior crista vestibuli crista vestibuli
(pyramis vestibuli)(pyramis vestibuli) recessus sphericusrecessus sphericus
(saccularis)(saccularis) recessus cochlearisrecessus cochlearis
macula cribrosa macula cribrosa mediamedia
macula cribrosa macula cribrosa inferiorinferior
Membranous Membranous labyrint (labyrint (Labyrinthus Labyrinthus membranaceusmembranaceus))
Vestibular labyrinthVestibular labyrinth ( (Labyrinhtus Labyrinhtus vestibularis)vestibularis)
Utriculus (Utriculus (Elipsoid sacElipsoid sac)) Sacculus (Sacculus (Spherical sacSpherical sac)) Ductus semicirculares (ampullae, Ductus semicirculares (ampullae,
crura)crura) Ductus utriculosaccularis, reuniensDuctus utriculosaccularis, reuniens Macula utriculi, sacculi – membrana Macula utriculi, sacculi – membrana
statoconiorum (statoconium, striola)statoconiorum (statoconium, striola) Crista ampullaris (sulcus, cupula)Crista ampullaris (sulcus, cupula)
Otolitic organsOtolitic organssaculus et utriculussaculus et utriculus
maculamacula Hairy cellsHairy cells Supportive cellsSupportive cells GeGellatinous layeratinous layer otootoconiaconia - - crystalscrystals
CaCOCaCO33
((otoliths – term for otoliths – term for crystals in reptilescrystals in reptiles))
Bony Bony labyrint (labyrint (Labyrinhtus Labyrinhtus osseusosseus))
Semicircular canalsSemicircular canals ( (Canales Canales semicircularessemicirculares))
Canalis semicircularis anterior (Canalis semicircularis anterior (parallel to parallel to the pyramid axisthe pyramid axis) – eminentia arcuata) – eminentia arcuata
Canalis semicircularis posterior (Canalis semicircularis posterior (verticalvertical)) Canalis semicircularis lateralis (Canalis semicircularis lateralis (horizontalhorizontal) )
– prominentia c.s.l.– prominentia c.s.l.
ampulla ossea (3)ampulla ossea (3)
crus commune (ant. + post.), simplex (lat.)crus commune (ant. + post.), simplex (lat.)
Semicircular canalsSemicircular canals
Membranous inside bonyMembranous inside bony ReceptorReceptors in ampulass in ampulas cristae ampullarescristae ampullares
Crest 90° to canal axisCrest 90° to canal axis cupula – gelcupula – gelatinous substanceatinous substance Hairy cellsHairy cells Support cellsSupport cells
Hairy cellsHairy cells
Two typesTwo types On apical surfaceOn apical surface::
1 kinocili1 kinociliaa Several stereociliasSeveral stereocilias
bazbazallyally - synapse - synapse with nerve fiberswith nerve fibers
Bony lBony labyrint (abyrint (Labyrinhtus Labyrinhtus osseusosseus))
SnailSnail ( (CochleaCochlea)) cupula, basis (2 a ¾ cupula, basis (2 a ¾ coilcoil)) scala vestibuli scala vestibuli
helicotrema helicotrema scala scala tympanitympani
canalis spiralis cochleaecanalis spiralis cochleae lamina spiralis ossealamina spiralis ossea
lamella vestibularis + spiralislamella vestibularis + spiralis hamulus l.s. (hamulus l.s. (end in end in
helicotrema)helicotrema) lamina spiralis secundaria lamina spiralis secundaria
((only in first coilonly in first coil)) apertura interna canaliculi apertura interna canaliculi
cochleaecochleae
Bony Bony labyrint (labyrint (Labyrinhtus Labyrinhtus osseusosseus))
Snail Snail ((CochleaCochlea))SpindleSpindle ( (ModiolusModiolus))
basisbasis laminalamina canalis spiralis – canalis spiralis –
ganglion cochleareganglion cochleare canales longitudinales canales longitudinales
– – n. cochlearisn. cochlearis
Bony Bony labyrint (labyrint (Labyrinhtus Labyrinhtus osseusosseus))
Inner acustic meatusInner acustic meatus ( (Meatus Meatus acusticus internusacusticus internus)) porus acusticus internusporus acusticus internus
