Ear 3
Ear 3
Ear 3
The auditory ossicles conduct sound from the tympanic membrane to the inner ear.
Sound waves picked up by the external ear vibrate the tympanic membrane, which
in turn mobilizes the ossicular chain of the middle ear. The footplate of the stapes
applies a mechanic pressure on the oval window and the vibration reaches the
peri_lymphatic fluid of the cochlea. Inside the
inner ear these vibrations are converted to nerve signals that are carried by the auditory
nerve to the brain.
And according to this hearing loss could be conductive when the problem is
either in the external or middle ear, sensory if the problem in the inner ear and
the ascending neural connections , or mixed.
Bony Labyrinth
The bony labyrinth is a series of bony cavities within the petrous part of
the temporal bone. It consists of three parts – the cochlea, vestibule and the
three semi-circular canals.
Vestibule
The vestibule is the central part of the bony labyrinth. It is separated from the
middle ear by the oval window, and communicates anteriorly with the cochlea
and posterioly with the semi-circular canals. Two parts of the membranous
labyrinth; the saccule and utricle, are located within the vestibule.
Membranous Labyrinth
The membranous labyrinth is a continuous system of ducts filled
with endolymph. It lies within the bony labyrinth, surrounded by perilymph. It is
composed of the cochlear duct, three semi-circular ducts, saccule and the
utricle.
Semi-circular Ducts
The semi-circular ducts are located within the semi-circular canals, and share
their orientation. Upon movement of the head, the flow of endolymph within
the ducts changes speed and/or direction. Sensory receptors in the ampullae
of the semi-circular canals detect this change, and send signals to the brain,
allowing for the processing of balance.
The inner ear has two main parts. The cochlea , which
is the hearing portion, and the semicircular canals is the
balance portion.
Organ of corti
The organ of corti is supported by a membrane called the basilar membrane. It about the size
of a pea, and acts as a transducer, converting vibration into nerve impulses. It has hair cells
and supporting cells. Hair cells have long stiff microvilli called stereocilia on their apical
surfaces. Microvilli are fine hair-like structures on cells that help to increase cell surface area.
On top of these stereocilia is a jelly-like membrane called the tectorial membrane. Four rows
of hair cells spiral along the length of the organ of Corti. Of these, there are about 3500 inner
hair cells (IHCs), each with a cluster of 50-60 stereocilia graded from short to tall. There are
another 20 000 outer hair cells (OHCs) that are arranged in three rows opposite the IHCs.
Each OHC has about 100 stereocilia with their tips embedded in the tectorial membrane
above them. These outer hair cells adjust the response of the cochlea to different sound
frequencies so as to enable the inner hair cells to function more accurately. The physiological
mechanisms,
Tuning fork tests
These are tests of hearing most often used to differentiate between a
conductive and a sensorineural hearing loss. They should be performed
with a tuning fork of 512 Hz. If the frequency is lower, vibrations are
produced that can mislead patients who think this is an auditory stimulus.
The ends of a tuning fork are known as tynes. The loudest sound from
the tuning fork is produced at the end of the tyne.
Start the tuning fork by hitting your elbow or knee. Plucking the tynes
produces less efficient sound, and hitting a table or desk edge produces
overtones. Weber’s and Rinne’s test’s are performed together to help
identify the type of hearing loss.
Weber’s test
In this test the tuning fork is placed at the top of the patient’s
head. The patient then says which ear hears the sound loudest, or if it is
in the middle.
In normal hearing, sound is not localized to either ear. In sensorineural
hearing loss, the non-affected ear hears the sound loudest. In conductive
loss the sound is heard loudest in the affected ear.
Rinne’s test
This test is used to compare air conduction with bone conduction.
The activated tuning fork is placed behind the patient’s ear, against
the mastoid process. The patient is asked to say when they stop hearing
the stimulus. The tuning fork is then moved to a position 2 cm away from
the EAC and held with the tips of the tynes level and in line with the ear
canal. The patient is then asked if they can hear the sound.
This test can be modified by moving the tuning fork from the mastoid
to the EAC before the sound has diminished. The patient is then asked
which is the louder sound.
The test results can be confusing, because a pathological test result
is called a negative test! This is contrary to almost all other tests in medicine,
where a positive result is an abnormal result and a negative result
is normal. Often a description of the findings is used instead.
- Positive test: air conduction is better than bone conduction
(AC > BC). This is a normal finding.
- Negative test: bone conduction is better than air conduction
(BC > AC). This is abnormal and suggests conductive hearing loss.
False negative Rinne’s test
This happens when the sound is actually being heard by the other ear.
Sound conducted by bone is absorbed and travels across the skull, so
when the tuning fork is placed on the left side it will be heard almost as
well by the right inner ear as the left.