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Auditory and Auditory and vestibular systemvestibular system
AurisAuris, is, is = Us = Us, oton, oton
Auditory and vestibular Auditory and vestibular systemsystem
external ear external ear
((auris auris externaexterna))
middle earmiddle ear
((auris mediaauris media)) internal earinternal ear
((auris auris internainterna))
= organum = organum
vestibulo-vestibulo-
cochlearecochleare
External ear (External ear (Auris Auris externaexterna))
auricle auricle ((auriculaauricula, , pinnapinna) ) elastic cartilageelastic cartilage
external acoustic external acoustic meatusmeatus
((meatus acusticus meatus acusticus externusexternus))
tympanic membranetympanic membrane
((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 surfaceposterior surface = negative = negative image of the anterior oneimage of the anterior one
AuriclAuriclee
ligamentsligaments: lig. auriculare ant., : lig. auriculare ant., sup., post.sup., post.
musclesmuscles - - innervationinnervation: : n. facialisn. facialis extrinsic musclesextrinsic muscles = facial = facial
musclesmuscles mm. auriculares (ant., sup., inf.)mm. auriculares (ant., sup., inf.) m. temporoparietalism. temporoparietalis
intrinsic musclesintrinsic muscles: : rudimentaryrudimentary m. tragicus + antitragicusm. tragicus + antitragicus m. helicis major+minorm. helicis major+minor m. obliquus + transversus auriculae, m. obliquus + transversus auriculae,
m. pyramidalis auriculaem. pyramidalis auriculae
cartilage:cartilage: cartilago auriculae - cartilago auriculae - elasticelastic
skinskin: dorsally more loosen, : dorsally more loosen, ventrally firmly fixed to ventrally firmly fixed to perichondrium - perichondrium - othematomaothematoma
Auricle – Auricle – supplysupply arteriesarteries: rr. auriculares ant. : rr. auriculares ant. a. a.
temporalis superficialistemporalis superficialis a. auricularis post. a. auricularis post. a. carotis a. carotis
externaexterna veinsveins: : v. jugularis ext.v. jugularis ext. lymphlymph: nn.ll. parotidei, mastoidei: nn.ll. parotidei, mastoidei nervesnerves: sensory: sensory
nn. auriculares ant. from nn. auriculares ant. from n. auriculotemporalis (n. auriculotemporalis (ventrocranial 2/3ventrocranial 2/3)) r. auricularis n. X. (r. auricularis n. X. (conchaconcha)) n. occipitalis minor (n. occipitalis minor (dosrocranialdosrocranial)) n. auricularis magnus (n. auricularis magnus (cudalcudal))
motor: n. VII.motor: n. VII.
External acoustic meatusExternal acoustic meatus((meatus acusticus meatus acusticus
externusexternus)) porus acusticus externus porus acusticus externus oblique ventromed. oblique ventromed. med. med.
again oblique ventromed. (totally converging again oblique ventromed. (totally converging ventrally 160ventrally 160º and convex descending, length about 22 º and convex descending, length about 22 mm)mm)
outer 2/3 – hyalinne cartilage opened ventrally and outer 2/3 – hyalinne cartilage opened ventrally and caudally (incisurae caudally (incisurae SantoriniSantorini), lamina tragi (ventrally)), lamina tragi (ventrally)
transition – the narrowest point (isthmus) – transition – the narrowest point (isthmus) – foreign foreign bodies !!!bodies !!!
inner inner 1/3 – 1/3 – osseous osseous – incisura tympanica – incisura tympanica RiviniRivini glandulae ceruminosae + sebaceaeglandulae ceruminosae + sebaceae cerumen – cerumen –
protectionprotection tragi (tragi (after age 30after age 30)) skin adheres firmly to pskin adheres firmly to perichondriuerichondriumm – – little little
inflammation is painfulinflammation is painful !!! !!! anterior wallanterior wall: : realtion torealtion to gl. parotis a gl. parotis andnd art. art.
temporomandibularistemporomandibularis
External acoustic meatusExternal acoustic meatus((meatus acusticus externusmeatus acusticus externus))
supplysupply arteriesarteries: similar to auricle + a. : similar to auricle + a.
