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Description : Check out this medical presentation on Ear, Nose, and Throat Facts, which is titled "Anatomy, Physiology and Disorders of the Hearing", to know about the anatomy physiology and disorders of the hearing.

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Slide 1-

Anatomy Physiology and Disorders of the Hearing Perry C. Hanavan, Au.D. Audiologist
Slide 2-

Major Divisions of the Ear Peripheral Mechanism Central Mechanism
Slide 3-

Question What is the purpose of the pinna? A. Cosmetics B. Sound collector C. Same side localization D. A and B E. A, B and C
Slide 4-

Outer Ear Pinna External Auditory Meatus Virtual Tour of the Ear Pinna Preauricular Tags Preauricular Pits EAM Cerumen Q-tips Microtia Anotia Atresia Function EAM resonance
Slide 5-

Pinna
Slide 6-

Question Another name for pinna? A. External auditory meatus B. External auditory canal C. Ear lobe D. Auricle E. None of the above
Slide 7-

Function of Outer Ear Collect sound Localization Resonator Protection Sensitive (earlobe) Other?
Slide 8-

Pinna The visible portion that is commonly referred to as "the ear" Helps localize sound sources Directs sound into the ear Each individual's pinna creates a distinctive imprint on the acoustic wave traveling into the auditory canal
Slide 9-

External Auditory Meatus Extends from the pinna to the tympanic membrane About 26 millimeters (mm) in length and 7 mm in diameter in adult ear. Size and shape vary among individuals. Protects the eardrum Resonator Provides about 10 decibels (dB) of gain to the eardrum at around 3,300 Hertz (Hz). The net effect of the head, pinna, and ear canal is that sounds in the 2,000 to 4,000 Hz region are amplified by 10 to 15 dB. Sensitivity to sounds greatest in this frequency region Noises in this range are the most hazardous to hearing
Slide 10-

Outer Ear Resonance Influence of pinna (p) Influence of ear canal (m) Combine influence (t) At 3000 Hz, the final amplification (t) is 20 dB
Slide 11-

Question Cerumen should be routinely removed from the ear canal? A. True B. False
Slide 12-

Cerumen The purpose of wax: Repel water Trap dust, sand particles, micro-organisms, and other debris Moisturize epithelium in ear canal Odor discourages insects Antibiotic, antiviral, antifungal properties Cleanse ear canal
Slide 13-

Embryological Development External Ear Development
Slide 14-

Disorders of the Outer Ear
Slide 15-

Outer Ear Hearing Disorders Outer ear CHARGE Down Syndrome Ears small and low set Fetal Alcohol Syndrome Deformed ears DiGeorge syndrome Low set ears
Slide 16-

Grow Ear?
Slide 17-

External Ear Care Hazardous to health: Ear candling Swabs Foreign objects
Slide 18-

Time of Onset
Slide 19-

Middle Ear The function of the middle ear is to? A. Cause middle ear infections in young children Amplify sounds Interpret sounds Analyze sounds None of the above
Slide 20-

Middle Ear The Eustachian tube is a part of the middle ear? No, it is a part of the inner ear No, it isn’t part of the hearing mechanism Yes I don’t know
Slide 21-

Middle Ear Which is not true? There are two middle ear muscles There are three ossicles There are three layers of tympanic membrane tissue The acoustic reflex occurs from soft sounds The stapes is the smallest bone in the human body
Slide 22-

Middle Ear Tympanic Cavity Tympanic Membrane Ossicles Middle Ear Muscles Eustachian Tube Mastoid Virtual Tour of the Ear Middle Ear Cavity Ossicles Middle Ear Muscles Mastoid Eustachian Tube Function Amplifier Cholesteatoma Temporal bone fractures Otitis Media PE tubes Otosclerosis
Slide 23-

Function of Middle Ear Conduction Conduct sound from the outer ear to the inner ear Protection Creates a barrier that protects the middle and inner areas from foreign objects Middle ear muscles may provide protection from loud sounds Transducer Converts acoustic energy to mechanical energy Converts mechanical energy to hydraulic energy Amplifier Transformer action of the middle ear only about 1/1000 of the acoustic energy in air would be transmitted to the inner-ear fluids (about 30 dB hearing loss)
Slide 24-

