Auditoy System Flashcards

1
Q

What are the mechanisms of pressure amplification in the middle ear?

A

. Two Mechanisms of Pressure Amplification in the Middle Ear
Mechanical transformation of the sound signal (pressure waves) in the middle ear leads to a 70-100-fold amplification of the pressure force. Two mechanisms contribute to this pressure amplification:

Size Difference Due to the small size of the oval window, compared to the size of the tympanic membrane, which is 20 times larger, the force at the oval window becomes about 20 times greater than at the tympanic membrane.

Lever Ratio of the Ossicular Chain The force at the oval window is further increased because the ossicles act like levers of a mechanical scale. Large movements (with little force) of the tympanic membrane are transformed into little movements (with greater force) at the oval windo

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2
Q

Middle ear can amplify low intensity sounds by two mechanisms…

A

• The middle ear can amplify low intensity sounds by two mechanisms
Pressure= Force/ Area
1. Decrease Area (decrease area by 20–> increase pressure by 20)
2. Increase Force

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3
Q

How can two middle ear muscles limit excessive pressure?

A

Two Middle Ear Muscles Limit Excessive Pressure

The movement of the ossicular chain can be limited by the contraction of two small middle ear muscles: activation of the m. tensor tympani, which is attached to the malleus and is innervated by the trigeminal nerve (CN V), limits the movement of the tympanic membrane; activation of the m. stapedius, innervated by the facial nerve (CN VII), limits the movement of the stapedius. They both protect the inner ear from damage.

High intensity sound activates the tensor tympani and stapedius muscles through the attenuation reflex. Due to the delay of this reflex from the onset of sound, this reflex cannot prevent damage from sudden increases in sound intensity (for example, caused by explosions).

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4
Q

Describe sound attenuation

A

Contraction of m. tensor tympani and m. stapedius occurs in response to high intensity sound – attenuation reflex

  • Contraction restricts the movement of the tympanic membrane and stapes against the oval window
  • The chain of ossicles becomes more rigid
  • Deleterious effects of sustained loud noises on the inner ear are reduced
  • Reflex does not offer protection against sudden loud sounds - acquired hearing loss is possible
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5
Q

There is a place code for sound frequencies…..

A

There is a Place Code for Sound Frequencies

The mechanical properties of the basilar membrane differ at different places and the amount of deflection of the basilar membrane is based on its mechanical properties.

Near the oval window, at its base, the basilar membrane is narrow and stiff, and therefore is activated most effectively deflected by high frequencies. At the tip (apex) of the cochlea (helicotrema), the basilar membrane is wide and floppy and therefore most effectively deflected by low frequencies.

The sum of deflection of the basilar membrane by a certain frequency of sound is described by the “envelope of waves”, which covers the deflections of the basilar membrane at different stages of the travel of the waves.

Maximum deflection of the basilar membrane causes maximum activation of the hair cells at this part of the basilar membrane and produces the highest signal in the afferent neurons.
This concept, where the place (or location) of a nerve cell encodes for a specific stimulus feature (frequency, in this instance) is called a place code.

The envelopes of waves for high frequencies have their maxima closer to the oval window, where the basilar membrane is narrow and stiff. Low frequencies are represented closer to the apex of the cochlea near the helicotrema, where the basilar membrane is wide and floppy.

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6
Q

There is a place code for sound frequencies on the basilar membrane…

A

Maximum deflection = maximum hair cell activation

Base narrow and stiff, high frequencies —> apex wide and floppy, low frequencies

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7
Q

Summarize encoding sound frequency

A

Encoding Sound Frequency
Place Code for Sound Frequencies
• Any small region of the basilar membrane undergoes its largest oscillation for only a narrow range of frequencies
• Since the auditory neurons are connected to a small number of hair cells, near each other, each neuron is most sensitive over a narrow range of frequencies
• The most sensitive frequency for an auditory nerve fiber is that neuron’s characteristic frequency

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8
Q

What does the cochlea do?