auricularis prof. auricularis prof. a. maxillarisa. maxillaris veinsveins: v. temporalis superficilais, v. : v. temporalis superficilais, v.
auricularis post.auricularis post. lymphlymph: nn.ll. parotidei, mastoidei: nn.ll. parotidei, mastoidei nervesnerves: : r. auricularis n.X.r. auricularis n.X. (dorsocaudal (dorsocaudal
part), n. auriculotemporalis part), n. auriculotemporalis r. meatus r. meatus acustici externiacustici externi
Tympanic membrane - Tympanic membrane - structurestructure
sulcus tympanicus, incisura tympanica sulcus tympanicus, incisura tympanica RiviniRivini 9x10 mm, thickness 0,1 mm, surface 55 mm9x10 mm, thickness 0,1 mm, surface 55 mm22
anulus fribrocartilagineusanulus fribrocartilagineus
outer surface - thinned epidermis (outer surface - thinned epidermis (ectodermectoderm)) layer of dense connective tissue layer of dense connective tissue
((mesenchymemesenchyme)) inner surface – simple cuboid epitlelium inner surface – simple cuboid epitlelium
((endodermendoderm))
Tympanic Tympanic membrane membrane OtoscopyOtoscopy
umbo m.t.umbo m.t. stria mallearisstria mallearis prominetia mallearisprominetia mallearis plica mallearis ant. + post.plica mallearis ant. + post. light reflex – trigonum light reflex – trigonum WildeWilde(= cone of light, light reflex, Politzer's (= cone of light, light reflex, Politzer's luminous cone) luminous cone) Bezold‘s triasBezold‘s trias: prominentia + stria + : prominentia + stria + reflexreflexpars flaccida pars flaccida ShrapnelliShrapnelli (5 mm (5 mm22) x pars ) x pars tensatensa
- declination (50- declination (50ºº sagitally) sagitally)- inclination (45 - inclination (45 ºº transversally) transversally)
paracentesisparacentesis: dosrocaudal quadrant: dosrocaudal quadrant
Tympanic membrane - Tympanic membrane - supplysupply
arteriesarteries:: a. auricularis prof. a. auricularis prof. a. maxillaris a. maxillaris
(outer surface)(outer surface) aa. tympanicae (inner surface)aa. tympanicae (inner surface)
lymphlymph: nnl.l. mastoidei, parotidei: nnl.l. mastoidei, parotidei nervesnerves::
a. auricularis n.X.a. auricularis n.X. n. auriculotemporalis n. auriculotemporalis r. r.
membranae tympanicaemembranae tympanicae
Střední ucho (Střední ucho (Auris Auris mediamedia))
Středoušní dutina Středoušní dutina ((Cavitas tympaniCavitas tympani))
Středoušní kůstky Středoušní kůstky ((Ossicula aditusOssicula aditus))
Středoušní klouby Středoušní klouby ((Articulationes Articulationes ossiculorum auditusossiculorum auditus))
Středoušní svaly Středoušní svaly ((Musculi Musculi ossiculorum auditusossiculorum auditus))
Sluchová trubice Sluchová trubice ((Tuba auditivaTuba auditiva EustachiiEustachii))
Tympanic cavity (Tympanic 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 antrum mastoideum (+ cellulae mastoideae)mastoideae)
paries paries caroticuscaroticus paries paries membranaceusmembranaceus paries labyrinthicusparies labyrinthicus
promontorium promontorium – first thread of – first thread of cochleacochlea
sulcus sulcus promontorii – promontorii – plexus plexus tympanicustympanicus
fenestra fenestra vestibulivestibuli (= (= ovalis) – basis ovalis) – basis stapedis + stapedis + membrana membrana stapediastapedia
fenestra fenestra cochlaecochlae (= (= rotunda) – rotunda) – membrana membrana tympani tympani secundariasecundaria