The middle ear: Converts acoustic energy to hydraulic Converts hydraulic energy to mechanical Converts acoustic energy to mechanical Converts acoustic energy to electrical Converts mechanical to electrical
Slide 25-

Middle Ear Tympanum: Timpani, or kettledrums, are musical instruments in the percussion family. A type of drum, they consist of a skin called a head stretched over a large bowl commonly made of copper. They are played by striking the head with a special drum stick called a timpani stick. Timpani evolved from military drums to become a staple of the classical orchestra in the 17th century. Today, they are used in many types of musical ensembles including classical orchestra
Slide 26-

Tympanic Membrane The eardrum separates the outer ear from the middle ear Creates a barrier that protects the middle and inner areas from foreign objects Cone-shaped in appearance about 17.5 mm in diameter The eardrum vibrates in response to sound pressure waves. The membrane movement is incredibly small as little as one-billionth of a centimeter
Slide 27-

The pars tensa portion of the TM: Consists of 2 layers of tissue Consists of 4 layers of tissue Consists of 1 layer of tissue Consists of 3 layers of tissue Consists of 5 layers of tissue
Slide 28-

Eustachian Tube The eustachian tube connects the front wall of the middle ear with the nasopharynx The eustachian tube also operates like a valve, which opens during swallowing and yawning This equalizes the pressure on either side of the eardrum, which is necessary for optimal hearing. Without this function, a difference between the static pressure in the middle ear and the outside pressure may develop, causing the eardrum to displace inward or outward This reduces the efficiency of the middle ear and less acoustic energy will be transmitted to the inner ear.
Slide 29-

The Eustachian tube: Opens when one yawns Opens when one smiles Opens when one blinks It is always open Never opens
Slide 30-

Ossicles Malleus (hammer) Incus (anvil) Stapes (stirrup) smallest bone of the body
Slide 31-

The middle ear amplifies sound: About 15 dB About 25 dB About 35 dB About 20 dB About 40 dB
Slide 32-

Transformer/Amplifier Transform the vibrating motion of the eardrum into motion of the stapes. The middle ear enhances the transfer of acoustical energy in two ways: The area of the eardrum is about 17 times larger than the oval window The effective pressure (force per unit area) is increased by this amount. The ossicles produce a lever action that further amplifies the pressure Without the transformer action of middle ear, about 1/1000 of acoustic energy in air transmitted to inner-ear fluids (about 30 dB loss). Malleus and incus vibrate together, transmitting the sound waves from the eardrum to the footplate of the stapes (this pushes the oval window in and out)(mechanical energy)
Slide 33-

Transformer/Amplifier Area ratio Thumbtack Lever crowbar
Slide 34-

Which provides the most amplification in the middle ear? The lever hypothesis The area/ratio hypothesis The Hanavan principle I don’t know None of the above
Slide 35-

Middle Ear Muscles Tensor tympani Attached to malleus Innervated by V, trigeminal nerve Stapedius Attached to stapes Innervated by VII, facial nerve Middle Ear Muscle Function: Help maintain ossicles in proper position Protect inner ear from excessive sound levels When ear exposed to sound levels above 70 dB, the muscles contract, decreasing amount of energy transferred to inner ear This protective reflex termed "acoustic reflex"
Slide 36-

The VII cranial nerve innervates: Tensor tympani muscle Incus Stapedial muscle Malleus Stapes
Slide 37-

The tensor tympani: Innervated by the facial nerve Innervated by the trigeminal nerve Innervated by the VII cranial nerve Innervated by the VIII cranial nerve Innervated by the VI cranial nerve
Slide 38-

Ligaments of Middle Ear Function restrict and confine the effect of ossicles to act as a lever restrict movements to reduce the chance of damage to the inner ear prevents distortion to sound
Slide 39-

Mastoid
Slide 40-

Mastitis Inflammation of the mastoid Inflammation of the breast Cancer of the mast cells A and B B and C
Slide 41-

