DOCSLIB.ORG

Medical Robotics and Computer- Integrated Therapy Delivery: Coupling Information to Action in 21’St Century Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medical Robotics and Computer- Integrated Therapy Delivery: Coupling Information to Action in 21’St Century Surgery Medical Robotics and Computer- Integrated Therapy Delivery: Coupling Information to Action in 21’st Century Surgery Russell H. Taylor Dept. of Computer Science/Radiology/Mechanical Engineering Director, Center for Computer-Integrated Surgical Systems and Technology The Johns Hopkins University 3400 N. Charles Street; Baltimore, Md. 21218 [email protected] NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Thanks to many people … • J. Anderson • J. Lazarus • K. Chinzei • W. Bargar • D. Long • N. Hata • A. Bzostek • K. Masamune • R. Kikinis • B. Eldridge • K. Murphy • D. Stoianovici • G. Fichtinger • D. Yousem • A. Patriciu • J. Funda • B. Jaramaz • L. Whitcomb • F. Frassica • A. DiGioia • R. Goldberg • A. Lahmer • A. Okamura • S. Gomory • M. Borner • C. Davatzikos • G. Hager • A. Bauer • E. Atalar • L. Joskowicz • A. Barnes • E. Zerhouni • Y. Kim • P. Jensen • L. Kavoussi • R. Kumar • J. Yao • P. Kazanzides • D. Shen • B. Mittelstadt • H. Paul • C. Riviere • M. Li • J. Wenz • D. Yousem • D. Sheng • E. DeJuan • A. Kalvin • D. Rothbaum • J. Roy • C. Cutting • A. Gueziec • A. Morris • M. Talamini … and many more NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 1 Prediction The impact of computer- integrated surgical systems and technology on medical care in the next 20 years will be as great as the impact of computer-integrated manufacturing systems and technology on industrial production over the past 20 years. Engineering Research Center for Computer Integrated Surgical Systems and Technology NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Basic means for fulfilling prediction: systems that integrate information to action • Provide new capabilities that transcend human limitations in surgery • Increase consistency and quality of surgical treatments • Promote better outcomes and more cost-effective processes in surgical practice NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 2 Patient Computers images & treatment and networks plans Decision Images & other Command & support & Treatment sensor data control commands records & outcome data Interface devices patient surgeon NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Preoperative Intraoperative Computer- Update Model Update Plan assisted planning Patient-specific Computer- Model Assisted Execution Postoperative Atlas Computer- Assisted Assessment Patient NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 3 Preoperative Intraoperative Computer- Update Model Update Plan assisted Surgicalplanning Surgical “CAD” “CAM” Patient-specific Computer- Model Assisted Execution Atlas Computer- Assisted SurgicalAssessment “TQM” Patient Postoperative NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Preoperative Intraoperative Computer- Update Model Update Plan assisted planning Surgical Patient-specific Computer- Model Assisted AssistantsExecution Postoperative Atlas Computer- Assisted Assessment Patient NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 4 NSF Engineering Research Center for Computer-Integrated Surgical Systems and Technology • Multi-institution, multi-disciplinary center – Johns Hopkins University + Medical Institutions – MIT + Brigham & Women’s Hospital – CMU + Shadyside Hospital • University researchers, clinicians, industry • Research, Systems, Education, Outreach NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Medical robotics and CIS Systems • Surgical CAD/CAM Preoperative Intraoperative Systems Computer- Update Model Update Plan assisted planning Surgical CAD/CAM Patient-specific Computer- • Surgical Assistant Model Assisted Execution Systems Postoperative Atlas Computer - Assisted Assessment • Concluding remarks Patient Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000 NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 5 Orthopaedic Surgical CAD/CAM Example: Joint Replacement Surgery Photo: courtesy Brian Davies NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Urologic Surgical CAD/CAM Example: Robotic TURP Photo: courtesy Brian Davies NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 6 Optimized Local Therapy • Deliver optimized patterns of local treatments (e.g., radiation seeds, injections) with an image-guided robot • Applications – Prostate, brain, spine, liver, bone, kidney …. Photo: D. Stoianovici, L. Kavoussi • Advantages – Accuracy of dose – Cost and time of procedure – Lower morbidity – Avoid complications – Enable new treatments NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Example: Stereotactic Neurosurgery Neuromate (ISS) IGOR (Lavallee, Troccaz, et al) NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 7 Example: Radiosurgery Accuray Cyberknife® Varian Clinac® NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Current