Tympanic cavityTympanic cavityparies labyrinthicusparies labyrinthicus
Tympanic cavity - Tympanic 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: nn.ll. parotidei, mastoidei, : nn.ll. parotidei, mastoidei,
cervicales profundi, retropharyngeicervicales profundi, retropharyngei nervesnerves: :
n. tympanicus (n.IX) – sensory + n. tympanicus (n.IX) – sensory + parasympathetic (ganglion tympanicum)parasympathetic (ganglion tympanicum)
r. pharyngeus (n.V2) for cartilagineous r. pharyngeus (n.V2) for cartilagineous part of auditory tubepart of auditory tube
nn. caroticotympanici (sympathetic)nn. caroticotympanici (sympathetic)
Auditory ossicles (Auditory ossicles (Ossicula Ossicula aditusaditus))
MalleusMalleus (Hammer(Hammer)) caputcaput collumcollum manubriummanubrium processus lateralisprocessus lateralis processus anteriorprocessus anterior
Auditory ossicles (Auditory ossicles (Ossicula Ossicula aditusaditus))
Incus Incus ((AnvilAnvil)) corpuscorpus crus longumcrus longum
processus lenticularisprocessus lenticularis crus brevecrus breve
Stapes Stapes ((StirrupStirrup)) caputcaput (collum)(collum) crus ant. + post.crus ant. + post. basisbasis
Junctures and articulationsJunctures and articulations((Articulationes ossiculorum Articulationes ossiculorum
auditusauditus))
art. incudomallearis art. incudomallearis (saddle-shape)(saddle-shape)
art. incudostapedia art. incudostapedia (ball and socket)(ball and socket)
syndesmosis syndesmosis tympanostapedialistympanostapedialis
otosclerosis – otosclerosis – ossificationossification
sometimes both joints are sometimes both joints are replaced with replaced with syndesmosissyndesmosis
Ligaments Ligaments ((Ligg. ossiculorum Ligg. ossiculorum auditusauditus))
lig. mallei antlig. mallei ant. (spina . (spina o.s.)+ o.s.)+ supsup.+ .+ latlat..
lig. incudis suplig. incudis sup. . (fossa i.) + (fossa i.) + postpost..
membrana membrana stapedialisstapedialis (fenestra (fenestra vestibuli)vestibuli)
lig. anulare lig. anulare stapedialestapediale (fenestra (fenestra vestibuli)vestibuli)
membrana tympani membrana tympani secundariasecundaria
(fenestra cochleae)(fenestra cochleae)
Muscles of Muscles of auditory auditory ossiclesossicles
m. tensor tympanim. tensor tympani semicanalis m.t.t.semicanalis m.t.t. processus cochleariformisprocessus cochleariformis manubrium malleimanubrium mallei
inervace:inervace: n.V3 n.V3
m. stapediusm. stapedius eminetia pyramidaliseminetia pyramidalis collum stapediscollum stapedis
innervation:innervation: n.VII n.VIIn. stapedius z pars n. stapedius z pars
mastoidea canalis nervi mastoidea canalis nervi facialisfacialis
Tympanic cavityTympanic cavity shape of hourglass– 2 mm at level of tympanic shape of hourglass– 2 mm at level of tympanic
membrane (= mesotympanon)membrane (= mesotympanon) recessus epitympanicus (= recessus epitympanicus (= atticusatticus, epitympanon, , epitympanon,
epitympanum) – 6 mmepitympanum) – 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‘s spacePrussak‘s space)) plica chordae tympani, incudialis, stapedialisplica chordae tympani, incudialis, stapedialis mucosa – simple cuboid epitlelium (various height)mucosa – simple cuboid epitlelium (various height) mucous cells olny close to the ositum tubae mucous cells olny close to the ositum tubae
auditivareauditivare !!!!!! no glands !!!no glands !!!