Question The correct order of the ossicles from the TM to inner ear is? Anvil, hammer, stapes Hammer, incus, anvil Hammer, anvil, stapes Stapes, anvil, hammer Malleus, stapes, incus
Slide 42-

Development of Middle Ear Middle Ear Development
Slide 43-

Middle Ear Disorders Middle Ear disorders Acute otitis media Otosclerosis Disarticulation Mastoiditis Tympanosclerosis OME TM Perforation TM Retraction Cholesteatoma Down Syndrome Treacher Collins Syndrome BOR Syndrome
Slide 44-

OM/OME
Slide 45-

Cholesteatoma
Slide 46-

Otosclerosis Develops most frequently between ages of 10 and 30. About 10–15% of patients have unilateral loss. Affects women more frequently than men by a ratio of 2:1. Pregnancy once thought to be a risk factor for the development and / or worsening of otosclerosis…recent studies have disputed this. May progress to nerve deafness called cochlear otosclerosis.
Slide 47-

Question The Amy Tan syndrome is: Down syndrome BOR syndrome Treacher Collins syndrome Measles syndrome Waardenburg syndrome
Slide 48-

Question The function of the inner ear: Balance Hearing Touch All the above A and B
Slide 49-

Inner Ear Auditory Vestibular Virtual Tour of the Ear Vestibular semicircular canals utricle and saccule Cochlear traveling wave traveling wave traveling wave pathologies
Slide 50-

Function of Inner Ear Convert mechanical sound waves to neural impulses that can be recognized by the brain for: Hearing Balance
Slide 51-

Balance Linear motion Rotary motion
Slide 52-

Question Which is true about the inner ear and balance? The semicircular canals detect linear motion The utricle and saccule detect linear motion The cochlea detects linear motion The utricle and saccule detect rotary motion
Slide 53-

Cochlea The cochlea resembles a snail shell and spirals for about 2 3/4 turns around a bony column Within the cochlea are three canals: Scala Vestibuli Scala Tympani Scala Media
Slide 54-

Question The channel that houses the organ of Corti: Scala tympani Scala media Scala vestibuli Semicircular canals B and D
Slide 55-

Barald, K. F. et al. Development 2004;131:4119-4130 Anatomy of the adult mammalian cochlea
Slide 56-

Organ of Corti
Slide 57-

Organ of Corti
Slide 58-

Organ of Corti
Slide 59-

OHC vs. IHC Function
Slide 60-

OHC Motility Models
Slide 61-

Afferent Neural Innervations
Slide 62-

Hair Cells Outer Hair Cells Inner Hair Cells OHC movie
Slide 63-

OCH Cilia Theory: Tip-links <<>>
Slide 64-

OHC Cilia: Tip-links
Slide 65-

Tip Link Protiens
Slide 66-

Stereocilia Stereocilia move sideways and lengthen (Oct 2, 2012)
Slide 67-

Flexoelectric Effect Quiet sounds are magnified by bundles of tiny, hair-like tubes atop "hair cells" in the ear (stereocilia: when the tubes dance back and forth, they act as "flexoelectric motors" that amplify sound mechanically. "It's like a car's power steering system. " " You turn the wheel and mechanical power is added. Here, the incoming sound is like your hand turning the wheel, but to drive, you need to add power to it. These hair bundles add power to the sound. If you did not have this mechanism, you would need a powerful hearing aid.“ http://www.medicalnewstoday.com/articles/147081.php
Slide 68-

OHC Somatic Motility
Slide 69-

Question Which cells are motile? Brain cells Inner hair cells Outer hair cells B and C None of the above
Slide 70-

OHC—With and Without Prestin No other cells except OHC Prestin is the motor protein of mammalian OHCs. It is highly expressed in OHC, and is not expressed in nonmotile IHC.
Slide 71-

OHC—With and Without Prestin About 55 dB difference OHC in Prestin Knockout Mouse
Slide 72-

Traveling Waves Traveling wave Basilar membrane Traveling Wave info Cochlear Traveling Wave
Slide 73-

