The audio-vestibular system Flashcards

1
Q

How were the vestibular organs formed?

A

-Evolved first from Statocyst (does not exist in humans but did in cumcumbers): a ball of cells, inside was lined with small hairs and had a calcified ball inside of it
- When the ball would move it would deflect the hair
- Deflection would correspond to gravity/ movement (plants knew which way to grow)
- The statocyst then evolved into a utriculus, then a sacculus then into our 2 vestibular organs:
1. Semicircular canals
2. Cochlea
(still use the same principle, something in the ear moves, deflects hairs, corresponds to gravity/ movement)

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2
Q

What is the difference in the role of the vestibular organs vs the hearing organs?

A

Vestibular organ: capture low frequency motion (movements)
Hearing organ: capture high frequency motion (sound)

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3
Q

What does the frequency of sound waves represent?

A

“pitch”
Frequency/pitch (Hz): Cycles per second, perceived tone

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4
Q

What does the Amplitude of sound waves represent?

A

“Loudness”
Amplitude/loudness (dB): Sound pressure, subjective attribute correlated with physical strength.

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5
Q

What is the normal human range of hearing?

A

Frequency: 20–20,000Hz
Loudness: 0 dB to 120 dB sound pressure level (SPL)

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6
Q

How is the ear split?

A

Made up of 3 parts:
1. Outer ear
2. Middle ear
3. Inner ear

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7
Q

What is the function of the outer ear?

A
  • To capture sound and to focus it to the tympanic membrane (this is very fragile)
  • Modest amplification (10DB) of upper range of speech frequencies by resonance in the canal.
  • To protect the ear from external threats
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8
Q

What is the function of the middle ear?

A
  • Mechanical amplification (can provide an additional 20-30dB)
  • Does have some structures that reduce sound but overall, the same is amplified
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9
Q

How is sound amplified in the middle ear?

A
  1. Vibrations enter the middle ear from the air after travelling through the outer ear
  2. The vibrations encounter the tympanic membrane: sound waves converted from air into mechanical movement- the tympanic membrane moves at the exact same frequency as the vibrations (same frequency that we hear)
  3. The tympanic membrane is attached to the ossicles (3 bones: Malleus, Incus and Stapes) that are very sensitive to the movement of the tympanic membrane
  4. Therefore, they amplify the vibrations to a large extent (increasing our ability to detect low levels of sound)
  5. The stapes bone is finally attached to the oval window (end of the middle ear) and it is much smaller than the tympanic membrane (go from larger entry-smaller= increased pressure, again amplifying the sound)
  6. The tensor tympani and stapedius muscles are there to reduce sound if too loud
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10
Q

How do the Tensor tympani and Stapedius muscles carry out their role?

A
  • Innervated by different muscles but have the same role (to reduce sound if too loud)
  • Tensor tympani muscle is attached to the tympanic membrane: if sound is too loud it contracts= stiffens the tympanic membrane, reducing the sound
  • Stapedius is attached to the Stapes (last bone): if sound is loo loud it contracts= stiffens the Stapes, reducing the sound
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11
Q

What is the function of the inner ear?

A
  • The hearing part of the inner ear is the cochlea
  • Here, we want to change the mechanical movement into movement in fluid
  • Contains medium/ fluid that moves at the same frequency (and captures the same amplitude (loudness) as the Stapes (last bone of middle ear)
  • Then change the movement in fluid into neural signals/ impulses (known as transduction)
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12
Q

Describe the structure of the cochlea

A

The cochlea contains 3 compartments:
1. The stapes is attached to the oval window which is attached to the Scala vestibuli (1st compartment)
2. This bone structure is connected to the Scala tympani (2nd compartment) which connects to the round window
- both bones contain perilymph (high in sodium)
3. These bone structure form the spiral- in the centre, between the 2 bones is the Scala media (3rd compartment) which is a membranous structure, contains endolymph (high in potassium)- this is where the organ of Corti (hearing organ) is located

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13
Q

Where is the organ of Corti located?

A

The basilar membrane inside the Scala media

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14
Q

What is the role of the basilar membrane? how does it carry it out?

A

“To capture different levels of frequency”
- Basilar membrane is arranged tonotopically (arranged based on frequency)
- It starts at the base very stiff and narrow and becomes longer and more loose towards the apex
- High frequencies tend to produce vibrations in the 1st part of the membrane/ base
- Low frequencies end to produce vibrations in the last part/ apex
- Membrane is covered with hairs that are attached to nerves- send signals that correspond to the different frequencies

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15
Q

What is the structure of the hearing organ?

A
  • The organ of Corti/ hearing organ contains 2 types of hair cells (not really hair):
    1. Inner hair cells
    2. Outer hair cells
  • Hair cells spikes =”stereocilia”
  • Stereocilia of inner hair cells are arranged in single lines
  • Stereocilia of outer hair cells are arranged in rows of 3
  • Above the hair cells is the tectorial membrane: rubs against the hairs, causes hair deflection, which will depolarise the cell
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16
Q

How does the tectorial membrane affect hair cells?

