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 membraneTympanic membrane((Membrana tympanica, Membrana tympanica,

MyrinxMyrinx))

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.)

PharyngotympaPharyngotympanic / auditory nic / auditory

tubetube((Tuba auditivaTuba auditiva))

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

CochleaCochlea

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

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

Sluchová dráha – 3D

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 external Development of external earear

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