Question High frequencies stimulate this part of inner ear: Apical portion of inner ear Basilar portion of inner ear Utricle Saccule Semicircular canals
Slide 74-

Inner Ear Etiologies Genetic Connexin 26 Excessive Noise Head Trauma Metabolic Diabetes, kidney disfunction, thyroid dysfunction Ototoxic Gentamiacin, cisplatin, etc. Disease
Slide 75-

Connexin 26
Slide 76-

Noise Trauma
Slide 77-

Question Persons with diabetes are at greater risk for hearing loss…this would be? Metabolic Noise related Ototoxic Genetic Acoustic trauma related
Slide 78-

Question Persons with Connexin 26 are at greater risk for hearing loss…this would be: Metabolic Noise related Ototoxic Genetic Acoustic trauma related
Slide 79-

Developmental Inner Ear Embryological Development
Slide 80-

Question The hearing nerve is located in: Eustachian tube External auditory meatus Internal auditory meatus Organ of Corti Tympani
Slide 81-

Question The auditory nerve is which cranial nerve: VI VII VIII V X
Slide 82-

VIII Cranial Nerve Auditory Branch Vestibular Branch Virtual Tour of the Ear Auditory Branch Vestibular Branch Spiral ganglion Acoustic Tumors
Slide 83-

The wave V latency used in the standard ABR IT5 and I-V delay measures is dominated by neural activity from the high-frequency regions of the cochlea. Thus, unless the tumor affects these high-frequency fibers sufficiently, standard ABR latencies will be normal. Large Tumor Abnormal Standard ABR Small Tumor Abnormal Standard ABR Small Tumor Normal Standard ABR
Slide 84-

IAM
Slide 85-

VIII Cranial Nerve
Slide 86-

Spiral Ganglion
Slide 87-

Question The Auditory Nerve is: V Cranial Nerve VI Cranial Nerve VII Cranial Nerve VIII Cranial Nerve IX Cranial Nerve
Slide 88-

Acoustic Neuroma Tumor
Slide 89-

Neurofibromatosis (NF2) Bilateral acoustic neuromas (tumors of the vestibulocochlear nerve or cranial nerve VIII also known as schwannoma) develop, often leading to hearing loss Multiple inherited schwannomas and meningiomas Non-malignant brain tumors (benign)
Slide 90-

Acoustic Neuroma
Slide 91-

Question Another term for acoustic tumor: VII cranial nerve tumor Vestibular schwannoma Facial nerve tumor Ear schwannoma
Slide 92-

Stem Cells Restore Hearing Human stem cells regenerate auditory nerve cells in gerbils
Slide 93-

Central Auditory Mechanism Auditory Path Virtual Tour of the Ear Auditory Path
Slide 94-

Central Auditory Path
Slide 95-

Auditory Pathway - CNS
Slide 96-

Tonotopic
Slide 97-

Etiologies Central auditory processing disorders Brainstem Cerebrum Corpus callosum Learning disorders Vascular Stoke Head trauma Tumors
Slide 98-

Nonorganic Hearing Loss Sometimes referred to as functional, feigning, etc. No physical evidence of hearing loss Conscious and unconscious Adults: medical/legal reasons Children: attention, psychological, reward, etc.
Slide 99-

Barald, K. F. et al. Development 2004;131:4119-4130 Development of the otocyst
Slide 100-

Barald, K. F. et al. Development 2004;131:4119-4130 Inductive interactions that regulate otocyst induction and ventral patterning
Slide 101-

Barald, K. F. et al. Development 2004;131:4119-4130 Development of the cochlear duct and organ of Corti
Slide 102-

Barald, K. F. et al. Development 2004;131:4119-4130 Effects of modulating gene expression on development of the organ of Corti (OC)
Slide 103-

Barald, K. F. et al. Development 2004;131:4119-4130 Generation of stereociliary bundle orientation
Slide 104-

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Slide 106-

Zheng, W. et al. Development 2003;130:3989-4000 Six1 expression during inner ear development