A

The Cochlea Decomposes Sound Stimuli into Component Frequencies Using a Place Code

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9
Q

What are the 2 kinds of hair cells?

A

Outer hair cells act as signal amplifiers in the inner ear (remember, there are also two signal amplification mechanisms in the middle ear earlier). Similar to muscle cells, motor proteins cause shortenings of the outer hair cells when they are depolarized and elongation when they are at rest.

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10
Q

What’s the impact of basilar membrane for inner ear amplification?

A

Basilar membrane deflected upwards by travelling waves - hair cells depolarised - outer hair cells compressed - basilar membrane pulled further upwards

Basilar membrane deflected downwards by travelling waves - hair cells hyperpolarised - outer hair cells expanded - basilar membrane pushed further
downwards

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11
Q

Describe the essence of the auditory pathways

A

The Essence of the Auditory Pathways

The auditory pathways, as outlined in your Haines Atlas, 9th edition, Figure 8-49, appear much more complicated than those of other sensory systems. While it is not necessary to know the pathway in full detail, it is important for you to at least understand the basics, such as the elements involved and the different levels within the central nervous system. The major elements of the auditory pathways are listed on the slide overleaf.

The pathways involve the peripheral nervous system (PNS), in essence the auditory portion of the vestibulo-cochlear nerve (CN VIII) and all levels of the brain, starting in the upper portion of the medulla and ending in the primary auditory cortex (A1) of the cerebral cortex. The auditory nerve enters the brainstem at the level of the ponto-medullary junction, and the fibers synapse in the anterior and posterior cochlear nuclei.

From there onwards, the auditory pathways are characterized by extensive crossing fiber connections at each level of the auditory system. For this reason, except for lesions affecting the structures of the ear, the eighth nerve, or cochlear nuclei, there are no lesions that produce unilateral hearing loss. Unilateral lesions affecting higher structures, such as the primary auditory cortex, can disrupt the ability to localize sound, however.

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12
Q

What are the elements of the auditory pathways?

A
Cerebral cortex
• Transversetemporalgyrus
Thalamus
• Medial geniculate nucleus
Midbrain
• Inferior colliculus
Pons
• Lateral lemniscus nucleus • Superior olive
• Trapezoid nucleus
Medulla
• Cochlear nuclei (A & P)

Above are CNS

Auditory nerve (CN VIII)
• Spiral ganglion
Above are PNS

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13
Q

What are the anatomy of the primary auditory cortex?

A

The Primary Auditory Cortex (A1)
Localization of the Primary Auditory Cortex
Primary auditory cortex is localized in Brodmann areas 41 and 42 at the transverse temporal gyrus (gyri) of Heschl on the superior surface of the temporal lobe.

Organization of the Primary Auditory Cortex
Similar to other primary sensory cortices, primary auditory cortex has:

Tonotopic Organization Instead of a spatial map, as we saw in primary somatosensory and visual cortices, the organization of the primary auditory cortex is tonotopic, which means that the sound frequencies are mapped and distributed along a rostro-caudal axis. Low frequencies are represented more rostrally (and laterally), whereas high frequencies are represented more caudally (and medially).

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14
Q

What is conductive hearing loss?

A

Conductive hearing loss is caused by anything that impedes the conduction of sound vibrations through the external auditory canal or middle ear. Conversely, a lesion of the organ of Corti or the auditory nerve leads to sensorineural hearing loss

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15
Q

How does otosclerosis cause hearing loss?

A

Otosclerosis causes Conductive Hearing Loss
In otosclerosis there is a gradual replacement of normal bone of the bony labyrinth and the stapes footplate by lamellar new bone. This leads to a fusion of the stapes with the borders of the oval window and, as a consequence, a conductive hearing loss, which may be up to an extent of 40 dB sound pressure level.

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16
Q

How does the vestibular Schwannoma cause Sensineural Hearing Loss?

A

Vestibular Schwannoma causes Sensorineural Hearing Loss
A vestibular Schwannoma is a benign tumor originating from the Schwann cells of the vestibular division of CN VIII. The tumor compresses the vestibulo-cochlear nerve within the internal auditory meatus. Auditory symptoms are sensorineural hearing loss and tinnitus.