Mastoid antrumMastoid antrum((Antrum mastoideumAntrum mastoideum))
aditus ad antrum aditus ad antrum mastoideummastoideum
cellulae mastoideaecellulae mastoideae
((developing developing postnatally – 6th year postnatally – 6th year of ageof age)) pneumatic typepneumatic type diploic typediploic type sclerotic typesclerotic type
cellulae tympanicaecellulae tympanicae simple flat simple flat
epitheliumepithelium closely related to closely related to
sinus sigmoideussinus sigmoideus mastoidectomymastoidectomy
Pharyngotympanic / Pharyngotympanic / auditory tube (auditory 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) – tonsilla + lat., lamina membranacea) – tonsilla tubaria tubaria Gerlachi Gerlachi located under the located under the mucosamucosa in hypertorphy of tonsilla pharyngealis in hypertorphy of tonsilla pharyngealis
ventilation disturbance (mainly in ventilation disturbance (mainly in children) children) mesotitis mesotitis
ostium pharyngeum (at level of meatus ostium pharyngeum (at level of meatus nasi inf.)nasi inf.)
Pharyngotympanic / Pharyngotympanic / auditory tube (auditory tube (Tuba Tuba
auditivaauditiva) ) Tuba auditoria, tuba Tuba auditoria, tuba pharyngotympanica, salpinx, tuba pharyngotympanica, salpinx, tuba
EustachiiEustachii equalizes pressure in pharynx and in equalizes pressure in pharynx and in
tympanic cavitytympanic cavity width 2 mm, length 40 mmwidth 2 mm, length 40 mm transition of pseudostrstified columnar transition of pseudostrstified columnar
epithelium into simple columnarepithelium into simple columnar glandulae tubariae, mucous cells – glandulae tubariae, mucous cells – in in
cartilagineous partcartilagineous part in children: more, horizntal, shorter and in children: more, horizntal, shorter and
widerwider cathetrizatino via nasal cavitycathetrizatino via nasal cavity
opening: opening: • m. tensor m. tensor tympanitympani• m. m. salpingopharynsalpingopharyngeusgeus
? role of ? role of m. m. levator velilevator veli palatini unclear ?palatini unclear ?
• Ostmann‘s fat Ostmann‘s fat padpad
Pharyngotympanic / auditory tube((Tuba Tuba
auditivaauditiva))
Internal ear (Internal ear (Auris Auris internainterna))
organum vestibulocochleareorganum vestibulocochleare osseous labyrinth osseous labyrinth ((labyrinhtus osseuslabyrinhtus osseus))
vestibule (vestibule (vestibulumvestibulum)) semicircular canals (semicircular canals (canales semicircularescanales semicirculares)) cochleacochlea internsl acoustic meatus (internsl acoustic meatus (meatus acusticus meatus acusticus
internusinternus)) spatium perilymphaticumspatium perilymphaticum
membranous labyrinthmembranous labyrinth ( (labyrinthus labyrinthus membranaceusmembranaceus)) labyrinthus vestibularislabyrinthus vestibularis labyrinthus cochlearislabyrinthus cochlearis spatium endolymphaticumspatium endolymphaticum
Osseous labyrinth (Osseous labyrinth (labyrinthus labyrinthus osseusosseus))
vestibule (vestibule (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 labyrinth(labyrinth(Labyrinthus Labyrinthus
membranaceusmembranaceus))Vestribular labyrinth (Vestribular labyrinth (Labyrinhtus Labyrinhtus
vestibularis)vestibularis) utricle (utricle (utricuusutricuus)) saccule (saccule (sacculussacculus)) semicircular ducts (semicircular ducts (ductus ductus
semicircularessemicirculares)) ampullae, cruraampullae, 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)
Otolithic organsOtolithic organssaculus et utriculussaculus et utriculus
maculamacula hair cellshair cells supporting cellssupporting cells gelatinous layergelatinous layer otootoconiaconia – crystal of CaCO – crystal of CaCO33
((otoliths – term for crystal in reptilesotoliths – term for crystal in reptiles))
Osseous labyrith (Osseous labyrith (Labyrinhtus Labyrinhtus osseusosseus))
Semicircular canals (Semicircular canals (Canales Canales semicircularessemicirculares))