fundus m.a.i.fundus m.a.i. crista transversa + verticaliscrista transversa + verticalis area n. VII. area n. VII. area cochlearis – tractus spiralis area cochlearis – tractus spiralis
foraminosusforaminosus area vestibularis sup. + inf.area vestibularis sup. + inf. foramen singulareforamen singulare
Membranous Membranous labyrint (labyrinthus labyrint (labyrinthus membranaceus)membranaceus)
Labyrinhtus cochlearisLabyrinhtus cochlearisscala media = ductus cochlearisscala media = ductus cochlearis paries vestibularis: paries vestibularis: membrana vestibularis membrana vestibularis
ReissneriReissneri paries externus: paries externus: stria vascularisstria vascularis, prominentia , prominentia
spiralis, vas prominens, lig. spiralespiralis, vas prominens, lig. spirale paries tympanicus (= membrana spiralis): crista paries tympanicus (= membrana spiralis): crista
basilaris, basilaris, lamina basilarislamina basilaris, vas spirale, vas spirale limbus spiralis: labium limbi tympanici, labium limbus spiralis: labium limbi tympanici, labium
limbi vestibularis, (dentes acustici)limbi vestibularis, (dentes acustici) membrana tectoriamembrana tectoria Organum spirale Organum spirale CortiCorti
membrana reticularis, sulcus spiralis internus + externusmembrana reticularis, sulcus spiralis internus + externus
SnailSnail ( (CochleaCochlea))
Scala mediaScala media
Contain Contain endolymendolymphph onon lamina basilaris lamina basilaris isis Corti org Corti organan Covered by Covered by membrana tectoriamembrana tectoria Bony Bony lamina spiralislamina spiralis ligamentum spiraleligamentum spirale
Corti orgCorti organan ( (Organum Organum spirale)spirale)
Hairy cellsHairy cells outerouter (3-4 (3-4 rowsrows) a) andnd innerinner (1 (1 rowrow)) On surface On surface stereocilistereociliaa
Apices sank insideApices sank inside membrana tectoria membrana tectoria Between them Between them NuelNuelee spacespace
Supportive cellsSupportive cells pillarspillars ( (CortihoCortiho) – ) – border inner tunnelborder inner tunnel phaphalangelangealal ( (Deiters)Deiters) – – cover hairy cellscover hairy cells Outer supportiveOuter supportive – cylindric – cylindricalal HensenHensen a andnd
cuboidcuboid ClaudiusClaudius
EndolymEndolymphph a andnd perilym perilymphph
EndolymEndolymphph: : similar to intracellular fluidsimilar to intracellular fluid
stria vascularis stria vascularis scala media scala media ductus endolymphaticus ductus endolymphaticus saccus saccus endolymphaticus (endolymphaticus (blindblind) ) veinsveins
PerilymPerilymphph: : similar to CSFsimilar to CSF canalicus cochleae canalicus cochleae connected with connected with
subarachnoid spacesubarachnoid space
Inner earInner ear – – blood supplyblood supply
ArteriesArteries: : a. basilaris a. basilaris a. inf. ant. cerebelli a. inf. ant. cerebelli a. labyrinthia. labyrinthi
VeinsVeins: : vv. labyrinthi vv. labyrinthi sinus petrosus inf. sinus petrosus inf. v. aqueductus vestibuli, v. aqueductus v. aqueductus vestibuli, v. aqueductus
cochleaecochleae
LymphLymph: : replaced by replaced by endolymendolymphph a andnd perilym perilymphph
Inner earInner ear - nerv - nervesesNervus vestibularisNervus vestibularis – –
ggl. vestibulare ggl. vestibulare ScarpaeScarpae
pars superiorpars superior n. utriculoampullarisn. utriculoampullaris
pars inferiorpars inferior n. saccularisn. saccularis n. ampullaris posteriorn. ampullaris posterior
Nervus cochlearisNervus cochlearis – – ggl. cochleare ggl. cochleare CortiCorti
!!! !!! BipolBipolar neuronsar neurons !!! !!!
