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