ERC focus applications Prostate Liver Spine ~210,000 new/year Mets from colorectal $120 billion cost 25% men in lifetime 130,000 new /year 70% in lifetime 60,000 death /year ~30-40% prostatectomy ~20% radiation seeds ~30-40% extracapsular NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 8 One endpoint: 1-stop shopping Pre-op Image In-scanner Screening patient robotically and plan assisted treatment treatment pattern Reimage volume •Follow up •Statistics Maintain Post-op Treatment imaging •Process Log learning NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Key Enablers • Imaging – Image-based modeling & analysis – Integration of image sensors with delivery devices for guidance and monitoring – Design points set for interventions NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 9 Example: integrated MRI imaging and therapy delivery 78 µm resolution ! Beagle prostate Canine urethra Photo: E. Atalar, JHU Combined endoscopic MRI coil & RF ablator Coaxial transmission line RF electrodes LCR Surface coil Scanner E. Atalar, JHU NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Statistical atlas of prostate cancer Christos Davatzikos & Dinggang Shen • Labeled images* of 20 subjects for cancer and normal tissue • Deformably registered images to average prostate (red) • Computed spatial distribution of cancer (green) • Computed 5 needle positions to maximize probability of detection • Use statistical correlation of cancer spatial distributions to optimize pattern * Images provided by Jianchao Zeng, Georgetown U. NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 10 Key Enablers • Imaging • Robots & delivery aids – Modular designs – Compatible with imaging device – End effectors Sketch: Kirby Vosberg, Ferenc Jolesz NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Remote Center of Motion (RCM) • 2 DOF • Mechanically constrained motion center • Maintains entry site R. Taylor, D. Stoianovici, L. Whitcomb, A. Barnes NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 11 Alternate RCM implementations: Parallel linkages Goniometer arcs Davies, et al. NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Photo: D. Stoianovici, JHU Urology Dept NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 12 CT-Compatible End-Effector R. Susil , R. Taylor, J. Anderson, D. Stoianovici NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 Phantom Experiment • Standard prostate phantom • Demonstrated ~1mm accuracy with robot from single CT image targeting R. Susil , G. Fichtinger, K. Masamune, A. Patriciu, D. Stoianovici, E. DeWeese , R. Taylor NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001 13 Clinical example • Kidney biopsy • Robot registered to CT from single image using markers on end-effector Photos: D. Stoianovici, L. Kavoussi, A. Patriciu, S. Solomon (JHU Bayview) Other contributors: R. Susil, G. Fichtinger, K. Masamune, R. Taylor (JHU WSE) NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology Copyright © CISST ERC, 2000, 2001
Load more

Recommended publications
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • GLOSSARY of MEDICAL and ANATOMICAL TERMS
    GLOSSARY of MEDICAL and ANATOMICAL TERMS Abbreviations: • A. Arabic • abb. = abbreviation • c. circa = about • F. French • adj. adjective • G. Greek • Ge. German • cf. compare • L. Latin • dim. = diminutive • OF. Old French • ( ) plural form in brackets A-band abb. of anisotropic band G. anisos = unequal + tropos = turning; meaning having not equal properties in every direction; transverse bands in living skeletal muscle which rotate the plane of polarised light, cf. I-band. Abbé, Ernst. 1840-1905. German physicist; mathematical analysis of optics as a basis for constructing better microscopes; devised oil immersion lens; Abbé condenser. absorption L. absorbere = to suck up. acervulus L. = sand, gritty; brain sand (cf. psammoma body). acetylcholine an ester of choline found in many tissue, synapses & neuromuscular junctions, where it is a neural transmitter. acetylcholinesterase enzyme at motor end-plate responsible for rapid destruction of acetylcholine, a neurotransmitter. acidophilic adj. L. acidus = sour + G. philein = to love; affinity for an acidic dye, such as eosin staining cytoplasmic proteins. acinus (-i) L. = a juicy berry, a grape; applied to small, rounded terminal secretory units of compound exocrine glands that have a small lumen (adj. acinar). acrosome G. akron = extremity + soma = body; head of spermatozoon. actin polymer protein filament found in the intracellular cytoskeleton, particularly in the thin (I-) bands of striated muscle. adenohypophysis G. ade = an acorn + hypophyses = an undergrowth; anterior lobe of hypophysis (cf. pituitary). adenoid G. " + -oeides = in form of; in the form of a gland, glandular; the pharyngeal tonsil. adipocyte L. adeps = fat (of an animal) + G. kytos = a container; cells responsible for storage and metabolism of lipids, found in white fat and brown fat.
