Physiology and Clinical Aspects of Hearing and Balance Flashcards
The middle ear transforms acoustic energy from the medium of air to the medium of fluid. How does the middle ear amplify the sound?
Ratio of tympanic membrane to stapes footplate is 17:1
Lever action of ossicular chain - pressure on stapes footplate to ratio on pressure is 1.3:1
How does the organ of corti change in order to pick up lower frequency sounds?
Fibres on basillar membrane become larger
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What is the weber test?
Tuning fork test
Used to test lateralisation
What is the Rinne test?
Used to determine loss of hearing in one ear.
It compares perception of sounds transmitted by air conduction to those transmitted by bone bone conduction via the mastoid.
Used to screen for conductive hearing loss
What are the different types of audiometry?
Pure tone audiometry
Visual reinforcement audiometry
Play audiometry
Tympanometry
What is pure tone audiometry?
Pure-tone air conduction hearing test determines the faintest tones a person can hear at selected pitches (frequencies), from low to high. During this test, earphones are worn so that information can be obtained for each ear.
What is the effect of osteosclerosis on the ear?
Bone deposition in annular ligament, prevents sound being conducted to cochlea
How does an audiogram show conductive loss?
There is a gap between bone conduction and air conduction seen on the graph
What are the different forms of audiometry?
Pure tone audiometry
Visual reinforcement audiometry
Play audiometry
Tympanometry
How does tympanometry work?
Tympanometry pushes air pressure into the ear canal, making the eardrum move back and forth. The test measures the mobility of the eardrum
What graph is produced from tympanography?
Tympanogram
What does tympanography tell you about the eardrum?
Tells you if the eardrum is stiff, perforated or if it moves too much. It can also assist in the detection of fluid in the middle ear and wax blocking of the ear canal.
What does objective testing detect?
Makes use of autoacoustic emissions
Can detect blockage in the outer ear canal as well as the presence of the middle ear fluid and damage to the outer hair cells in the cochlea.
How does objective testing work?
When the cochlea is stimulated by a sound, the inner ear gives off an almost inaudible sound called a Otoacoustic emissions (OAEs). When sound stimulates the cochlea, the outer hair cells vibrate. The vibration produces a nearly inaudible sound that echoes back into the middle ear. The sound can be measured with a small probe inserted into the ear canal.
What information does the auditory brainstem response tell us?
Gives information about the inner ear and brain pathways for hearing.
Who is auditory brainstem response recommended to?
Children or others who have a difficult time with conventional behavioural methods of hearing screening. Also used in newborn screening programmes.
How does the auditory brainstem response test work?
Electrodes are pasted onto the patients head, these electrodes record brain wave activity in response to sound when the patient rests quietly or sleeps.
What is management of hearing loss?
Surgery
Sound amplification
Direct stimulus of cochlear nerve cells
Intracochlear modification (for the future)
What types of hearing aid are there?
Hearing aid
Open fit hearing aid
Bone anchored hearing aid (BAHA)
Middle ear implant
Cochlear implant
What is the vestibulo-occular reflex?
The VOR stabilises gaze by moving eyes in order to compensate for head and body movement. This fixes image on retina for clear sight.
What systems are involves in regulating body balance?
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What are clinical conditions of the inner ear that affect balance?
Benign Paroxysmal Positional Vertigo
Vestibular Neuritis
Meniere’s Disease
What is the cause of benign paroxysmal positional vertigo?
Mechanism involves a small calcified otolith moving around loose in the inner ear
What is the test and treatment for benign paroxysmal positional vertigo?
Diagnostic test: Dix - hallpike test results in nystagmus
Treatment: Epley manouvre
What is vestibular neuritis?
Vestibular neuronitis, or neuritis, is an infection of the vestibular nerve in the inner ear. It causes the vestibular nerve to become inflamed, disrupting your sense of balance.
What are the features of Ménière’s disease?
Ménière’s disease (MD) is a disorder of the inner ear that is characterized by episodes of feeling like the world is spinning(vertigo), ringing in the ears (tinnitus), hearing loss, and a fullness in the ear.
Give an example of a clinical condition that affects balance
Migraine