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ENT Advanced > The External and Middle Ear > Flashcards

The External and Middle Ear Flashcards

1
Q

Innervation of the auricle? -4

A
  1. -greater auricular,
  2. -lesser occipital
  3. Facial CN7 branches
  4. Vagus CN10 branches
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2
Q

Why can cleaning your ears sometimes cause you to cough?

A

Can stimulate the auricular branch of the vagus nerve Vagus nerve is responsible for the cough reflex

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3
Q

Vasculature of the auricle? -2

A

Posterior auricular,

superficial temporal

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4
Q

What is the external acoustic meatus?

A

Sigmoid shaped tube extending from the deep part of the concha to the tympanic membrane

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5
Q

What gives the external acoustic meatus structure?

A

Cartilage from the auricle + Bony support from the temporal bone

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6
Q

Innervation of the external acoustic meatus? -2

A
  • Mandibular CN5B3
  • Vagus CN10
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7
Q

Describe the direction that the external acoustic meatus travels

A

Initially superioanterior Then superioposterior Then inferioanterior

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8
Q

What are the 3 layers of the tympanic membrane?

A
  • Outside = skin
  • Core = Connective tissue
  • Inside = Mucous membrane
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9
Q

What is the tympanic membrane connected to?

A

Surrounding temporal bone by a fibrocartilaginous ring

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10
Q

How is the malleus attached to the tympanic membrane?

A

The handle of malleus attaches at the umbo and Continues superiorly

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11
Q

What are the parts of the membrane moving away from the tympanic membrane called? -2

A

Anterior and posterior mallear folds

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12
Q

What is an auricular hematoma?

A

blood collection between cartilage and overlying perichondrium usually as a result of trauma

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13
Q

What can an auricular haematoma lead to and how?

A

Accumulation of blood disrupts the vascular blood supply to the cartilage of the pinna so if not drained quickly, can –> cauliflower ear

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14
Q

Main causes of tympanic membrane perforation - 2

A
  1. Trauma
  2. Otitis media (purulent fluid build up –> rupture)
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15
Q

Function of the auricle?

A

Captures and transmits sound to the external acoustic meatus

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16
Q

Which bone does the middle ear lie within?

A

temporal bone

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17
Q

Where does the middle ear extend from and to?

A

From the tympanic membrane to the lateral wall of the internal ear

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18
Q

Purpose of the middle ear?

A

Transmit vibrations from the tympanic membrane to the inner ear via three bones

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19
Q

Sections of the middle ear? -2

A
  1. Tympanic cavity - medial to the tympanic membrane and contains majority of bones of the middle ear
  2. EpiTympanic recess - superiorly, near mastoid air cells
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20
Q

Borders of the middle ear?

Roof / Lateral / Floor / Medial / Posterior / Anterior

A

Visualised as a rectangular box

Roof: Petrous temporal bone

Lateral: TM and epitympanic recess

Floor: “Jugular Floor” Thin layer of bone separates it from internal jugular

Medial: lateral wall of inner ear

Posterior: “Mastoid Wall” A bony partition between the tympanic cavity and mastoid air cells. Hole in the partition superiorly allowing communication called the aditus to the mastoid antrum

Anterior: thin bony plate with two openings for the auditory tube and tensor tympani muscle. Separates mid ear from internal carotid

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21
Q

What does the Middle Ear roof separate the middle ear from?

A

Middle cranial fossa

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22
Q

What makes a bulge in the medial wall of the inner ear?

A

Facial CN7

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23
Q

Names of the auditory ossicles? -3

A

MIS ossicle bones

Malleus

Incus

Stapes

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24
Q

Where does the head of the malleus lie?

A

Epitympanic recess where it articulates with the incus

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25
Q

What are the muscles called in the middle ear? -2

A

Tensor tympani and stapedius

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26
Q

Function of the muscles of the middle ear?

A

Contract in response to loud noise, inhibiting vibrations of the bones Reduces transmission of sound to the inner ear Called the acoustic reflex

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27
Q

Describe attachment of Middle ear muscles -2

A
  1. Tensor tympani: from auditory tube to handle of malleus, pulling malleus medially
  2. Stapedius: attaches to stapes
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28
Q

Innervation of the middle ear muscles? -2

A

Tensor tympani = [Mandibular CN5B3]

Stapedius - Facial CN7

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29
Q

Where are the mastoid air cells located? What are they?

A

Posterior to the epitympanic recess within the [mastoid antrum cavity] of temporal bone; Collection of air-filled spaces

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30
Q

Function of the mastoid air cells?

A

Act as a buffer system - release air into the tympanic cavity when pressure is too low

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31
Q

How do the mastoid air cells communicate with the middle ear?

A

Aditus to middle antrum

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32
Q

What two things does the EPAT [Eustachian Pharyngotympanic Auditory Tube] connect?