A

“deflects the hair cells”
- If the tectorial membrane moves up- the hairs move forward
- If the tectorial membrane moves down- hairs move back

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17
Q

What are the roles of the 2 different hair cells?

A

Inner hair cells:
- Main ones that carry 95% of the afferent information of the auditory nerve.
- Function= The transduction of the sound into nerve impulses
- Receive the signals from the vibrations of the different sound frequencies
- Send the signals to the spiral ganglion cells
- Signals then sent through the auditory nerves to the brain

Outer hair cells:
- carry 95% of efferents of the auditory nerve (feedback from the brain)
- Function= modulation of the sensitivity of the response- if the sound send to the brain was too much or not it modulates it (protective)

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18
Q

Describe the process of transduction

A
  1. The spikes of the hair cells are called stereocilia
  2. Deflection of the stereocilia towards the longest spike (kinocilium), if the tectorial membrane moves up, will open K+ channels
  3. K+ influx= depolarisation
  4. Causes Ca2+ influx
  5. Causes excitatory NT release (glutamate) into the afferent nerve
  6. Nerve depolarises
  7. Higher amplitudes (louder) of sound will cause greater depolarization of the stereocilia and more K+ channel opening
  8. The opposite happens if the tectorial membrane moves down, stereocilia move back, K+ channels close
19
Q

Describe how signals move in the Auditory pathway

A
  1. Signal moves from the spiral ganglions in the cochlea via the vestibulo-cochlear nerve travel to the ipsilateral cochlear nuclei (monoaural neurons) in the brainstem- the signal from the left cochlear goes to the same side, left cochlear nucleus
  2. Auditory information crosses at the superior olive level but some stays on the same side (after this point all connections are bilateral- come from 2 sources)
    - so it is very rare to lose hearing completely
20
Q

What are the different types of hearing loss you can have?

A

ANATOMICAL:
1. Conductive hearing loss: Problem is located in outer or middle ear
2. Sensorineural hearing loss: The sensory organ (cochlear) or the nerve (auditory nerve). (90% of all hearing loss!)
3. Central hearing loss: Very rare and originates in the brain and brainstem

TIMING:
1. Sudden hearing loss minutes to days
2. Progressive hearing loss months to years

CONDUCTIVE
SENSORINEURAL

21
Q

What are the causes of conductive hearing loss?

A

Conductive hearing loss in outer ear:
- Wax
- Foreign body
Conductive hearing loss in the middle ear:
- Otitis (infection, inflammation= build up of fluid)
- Otosclerosis (abnormal bone growth inside the ear- bones fuse= reduced movement of the bones)

22
Q

What is conductive hearing loss?

A

sounds can’t get through the outer and middle ear

23
Q

What is sensorineural hearing loss?

A

It occurs from damage to the inner ear, the nerve that runs from the ear to the brain (auditory nerve), or the brain

24
Q

What are the causes of sensorineural hearing loss?

A

Sensorineural hearing loss in the inner ear:
- Noise
- Presbycusis (“old age hearing loss”- hair cells & nerves deteriorate)
- Ototoxicity (hearing loss from medicine: e.g. nerve damage from chemotherapy, antibiotics)

Sensorineural hearing loss in the auditory nerve:
- Acoustic neuroma / vestibular schwannoma (benign brain tumour)

25
Q

What clinical assessments are used to test auditory function?

A
  • Bedside tests (quick but not accurate!)
  • Whisper in ipsilateral ear whilst rubbing fingers in contralateral ear
  • Tuning Fork – 2 tests assess the presence of gross hearing loss:
    1. Weber test: place tuning fork on top/ centre of the head- should hear it coming from the middle
    2. Rinne test: first place tuning fork near the ear, then on the back bone of ear (should be louder moving through the air than the bone)
26
Q

What is an audiogram?

A

The audiogram is where the hearing thresholds are plotted to define if there is a hearing loss or not. A normal hearing threshold is located between 0 – 20dB
- Patients press a button when they hear the sound
- Can only be used for patients who are cognitively aware (not used in infants)

27
Q

What are Otoacoustic Emissions tests?

A
  • The normal cochlea produces low-intensity sounds called OAEs
  • These sounds are produced specifically by the outer hair cells as they expand and contract
  • Use a machine to detect these
  • This test is often part of the newborn hearing screening and hearing loss monitoring (suitable because no response/ cognitive awareness is required)
28
Q

How would you treat hearing loss?

A
  • Prevent underlying cause if possible (e.g. removing wax, surgery on tumours, treating infection with ABs)
  • Cochlear implants
  • Hearing aids
  • Brainstem implants
29
Q

What is the role and structure of the vestibular system?