    [Show full text]
  • Research Reports
    ARAŞTIRMALAR (ResearchUnur, Ülger, Reports) Ekinci MORPHOMETRICAL AND MORPHOLOGICAL VARIATIONS OF MIDDLE EAR OSSICLES IN THE NEWBORN* Yeni doğanlarda orta kulak kemikciklerinin morfometrik ve morfolojik varyasyonları Erdoğan UNUR 1, Harun ÜLGER 1, Nihat EKİNCİ 2 Abstract Özet Purpose: Aim of this study was to investigate the Amaç: Yeni doğanlarda orta kulak kemikciklerinin morphometric and morphologic variations of middle ear morfometrik ve morfolojik varyasyonlarını ortaya ossicles. koymak. Materials and Methods: Middle ear of 20 newborn Gereç ve yöntem: Her iki cinse ait 20 yeni doğan cadavers from both sexes were dissected bilaterally and kadavrasının orta kulak boşluğuna girilerek elde edilen the ossicles were obtained to investigate their orta kulak kemikcikleri üzerinde morfometrik ve morphometric and morphologic characteristics. morfolojik inceleme yapıldı. Results: The average of morphometric parameters Bulgular: Morfometrik sonuçlar; malleus’un toplam showed that the malleus was 7.69 mm in total length with uzunluğu 7.69 mm, manibrium mallei’nin uzunluğu 4.70 an angle of 137 o; the manibrium mallei was 4.70 mm, mm, caput mallei ve processus lateralis arasındaki and the total length of head and neck was 4.85 mm; the uzaklık 4.85 mm, manibrium mallei’nin ekseni ve caput incus had a total length of 6.47 mm, total width of 4.88 mallei arasındaki açı 137 o, incus’un toplam uzunluğu mm , and a maximal distance of 6.12 mm between the 6.47 mm, toplam genişliği 4.88 mm, crus longum ve tops of the processes, with an angle of 99.9 o; the stapes breve’nin uçları arasındaki uzaklık 6.12 mm, cruslar had a total height of 3.22 mm, with stapedial base being arasındaki açı 99.9 o, stapesin toplam uzunluğu 2.57 mm in length and 1.29 mm in width.
    [Show full text]
  • Michigan Ear Institute Otosclerosis
    Michigan Ear Institute Michigan Otosclerosis www.michiganear.com 34015-56111-109 BOOK Otosclerosis.indd 1 2/13/18 10:33 AM Dennis I. Bojrab, MD Seilesh C. Babu, MD John J. Zappia, MD, FACS Eric W. Sargent, MD, FACS DOCTORS Eleanor Y. Chan, MD Robert S. Hong, MD Ilka C. Naumann, MD Candice C. Colby, MD Christopher A. Schutt, MD Providence Medical Building 30055 Northwestern Highway Suite 101 Farmington Hills, MI 48334 Beaumont Medical Building LOCATIONS 3555 W. Thirteen Mile Road Suite N-210 Royal Oak, MI 48073 Oakwood Medical Building 18181 Oakwood Blvd. Suite 402 Dearborn, MI 48126 Providence Medical Center 26850 Providence Parkway Suite 130 Novi, MI 48374 248-865-4444 phone 248-865-6161 fax 1 34015-56111-109 BOOK Otosclerosis.indd 1 2/13/18 10:33 AM WELCOME Welcome to the Michigan Ear Institute, one of the nation’s leading surgical groups specializing in hearing, balance and facial nerve disorders. The Michigan Ear Institute is committed to providing you with the highest quality diagnostic and surgical treatment possible. Our highly experienced team of physicians, audiologists and clinical physiologists have established international reputations for their innovative diagnostic and surgical capabilities, and our modern, attractive facility has been designed with patient care and convenience as the foremost criteria. It is our privilege to be able to provide care for your medical problems and we will strive to make your visit to the Michigan Ear Institute a positive and rewarding experience. 3 34015-56111-109 BOOK Otosclerosis.indd 3 2/13/18 10:33 AM OTOSCLEROSIS Otosclerosis is a disease of the middle ear bones and sometimes the inner ear.