Canalis semicircularis anterior (parallel Canalis semicircularis anterior (parallel with axis of petrosal bone) – eminentia with axis of petrosal bone) – eminentia arcuataarcuata
Canalis semicircularis posterior Canalis semicircularis posterior (perpendicular)(perpendicular)
Canalis semicircularis lateralis (horizontal) Canalis semicircularis lateralis (horizontal) – 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 canals and Semicircular canals and ductsducts
membranous ducts in bony canalsmembranous ducts in bony canals receptors in ampullaereceptors in ampullae cristae ampullarescristae ampullares
perpendicular to axis of canal perpendicular to axis of canal gelatinous massgelatinous mass hair cellshair cells supporting cellssupporting cells
Hair cellsHair cells
two typestwo types apical surface:apical surface:
1 kinocilia1 kinocilia more stereociliamore stereocilia
basally – synapsis with nerve fibersbasally – synapsis with nerve fibers
Osseous labyrinth (Osseous labyrinth (Labyrinhtus Labyrinhtus osseusosseus))CochleaCochlea
cupula, basis (2 and ¾ cupula, basis (2 and ¾ thread)thread)
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. (ends in ends in
helicotrema)helicotrema) lamina spiralis secundaria (lamina spiralis secundaria (in in
first thread only)first thread only) apertura interna canaliculi apertura interna canaliculi
cochleaecochleae
Osseous labyrinth (Osseous labyrinth (Labyrinhtus Labyrinhtus osseusosseus))CochleaCochlea
ModiolusModiolus basisbasis laminalamina canalis spiralis – canalis spiralis –
ganglion cochleareganglion cochleare canales longitudinales canales longitudinales
– – n. cochlearisn. cochlearis
Osseous labyrinth (Osseous labyrinth (Labyrinhtus Labyrinhtus osseusosseus))
Internal acoustic meatus (Internal acoustic 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 labyrinth (Membranous labyrinth (labyrinthus labyrinthus membranaceusmembranaceus))
Cochlear labyrinth Cochlear labyrinth ((Labyrinthus Labyrinthus cochleariscochlearis))
scala 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
Scala mediaScala media
contains endolymphcontains endolymph lamina basilaris with Corti‘s organlamina basilaris with Corti‘s organ membrana tectoria covers Corti‘s membrana tectoria covers Corti‘s
organorgan osseous lamina spiralisosseous lamina spiralis ligamentum spiraleligamentum spirale
Corti‘s / spiral organ (Corti‘s / spiral organ (Organum Organum spiralespirale))
hair cellshair cells external (3-4 rows) and internal (1 row)external (3-4 rows) and internal (1 row) stereocilia on surfacestereocilia on surface
ends inserted in membrana tectoriaends inserted in membrana tectoria Nuel‘s space Nuel‘s space in betweenin between
supporting cellssupporting cells pillar cells (pillar cells (CortiCorti ) ) – lay the internal – lay the internal
tunneltunnel phalangeal (phalangeal (DeitersDeiters)) – cover hair cells– cover hair cells outer supporting – columnar (outer supporting – columnar (HensenHensen) )
and cuboid (Claudius)and cuboid (Claudius)
Endolymph and Endolymph and perilymphperilymph
endolymphendolymph: similar to intracellular : similar to intracellular fluid fluid
stria vascularis stria vascularis scala media scala media ductus ductus endolymphaticus endolymphaticus saccus saccus endolymphaticus (blind) endolymphaticus (blind) veins veins
perilymphperilymph: similar to CSF: similar to CSF
canalicus cochleae is connected with canalicus cochleae is connected with subarachnoid spacesubarachnoid space
Internal ear – Internal ear – vascular vascular supplysupply
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 with endolymph and : replaced with endolymph and perilymphperilymph
Internal ear - Internal ear - nervesnervesnervus 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. – ggl. cochleare cochleare CortiCorti
!!! !!! bipolar neuronsbipolar neurons !!! !!!