17
Q

How does Meniere’s Dusease cause sensineural hearing loss?

A

Meniere’s Disease causes Sensorineural Hearing Loss
Characterized by repeated episodes of vertigo, accompanied by tinnitus and progressive sensorineural hearing loss. Most cases sporadic, but up to ~10% cluster in families. Distortion of the membranous labyrinth results from overaccumulation of endolymph that can lead to fluctuating hearing loss, occasional episodic vertigo, tinnitus and a sense of aural fullness.

18
Q

What is acquired hearing loss?

A

Acquired Hearing Loss

Extremely loud percussive sounds, such as explosions or gun fire, can rupture the tympanic membrane and cause conductive hearing loss.

Repeated exposure to high sound intensities (100dB or higher), including sounds generated by machinery or amplified music, causes sensorineural hearing loss, due to the damage to hair cells in the organ of Corti. Lost hair cells cannot be replaced by cell division.

19
Q

What is age related hearing loss.?

A

Age-Related Hearing Loss
Presbyacusis (also presbycusis), or age-related hearing loss, is a progressive bilateral and symmetrical sensorineural hearing loss associated with aging.

Higher frequencies being affected most leading to an associated difficulty in speech discrimination. Multiple environmental and genetic factors are considered as causes and risk factors.

Our understanding of the pathophysiology of presbyacusis is incomplete but damage to hair cells, peripheral nerve damage and damage to central auditory pathways are all believed to contribute.

20
Q

How can hearing loss be bilateral or unilateral?

A

Peripheral pathway lesions, such as those caused by vestibular Schwannoma, which usually affect only one vestibulo-cochlear nerve (CN VIII), usually result in unilateral hearing loss, only affecting the ipsilateral side.

Central pathway lesions rarely cause unilateral hearing loss, as damage to a single element does not prevent the signal from reaching one of the primary auditory cortices, due to the redundancies built into the auditory pathways.

Cochlear Implants
Self Study: website of the National Institute on Deafness and other Communication Disorders on Cochlear Implants: What is a cochlear implant? How does a cochlear implant work?

Hearing Aids
Self Study: website of the National Institute on Deafness and other Communication Disorders

21
Q

How are conductive and sensorineural hearing loss differ?

A
  • Differing aetiologies

* Different outcomes upon auditory testing

22
Q

What are causes of conductive hearing loss?

A

Outer ear- wax, infection, foreign body

Middle ear-

Tympanic membrane (perforation / infection)

Ossicular chain (otitis media, barotrauma)

Oval window/stapes (otosclerosis)

23
Q

What causes sensorineural hearing loss?

A

Cochlea, CN VIII, nuclei

Inflammation – labyrinthitis (due to meningitis, viral infections e.g. flu, common cold or, more rarely, mumps, measles, rubella)

Ototoxic drugs

Trauma

Ménière’s disease

Vestibular schwannoma

Presbyacusis

24
Q

What are the main hearing tests?

A

The goals of assessing auditory function are to determine the type (conductive vs sensorineural), severity (mild, moderate, severe or profound), underlying anatomical basis (outer ear, middle ear, inner ear or CNS) and aetiology of the hearing impairment.

Several hearing tests may be employed, those in bold type will be addressed here:
• Basic Hearing Tests
• Low intensity sounds
• Tuning Fork Tests (Weber’s test, Rinne’s test)
• Audiogram (Testing at different frequencies along the normal frequency range of hearing)
• Tympanometry (a test of middle ear function)
• Acoustic Reflex (stapedius muscle)
• Speech/Word Recognition

25
Q

What is the use of basic hearing tests?

A

Basic Hearing Tests

To estimate the function of the auditory system, each ear is tested separately. The examiner may ask the patient to occlude one ear with a finger, and then whisper softly towards the unoccluded ear. The process is repeated with the other ear, and one has to make sure that the patient is not able to read lips.