Tuning fork exams (Rinné, Weber, Schwabach)
Examination of nystagmus (9 directions acc to Hering)
Romberg – standing and close eyes
Hautant – sitting and arms rising forward
Unterberger – close eyes and walking on spot 30s
VIII. - Nervus VIII. - Nervus vestibulocochlearisvestibulocochlearis
examinationexamination
VIII. - Nervus vestibulocochlearisVIII. - Nervus vestibulocochlearisirritationirritation / / palsypalsy
Lesion of hearing (= hypacusis anacusis ) deafness (= surditas)
Ear lisps (= tinnitus) – humming, whistling, ringing…
giddiness (= vertigo) By will not affectable eyeball movements (=
nystagmus) Slow component – stronger side pushes weaker side Fast component – compensatory movement back –
according to it is described direction of nystagmua
Defects of gait and walking (= ataxie)
Auditory path I. Projection → Ascending → Sensory 4 – neuronal Crossed as well as not crossed
1. neuron:
Bipolar cell in ganglion cochleare Corti in shape of spiral n. cochlearis n. VIII tract divides into 2 parts into nuclei cochleares ant. + post.
2. neuron: pons
Cells in nucleus cochlearis posterior (depth of tones) et anterior (intenzity of tones) – separated by pedunculus cerebellaris inferior crossing lemniscus lateralis colliculus inferior
Side tract:
nucleus olivaris superior ( contralaterally is inhibited from ncl. v corpus trapezoideum) estimation of space orientation of hearing
Auditory path II.
Auditory path
Auditory path III.
3. neuron: mesencephalon
cells in colliculus inferior brachium coll.inf.
tonotopic organization
commissura colliculi inferioris
4. neuron: diencephalon - metathalamus
cells in corpus geniculatum mediale lobus temporalis - gyrus temporalis transversus Heschli, area 41, 42
Auditory path – 3D
Vestibular path I.
• Projection → Ascending → SensoryProjection → Ascending → Sensory
• 3-neuronal, crossed3-neuronal, crossed
1. neuron1. neuron: bipolar cell ganglion vestibulare : bipolar cell ganglion vestibulare ScarpaeScarpae n. vestibularis n. vestibularis n. VIII n. VIII
• Part of fibers runs as tractus Part of fibers runs as tractus vestibulocerebellaris directus w/o vestibulocerebellaris directus w/o interconnection into cerebelluminterconnection into cerebellum
2. neuron2. neuron: cells nuclei vestibulares pontis : cells nuclei vestibulares pontis axons axons into different structuresinto different structures
Vestibular path II. – where to?
Cerebral cortex cerebellum RF → facilitatory descending system spine Nuclei of eyeball moving muscles
Via paramedial pontine RF reflex head-eyeball
3. neuron: cells nuclei ventrales thalami cerebral cortex
• lobus parietalis - gyrus postcentralis (area 2) – primary cortex
• parieto-inzular cortex (gyrus insularis longus) + lobus temporalis - gyrus temporalis transversus Heschli (area 41,42)
Vestibular path III. – into cortex
Tractus vestibulocerebellaris directusvestibulum corpus juxtarestiforme (v
PCI) nodulus + uvula (ipsilat.)
Tractus vestibulocerebellaris indirectus
vestibulum ncl. vestibulares corpus juxtarestiforme (v PCI) lobulus flocclulonodularis + vermis (bilat.)