A

Mid ear to nasopharynx

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33
Q

Function of the EPAT [Eustachian Pharyngotympanic Auditory Tube]?

A

Equalizes pressure of middle ear to that of the external auditory meatus

34
Q

What is cholesteatoma?

A

Growth of stratified squamous epithelium in the middle ear

Congenital vs Acquired

35
Q

What problems can cholesteatoma cause?

A

Damage bones of middle ear due to increase pressure & Releases osteolytic enzymes

Patients present with hearing loss and sometimes facial nerve palsy

36
Q

How to treat cholesteatoma?

A

Surgical removal

37
Q

What is mastoiditis?

A

Otitis media can spread to the mastoid air cells, as its a good site for pathogenic replication

38
Q

Complications of mastoiditis?

A

Mastoid process gets infected and can spread to middle cranial fossa causing meningitis

39
Q

How is mastoiditis treated?

A

Pus is drained from air cells, careful of nearby facial nerve

40
Q

What is glue ear?

A

Otitis media with effusion

41
Q

How does otitis media with effusion occur?

A

AKA Glue Ear

persistent dysfunction of EPAT (blockage, inflammation, genetic mutation) –> inability to equalize middle ear pressure –> negative pressure develops inside middle ear which draws out transudate from mucosa of the middle ear –> Glue Ear infection

EPAT [Eustachian Pharyngotympanic Auditory Tube]

42
Q

Why are children more prone to infection? -2

A

EPAT is shorter and more horizontal

EPAT [Eustachian Pharyngotympanic Auditory Tube]

43
Q

Which opening does the Stapes Base articulate

A

OV (Oval Vestibular) window

44
Q

Which opening does the Scala Tympani articulate

A

RC (Round Cochlear) window

45
Q

What role does the external ear play in hearing?

A

Collects sound

46
Q

What role does the middle ear play in hearing?

A

Amplifies sound

47
Q

What role does the inner ear play in hearing?

A

Transduces sounds

48
Q

What is the speed of sound in air?

A

330m/s

49
Q

Does sound travel faster or slower in water than air?

A

Faster

50
Q

What frequencies should humans hear ?

A

20 - 20,000 Hz

51
Q

What range of frequencies are tested on an audiogram?

A

250Hz to 6000Hz

52
Q

What does the frequency of a sound wave do?

A

Dictates how high or low

53
Q

What does the amplitude of a sound wave do?

A

Dictates loudness

54
Q

In the middle ear, how is sound amplified?

A

Stapes hits against the oval window with greater force when vibrations are higher

55
Q

What ligament suspends the stapes bone?

A

Annular ligament

58
Q

What muscles are related to the stapes bone?

A

Stapedius Tensor tympani

59
Q

What muscles open the Eustachian tube?

A

Tensor veli palatini Levator palatine

60
Q

What manoeuvre can be done to equalise the ears?

A

Valsalva manoeuvre

61
Q

What can cause glue ear to be more common?

A

Cleft palate which causes the muscles which open the eustachian tube to be dysfunctional

62
Q

Through which window is sound waves transmitted?

A

Oval

63
Q

What is the round window for?

A

Allows pressure to leave

64
Q

Where is the sound actually perceived?

A

The fine hairs on the cochlea

65
Q

What nerve transmits the sound vibrations to the brain?

A

Cochlear nerve

66
Q

What bone is the inner ear located in?

A

Petrous part of the temporal bone

67
Q

Where is perilymph?

A

Within the bony labyrinth

68
Q

Where is the endolymph?

A

Within the membranous labyrinth

69
Q

What makes up the membranous labyrinth?

A

3 semicircular ducts- anterior, posterior and lateral

70
Q

What connects each semicircular duct to its base- the utricle?

A

The ampulla

71
Q

What sensory organ is contained within the ampulla?

A

Cristae ampullaris

72
Q

What happens when endolymph moves against the cristae ampullaris?

A

Hair cells become depolarised which sets up an action potential

73
Q

What separates the endolymph and perilymph?

A

Basilar membrane

74
Q

How does gentamicin cause tinnitus?

A

It causes damage to the outer hair cells

75
Q

What is another name for stereo cilia?

A

Inner hair cells

76
Q

What is meant by tonotopic organisation of the cochlea?

A

Different areas of the basilar membrane are responsible for different frequencies of sound

77
Q

Where it the apex of the cochlea?

A

Furthest from the round window i.e. centre of spiral

78
Q

What are the two otolith organs called?

A

Utricle Saccule

79
Q

What structure is responsible for vertigo and what are they made of?

A

Otoconia Calcium carbonate crystals

80
Q

What is special about the orientation of the semicircular canals?

A

They are orientated at 90 degrees to each other and are paired.

81
Q

What causes deflection?

A

Movement of endolymph by bodily movement causes the stereocilia to deflect

82
Q

What is spontaneous nystagmus?

A

Movement of the eye without a stimulus

ENT Advanced (24 decks)

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