A
  • This system detects movement and gravity (the input into the system)
  • Via mechanical sensors (canals and otoliths- utricle and saccule organs that use small calcified stones to stimulate hairs to detect the movement & orientation SAME PRINCIPLE AS BEFORE)
  • The output of this system are perception and reflexes that maintain posture and gaze (ocular reflex “ability for eyes to remain aligned as we move” + postural control)
30
Q

Describe the arrangement of the vestibular organs in each ear?

A

Ear is made up of the:
- Utricule and saccule (located in the vestibule- joined by a conduit, saccule joined to the cochlea)
- 3 semicircular canals: anterior, posterior and lateral (have an ampulla, where the hair cells are located, on one side connecting them to the utricle)
- End is the cochlea

31
Q

Describe the arrangement of the otolith organs

A

The otolith organs are the Utricle and Saccule:
- Inside the Utricle and Saccules are masculae: contain a gelatinous matrix, otoliths and hair cells
- Linear acceleration and tilt= otolith movement
- The hair cells in the maculae of the Utricle are placed horizontally, therefore they are deflected by/ detect horizontal movement (side to side)
- The hair cells in the maculae of the Saccule are placed vertically, therefore they are detected by/ deflect vertical movement (up and down)

32
Q

What are otoliths?

A
  • Carbonate crystals that deflect the hair cells (tell the brain which way we’re moving/ orientation)
33
Q

What kind of movement do the semi-circular canals detect?

A

ANGULAR/ CIRCULAR MOVEMENT

34
Q

How is circular movement detected?

A
  • The 3 semicircular canals end with an ampulla (this is where the hair cells in the canal are located)
  • The hair cells are located on the ampullary crista attached at the top to the Cupula
  • Apart from the ampulla, the rest of the canal has endolymph (liquid high in potassium)
  • When there is rapid movement, the fluid does not move
  • Instead, the fluid exerts a force onto the ampulla
  • Cause the hair cells to deflect (depolarisation)
  • The orientation of the canals defines 3 planes: the canals work in pairs
  • Moves the hair cells
35
Q

When do the hair cells stop producing a signal?

A

NEVER:
- Hair cells are always producing a signal
- Hair cells have a resting potential which has a basal discharge to the nerve (brain knows when you’re at rest/ not moving)

36
Q

Which nuclei do vestibular nerves travel to?

A

Primary afferent nerves end in the vestibular nuclei in the brainstem (pons)

37
Q

What is the function of the vestibular system?

A
  • To detect and inform about head movements
  • Balance
  • To keep images fixed in the retina during head movements
38
Q

What are the 2 vestibular reflexes?

A
  1. Vestibulo-ocular Reflex
    (VOR)
    (test this reflex by doing quick movements of the head and check if eyes ramin intact/ fixed at one point- if eyes move with head thats a problem)
    2.Vestibulo Spinal Reflex
    (VSR)
    (reflex to get into positions to maintain balance)
39
Q

What is the vestibulo-ocular reflex

A
  • Keeps images fixed in the retina
  • Eye movement in opposite direction to head movement, but same velocity and amplitude
  • Connection between vestibular nuclei and oculomotor nuclei
40
Q

What are the different types of vestibular disorders you can have? what symptoms are associated with each one?

A

(Categorised depending on timing and laterality)
1. Acute and unilateral disorders:
- imbalance
- dizziness
- vertigo (feeling like the environment around you is spinning)
- nausea

  1. Slow and unilateral or any bilateral loss:
    - imbalance
    - nausea
41
Q

What are the 2 types of balance disorders? What can cause these disorder?

A

(depends on location)
1.Peripheral vestibular disorders
(disorder in vestibular organ and/or VIII nerve)
causes=
Vestibular neuritis (inflammation)
Benign Paroxysmal Positional Vertigo (BPPV)- calcium ball dislodged: brain thinks you’re moving when you’re not
Meniere’s disease

  1. Central vestibular disorders
    (disorder in CNS (brainstem/cerebellum))
    causes=
    Stroke
    Multiple Sclerosis
    Tumours
42
Q

What are the red flags a physician would detect when examining vestibular system?

A

Headache
Gait problems (problems walking)
Hyper-acute onset
Hearing loss
Prolonged symptoms (>4 days)

43
Q

What are the types of balance disorders you can have that are categorized by timing?

A

Acute=(conduct HINTS exam)
Vestibular Neuritis
Stroke
Recurrent=
Migraine
(Meniere’s Disease)
Intermittent=(conduct Dix-Hallpike test)
Benign Paroxysmal Positional Vertigo (BPPV)
Progressive=
Schwannoma vestibular (VIIIth nerve)
Degenerative conditions (MS)

44
Q

What is the HINTS exam

A

“Distinguish if it is a vestibular neuritis or stroke”
HeadImpulseTest​
Horizontal rotational VOR

Nystagmus​
Vestibular organ Vs Cerebellar/brainstem nystagmus

TestofSkewDeviation​
Verticalmisalignment - usually absent in peripheral pathology