Vestibular path III. – into cerebellum
Vestibular path III. – into spine
Ncl. fastigii cerebelli ncl. vestibularis lat. Deitersi (bilat.) tr. vestibulospinalis lateralis alfa + gama-motoneurons of extensors
Ncl. vestibularis medialis + inferior fasciculus longitudinalis medialis interneurons (+ and -) in cervica spine
reflex head-eye
ExaminationExamination otosotosccopopyy, otomi, otomiccrosrosccopopyy – – tympanice membranetympanice membrane
paracentparacentesisesis, gromet, grometss Tuning fork examinationsTuning fork examinations VestibulooVestibuloocculular ar reflex – nystagmusreflex – nystagmus vestibulospinvestibulospinalal reflex ( reflex (Romberg, UnterbergRomberg, Unterbergeer r
test)test) X-rayX-ray ( (projeprojectionction Stenvers – meatus acusticus Stenvers – meatus acusticus
intenrus, Schintenrus, Schüüller – proc. mastoideus)ller – proc. mastoideus), CT, , CT, angiograangiographyphy
audiometraudiometryy BER/BERA (ERA, AEP, ABR)BER/BERA (ERA, AEP, ABR) otoaotoaccustic emisustic emisionion ( (from external hairy cellsfrom external hairy cells)) nystagmus – ENG (PENG), nystagmus – ENG (PENG), calorycalory test test
Symptoms and ilnessesSymptoms and ilnesses Eye painEye pain = otalgi = otalgiaa giddinessgiddiness = vertigo = vertigo humminghumming / / whistlingwhistling = tinnitus = tinnitus nystagmus = nystagmus = fast synkinetic movementsfast synkinetic movements Cloth earsCloth ears - hypacusis - hypacusis deafnessdeafness = surditas = surditas morbus Menimorbus Menièère – ionre – ionic ic dysbalancedysbalance AterosAterosclerosis of clerosis of a. lybyrinthia. lybyrinthi meningitis – meningitis – most common reason for acquired most common reason for acquired
deafnessdeafness TreatmentTreatment: vazodilata: vazodilatationtion
Development of auditory and Development of auditory and vestibular systemvestibular system
3 3 sourcessources + nerv + nerve fiberse fibers 1. 1. branchial arch, cleft and membranebranchial arch, cleft and membrane MezenchymMezenchyme of e of 1 1stst a andnd 2 2ndnd branchial branchial
archarch Surface Surface eecctoderrm toderrm of the headof the head
Fibers from Fibers from mezencemezencephalonphalon
Development of external eaeDevelopment of external eae
meatus acusticus externusmeatus acusticus externus 11stst branchial cleftbranchial cleft After delivery shortAfter delivery short ( (danger of lesiondanger of lesion))
pinnapinna 6 auri6 auricular tuberclescular tubercles (mezenchym (mezenchymee)) Mostly Mostly 22ndnd branchial archbranchial arch ( (but also but also 11stst))
appendices preauricularesappendices preauriculares
Development of external earDevelopment of external ear
Development of middle earDevelopment of middle ear
11stst branchial exaginationbranchial exagination tuba auditiva et cavum tympanituba auditiva et cavum tympani
1. 1. branchial archbranchial arch malleus, incusmalleus, incus lig. mallei anteriuslig. mallei anterius m. tensor tympanim. tensor tympani
2. 2. branchial archbranchial arch stapesstapes m. stapediusm. stapedius
Development of middle earDevelopment of middle ear
antrum mastoideumantrum mastoideum Are not present Are not present cellulae mastoideae cellulae mastoideae
after deliveryafter delivery Appears in Appears in 22nd yearnd year Finished pneumatization cca in 6th yearFinished pneumatization cca in 6th year
Development of Development of membrana membrana tympanitympani
Outer epithelium from Outer epithelium from 11stst branchial cleftbranchial cleft
Inner epithelium from Inner epithelium from 11stst branchial branchial exaginationexagination
mezenchyme mezenchyme of of 11stst a andnd 2 2nd branchial nd branchial archarch
Development of inner earDevelopment of inner ear
Start at Start at 44th weekth week - - otic plaotic placcododee ((ektodermektoderm))