tuning-fork examination tuning-fork examination ((Rinné, WeberRinné, Weber, Schwabach), Schwabach)
examination of examination of nystagmusnystagmus (9 (9 direction – Hering direction – Hering classification) classification)
RombergRomberg – stand with closed – stand with closed eyeseyes
HautantHautant – sit, strecht arms – sit, strecht arms forwards and close eyesforwards and close eyes
UnterbergerUnterberger – close eyes and – close eyes and march on site for 30 smarch on site for 30 s
VIII. - Nervus VIII. - Nervus vestibulocochlearisvestibulocochlearis
examinationexamination
VIII. - Nervus VIII. - Nervus vestibulocochlearisvestibulocochlearis
irritation / palsyirritation / palsy affection of hearing (= hypacusis affection of hearing (= hypacusis anacusis ) anacusis )
deafness (= surditas)deafness (= surditas) tinnitus – humming, screeching ,ringing…tinnitus – humming, screeching ,ringing… dizzines (= vertigo)dizzines (= vertigo) involuntary eye movement (= involuntary eye movement (= nystagmus))= alternating smooth pursuit in one direction = alternating smooth pursuit in one direction
and saccadic movements in the other direction. and saccadic movements in the other direction. slow-phase – stronger side suppresses the weaker slow-phase – stronger side suppresses the weaker
oneone fast-phase – compenstory movements back – serve fast-phase – compenstory movements back – serve
for description of nystagmusfor description of nystagmus
disorders of stand and gait (= ataxia)disorders of stand and gait (= ataxia)
Auditory tract I. projection → ascending → sensory 4-neuron-tract decussated and partly non-decussated
1st neuron:
bipolar cell in ganglion cochleare Corti in shape of spiral n. cochlearis n. VIII splits into two fasciculi nucleus cochlearis ant. + post.
2nd neuron: pons
cells in nucleus cochlearis posterior (depth of tones) et anterior (intensity of tones) – separated with pedunculus cerebellaris inferior →→ decussatio → → lemniscus lateralis →→ colliculus inferior
collateral to:
nucleus olivaris superior ( inhibited collaterally from ncl. corporis trapezoidei) →→ learning of auditory space orientation
Auditory tract II.
Auditory tract III.
3rd neuron: mesencephalon
cells in colliculus inferior →→ brachium colliculi inferioris
tonotopic arrangement
commissura colliculi inferioris
4. neuron: diencephalon - metathalamus
cells in corpus geniculatum mediale →→ lobus temporalis - gyrus temporalis transversus Heschli, area 41, 42
Vestibular tract I.Vestibular tract I.
• projection → ascending → sensoryprojection → ascending → sensory
• 3-neuron-tract, decussated3-neuron-tract, decussated
1st neuron1st neuron: bipolar cell in ganglion vestibulare : bipolar cell in ganglion vestibulare ScarpaeScarpae → n. vestibularis → n. VIII → n. vestibularis → n. VIII
• some fibers run as tractus vestibulocerebellaris some fibers run as tractus vestibulocerebellaris directus to cerebellum without interpolationdirectus to cerebellum without interpolation
2nd neuron2nd neuron: cells in nuclei vestibulares pontis → : cells in nuclei vestibulares pontis → axons into various structures of CNSaxons into various structures of CNS
Vestibular tract II. – where?
cerebral cortex cerebellum RF → fascilitating descending system spinal cord nuclei of oculomotor nerves
via paramedian pontine RF reflex hhad-eye
3rd neuron: cells in nuclei ventrales thalami →→ cerebral cortex
• lobus parietalis - gyrus postcentralis (area 2) – primary cortex
• parieto-insular cortex (gyrus insularis longus) + lobus temporalis - gyrus temporalis transversus Heschli (area 41,42)
Vestibular tract III. – to cortex
tractus vestibulocerebellaris directusvestibulum →→ corpus juxtarestiforme (via
PCI) →→ nodulus + uvula (ipsilat.)
tractus vestibulocerebellaris indirectusvestibulum →→ ncl. vestibulares →→ corpus
juxtarestiforme (via PCI) →→ lobulus flocclulonodularis + vermis (bilat.)