Other basic tests include rubbing the patient’s hair between fingertips, or producing a clicking sound with two fingernails, to generate low intensity sound, and asking the patient whether he/she can hear it or not.

You will perform auditory testing in NB SG

26
Q

What’s the interpretation of Webers test?

A
  • In sensorineural hearing loss the sound lateralizes to the unaffected side
  • In conductive hearing loss the sound lateralizes to the affected side
27
Q

What is the procedure of Rinne’s test?

A
  1. Bone conduction -Tuning fork stem on the mastoid process. Sound bypasses outer and middle ear and is conducted through bone directly to inner ear
  2. Air Conduction
    Without stopping the tuning fork, bring it next to the ear, in the orientation shown. Sound is conducted through air to outer -> middle -> inner ear
Normal findings:
Air conduction (AC)>. Bone conduction (BC)

When the tuning fork is brought from the mastoid
process and placed next to the ear, patient should hear the sound once more, due to middle ear amplification

28
Q

What are the abnormal findings of Rinne’s test?

A

Rinne’s Test – Abnormal Findings

• BC > AC
– Conductive hearing loss

• AC > BC but times for both on one side decreased compared to the other
– Sensorineural hearing loss

• AC = BC = 0
– Total deafness

29
Q

What is the conduction of Webers test lateralizes to the left?

A

Example: Weber’s Test Lateralizes to the Left

  1. Conductive hearing loss on the left (sound lateralizes to affected side), or
  2. Sensorineural hearing loss on the right (sound lateralizes to contralateral side)

Conductive hearing loss on the left

Example: Weber’s Test Lateralizes to the Left Rinne’s Test Shows:

AC>BC

Or, AC = BC= 0

Sensorineural hearing Loss on the Right

30
Q

What is the audio gram ?

A

The audiogram is a chart of hearing sensitivity with frequency charted on the abscissa and intensity on the ordinate (see following slide). Intensity is the level of sound power measured in decibels and loudness is the perceptual correlate of intensity. An audiogram illustrates how loud a sound has to be (hearing level decibels), and at what frequency (Hertz), before the individual being tested can hear it.

Note that in the audiogram, zero (0) dB HL does not mean that there is no sound at all. Rather, it is the lowest intensity sound that a person with “normal” hearing ability would be able to detect at least 50% of the time. As you will see, some audiograms, in fact, begin at -10 dB HL or lower. Hence, the top line, at 0 decibels (dB HL), represents a very soft sound, with each horizontal line below representing successively louder sound

31
Q

How is an audio gram interpreted?

A

Interpreting the Audiogram
To interpret the audiogram, we must first
understand the symbols (see legend). You will
note different symbols for the right and
left ear, as well as for bone conduction and air
(earphone) conduction. Take the circle in the
black rectangle as an example.
The red circle indicates that this reading
represents air conduction for the right ear. The
‘abscissa,ordinate’ or ‘x,y’ position of the circle
tells us that for a sound with a frequency of
250Hz, its intensity must be at least 35 HL dB in
order for the patient to perceive it. An adult with normal hearing would be expected to perceive a sound of this frequency at an intensity in the range of 0-25 HL dB. Therefore, this finding is abnormal.
Since it pertains to air conduction, it suggests a conductive hearing deficit

The Audiogram
• Audiologists consider 0 -15 dB HL to be “normal hearing” in children (0 - 25 dB HL in adults).
• The most important frequencies for speech fall into the 250-6000 Hz range, as represented by the ‘speech banana’ in the upcoming slide. The vowel sounds of speech are typically low frequency sounds that make up the loudness of speech. The consonant sounds like “f”, “s”, and “th” are high frequency sounds

32
Q

What is presbyacusis?

A

• Progressive, usually bilateral, symmetrical sensorineural hearing loss

• Multifactorial process
– Intrinsic: e.g., loss of hair cells, atrophy of stria vascularis
– Extrinsic: e.g., noise, ototoxic medication

  • 40% individuals over 50y, 70% individuals over 70y affected by some degree of hearing loss
  • Higher frequency perception lost