Auditory pitAuditory pit Auditory sacAuditory sac (otocyst) (otocyst)
Extension for Extension for ductus + saccus ductus + saccus endolymphaticusendolymphaticus
DorzDorzal part al part utriutricculularar VentrVentral part al part sasaccularccular
Development of inner earDevelopment of inner ear
From utricular partFrom utricular part DisDiscoid extensionscoid extensions - ductus semicirculares - ductus semicirculares Widening into Widening into ampulampulaa a and origin of crestsnd origin of crests
From saccular partFrom saccular part divertikulum ductus cochlearis (divertikulum ductus cochlearis (convolutedconvoluted)) Origin of Origin of ductus reuniensductus reuniens Corti orgCorti orgaan (n (from the wall of from the wall of d. cochlearis)d. cochlearis) Origin of Origin of ganglion spiraleganglion spirale
Development of inner earDevelopment of inner ear
Surrounding Surrounding mezenchymmezenchymee changes into changes into cartillagenous cartillagenous capsula oticacapsula otica
There appears cavities and thus originate There appears cavities and thus originate perilymperilymphatic spacesphatic spaces
inin 20. - 22. 20. - 22. week cartillagenous model week cartillagenous model ossifiesossifies
CCaassuistiuisticc 1 1
malemale, 28 , 28 yearsyears Returned from vacation in EgyptReturned from vacation in Egypt otalgiotalgiaa 3 d 3 daysays Pain during palpationPain during palpation
objeobjectivective examination:examination: palpa palpatory sensitive tory sensitive tragustragus
otosotoscopycopy: : oedematic and reddish auditory oedematic and reddish auditory canal with white cellular detritecanal with white cellular detrite
CCaassuistiuisticc 1 - diagn 1 - diagnosisosis
otitis externaotitis externa Ilness of summer monthes and swimmingIlness of summer monthes and swimming
complicationscomplications: : especially in especially in DMDM
perichondritis perichondritis or destruction of or destruction of temporal bonetemporal bone
CCaassuistiuistic c 22
femalefemale, 3 , 3 yearsyears In the night burning pain of right ear, In the night burning pain of right ear,
crying, cannot ease, 2 days runny nosecrying, cannot ease, 2 days runny nose In the waiting room vomitingIn the waiting room vomiting temperaturetemperature 38,3°C 38,3°C
otosotoscopycopy: : tympanic membrane reddish, tympanic membrane reddish, smeared, protruding backsidesmeared, protruding backside
CCaassuistiuisticc 2 - 2 - diagndiagnosisosis
otitis media acuta l. dx.otitis media acuta l. dx.
treatment:treatment: paracentesis paracentesis
complicationscomplications: perfora: perforation of tympanic tion of tympanic membranemembrane
mastoiditis mastoiditis tromb trombosis of sosis of sinus inus sigmoideussigmoideus
labyrinthitislabyrinthitis (chronic otitis media)(chronic otitis media) grometa
CCaassuistiuisticc 3 3 femalefemale, 34 let, 34 let Pressure in left earPressure in left ear, , sudden cloth ear, sudden cloth ear,
humming humming tinnitus, rotatinnitus, rotatory vertigo, vomitustory vertigo, vomitus Vertigo disappearedVertigo disappeared, , the rest is still therethe rest is still there ObjeObjective examinationctive examination: harmonic : harmonic
vestibulvestibularar eventsevents (= (= dominance of on dominance of on labyrinthuslabyrinthus))
audiometraudiometryy: percep: perceptivetive cloth earcloth ear apiapiccooccochleochlearlyarly
treatmenttreatment: vazodilata: vazodilatationtion
CCazuistiazuisticc 3 - diagn 3 - diagnosisosis
MeniMenièèr r ilnessilness hydrops hydrops of the of the labyrintlabyrinthh
Mont after patient returns with the same Mont after patient returns with the same problemsproblems
dif.dgdif.dg.: .: circulatory problemscirculatory problems, , aterosateroscclerlerosisosis, , sclerosis multiplexsclerosis multiplex, , neurinom neurinom of the n. VIIIof the n. VIII