Vestibular tract III. – to cerebellum
Vestibular tract III. – to spinal cord
ncl. fastigii cerebelli →→ ncl. vestibularis lat. Deitersi (bilat.) →→ tr. vestibulospinalis lateralis →→ alfa + gama-motoneurons for extensors
ncl. vestibularis medialis + inferior →→ fasciculus longitudinalis medialis →→ interneurons (+ a -) in cervical spinal cord
reflex head-eye
ExaminationExamination otoscopy, otomicroscopy – tympanic membraneotoscopy, otomicroscopy – tympanic membrane
paracentesis, grometesparacentesis, grometes tuning fork examinationstuning fork examinations vestibuloocular reflex – nystagmusvestibuloocular reflex – nystagmus vestibulospinal reflexes (vestibulospinal reflexes (Romberg‘s, Romberg‘s,
Unterberger‘s test)Unterberger‘s test) X-ray (X-ray (Stenvers‘ projection– meatus acusticus Stenvers‘ projection– meatus acusticus
internus, Schinternus, Schüüller‘s – proc. mastoideus)ller‘s – proc. mastoideus), CT, , CT, angiographyangiography
audiometryaudiometry BER/BERA (ERA, AEP, ABR)BER/BERA (ERA, AEP, ABR) otoakustické emise (otoakustické emise (z vnějších vláskových z vnějších vláskových
buněkbuněk)) nystagmus – ENG (PENG), caloric testnystagmus – ENG (PENG), caloric test
Symptoms and diseasesSymptoms and diseases ear pain = otalgieear pain = otalgie dizziness = vertigodizziness = vertigo spontaneous ringing and buzzing in ears = spontaneous ringing and buzzing in ears =
tinnitustinnitus nystagmus = rhythmic, oscillating motions of nystagmus = rhythmic, oscillating motions of
eyeseyes hypacusishypacusis deafness= surditasdeafness= surditas morbus Menimorbus Menièère – ions dysbalancere – ions dysbalance atherosclerosis of a. lybyrinthiatherosclerosis of a. lybyrinthi meningitis – meningitis – most frequent cause of acquired most frequent cause of acquired
deafnessdeafness treatment: vasodilating drugstreatment: vasodilating drugs
Development of Development of vestibulo-cochlear vestibulo-cochlear
systemsystem3 sources+ nerve fibers3 sources+ nerve fibers 1st pharyngeal pouch, cleft and 1st pharyngeal pouch, cleft and
membranemembrane mezenchyme of 1st and 2nd mezenchyme of 1st and 2nd
pharyngeal archpharyngeal arch surface ectoderrm of headsurface ectoderrm of head
fibers from mesencephalonfibers from mesencephalon
Development of external Development of external earear
meatus acusticus externusmeatus acusticus externus 1st phryngeal cleft1st phryngeal cleft short in birth (beware of injury!)short in birth (beware of injury!)
pinnapinna 6 auriculr tubercles (mesenchyme)6 auriculr tubercles (mesenchyme) mainly from 2nd pharyngelaarchmainly from 2nd pharyngelaarch
with contribution of 1st one as wellwith contribution of 1st one as well
appendices preauricularesappendices preauriculares
Development of middle Development of middle earear
1st pharyngeal pouch1st pharyngeal pouch tuba auditiva et cavum tympanituba auditiva et cavum tympani
1st pharyngeal arch1st pharyngeal arch malleus, incusmalleus, incus lig. mallei anteriuslig. mallei anterius m. tensor tympanim. tensor tympani
2ndst pharyngeal arch2ndst pharyngeal arch stapesstapes m. stapediusm. stapedius
Development of middle Development of middle earear
antrum mastoideumantrum mastoideum cellulae mastoideae are not cellulae mastoideae are not
developed at birthdeveloped at birth appear at 2nd year of ageappear at 2nd year of age pneumatization finished in 6th pneumatization finished in 6th
year of ageyear of age
Development of Development of membrana tympanimembrana tympani
outer epithelium from 1st pharyngeal outer epithelium from 1st pharyngeal cleftcleft
inner epithelium from 1st pharyngeal inner epithelium from 1st pharyngeal pouchpouch
mesenchyme from 1st and 2nd mesenchyme from 1st and 2nd pharyngeal pharyngeal archarch
Development of internal Development of internal earear
beginning of 4th week – beginning of 4th week – otic placod otic placod ((ectodermectoderm))
auditory pitchauditory pitch auditory vesicle (otocyst)auditory vesicle (otocyst)
process for ductus + saccus process for ductus + saccus endolymphaticusendolymphaticus
dorsal part - utriculardorsal part - utricular ventral part - saccularventral part - saccular
Development of internal Development of internal earear
utricular part → :utricular part → : discoid processes → ductus semicircularesdiscoid processes → ductus semicirculares rozšíření v ampulu a vznik kristrozšíření v ampulu a vznik krist
saccular part →:saccular part →: diverticulum ductus cochlearis (getting diverticulum ductus cochlearis (getting
spiral)spiral) ductus reuniens appearsductus reuniens appears Corti‘s organ (from wall of ductus Corti‘s organ (from wall of ductus
cochlearis)cochlearis) ganglion cochleare appearsganglion cochleare appears
Development of internal Development of internal earear
surrounding mesenchyme changes surrounding mesenchyme changes into cartilagineous capsula oticainto cartilagineous capsula otica
cavities appears inside the capsula → cavities appears inside the capsula → perilymphatic spacesperilymphatic spaces
Week 20-22: ossification of Week 20-22: ossification of cartilagineous wallscartilagineous walls
Case-report 1Case-report 1
male, 28 letmale, 28 let returned back fron holiday in Egyptreturned back fron holiday in Egypt otalgia for 3 daysotalgia for 3 days palpation painfulpalpation painful
objective examination: tragus sensitive in objective examination: tragus sensitive in palpationpalpation
otoskopic examination: swollen reddish otoskopic examination: swollen reddish external acoustic meatus with white matter of external acoustic meatus with white matter of dead cellsdead cells
Case report 1 - diagnosisCase report 1 - diagnosis
otitis externaotitis externa disease of summer months and disease of summer months and
bathingbathing
complications: complications: mainly in diabetes mainly in diabetes mellitusmellitus
perichondritis or even destruction perichondritis or even destruction of temporal bonesof temporal bones
Case report 2Case report 2
female, 3 yearsfemale, 3 years during night sleep severe pain of right ear, during night sleep severe pain of right ear,
weeping, cannot be calmed, blowing her weeping, cannot be calmed, blowing her nose for 2 daysnose for 2 days
vomitting during examinationvomitting during examination temperature 38,3°Ctemperature 38,3°C
otoscopic examinatio: tympanic membrane otoscopic examinatio: tympanic membrane dark red, without contours, convexdark red, without contours, convex
Case report 2 - Case report 2 - diagnosisdiagnosis
mesotitis (otitis media) acuta l. dx.mesotitis (otitis media) acuta l. dx.
treatmenttreatment: paracentesis: paracentesis
complicationscomplications: : perforation of tympanic membraneperforation of tympanic membrane mastoiditis mastoiditis thrombosis of sinus thrombosis of sinus
sigmoideussigmoideus labyrinthitislabyrinthitis (chronic mesotitis)(chronic mesotitis) grometa
Case report 3Case report 3 female, 34 yearsfemale, 34 years feeling of pressure in left ear, sudden feeling of pressure in left ear, sudden
hypoacusis, buzzing tinnitushu, rotation hypoacusis, buzzing tinnitushu, rotation vertigo, vomitusvertigo, vomitus
vertigo disapeared, vertigo disapeared, other symptoms persistother symptoms persist oobjebjecctivtive examinatione examination: harmonic vestibul: harmonic vestibular ar
phenomensphenomens ( (signaling prevailing one signaling prevailing one labyrinthlabyrinth))
audiometraudiometryy: percep: perceptive hypacusis with tive hypacusis with apiapicocochlear predominancecocochlear predominance
treatmenttreatment: va: vassodilatodilating drugsing drugs
Case report 3 - diagnosisCase report 3 - diagnosis
MeniMenièèr‘s diseaser‘s disease hydrops of labyrinthhydrops of labyrinth
pacient will return in one month with pacient will return in one month with same symptomssame symptoms
dif.dgdif.dg.: circulation disorders, .: circulation disorders, atherosclerosis, sclerosis multiplex, atherosclerosis, sclerosis multiplex, acoustic neurinomaacoustic neurinoma