    [Show full text]
  • Otosclerosis and Stapes Surgery | How to Prepare and What to Expect |
    UW MEDICINE | PATIENT EDUCATION | | Otosclerosis and Stapes Surgery | How to prepare and what to expect | This handout explains otosclerosis, an ear problem that causes hearing loss. It also describes stapes surgery, which is done to improve hearing. What is otosclerosis? Otosclerosis (oh-toh-skleh-ROH-sis) is abnormal growth on the tiny stapes (stirrup) bone in your middle ear. This growth keeps the stapes from vibrating in response to sound. Otosclerosis is the most common cause of conductive hearing loss in adults. Conductive hearing loss is when sound waves cannot move normally in the ear (see DRAFTpage 3). At first, otosclerosis does not cause any symptoms. Hearing loss begins when the bone growth starts to affect how the stapes works. As the bone keeps growing, the Otosclerosis affects the stapes, a tiny hearing loss gets worse. bone in your middle ear. The good news is that hearing loss occurs in only 10% of people (10 out of 100) who have otosclerosis. Profound (severe) hearing loss and deafness are very rare. What causes otosclerosis? Otosclerosis can be hereditary, which means it may be passed from parents to their children. Someone in your family may have had the condition and passed it down to you. If you have otosclerosis, your children may inherit it. Hearing loss may not occur in all generations. The measles virus may affect whether or not you develop otosclerosis, but measles alone do not cause it. How is it treated? Your doctor may advise hearing aids or that you have stapes surgery to treat otosclerosis. Sometimes, both surgery and a hearing aid are needed.
    [Show full text]
  • The Nervous System: General and Special Senses
    18 The Nervous System: General and Special Senses PowerPoint® Lecture Presentations prepared by Steven Bassett Southeast Community College Lincoln, Nebraska © 2012 Pearson Education, Inc. Introduction • Sensory information arrives at the CNS • Information is “picked up” by sensory receptors • Sensory receptors are the interface between the nervous system and the internal and external environment • General senses • Refers to temperature, pain, touch, pressure, vibration, and proprioception • Special senses • Refers to smell, taste, balance, hearing, and vision © 2012 Pearson Education, Inc. Receptors • Receptors and Receptive Fields • Free nerve endings are the simplest receptors • These respond to a variety of stimuli • Receptors of the retina (for example) are very specific and only respond to light • Receptive fields • Large receptive fields have receptors spread far apart, which makes it difficult to localize a stimulus • Small receptive fields have receptors close together, which makes it easy to localize a stimulus. © 2012 Pearson Education, Inc. Figure 18.1 Receptors and Receptive Fields Receptive Receptive field 1 field 2 Receptive fields © 2012 Pearson Education, Inc. Receptors • Interpretation of Sensory Information • Information is relayed from the receptor to a specific neuron in the CNS • The connection between a receptor and a neuron is called a labeled line • Each labeled line transmits its own specific sensation © 2012 Pearson Education, Inc. Interpretation of Sensory Information • Classification of Receptors • Tonic receptors
    [Show full text]
  • Axial Skeleton 214 7.7 Development of the Axial Skeleton 214
    SKELETAL SYSTEM OUTLINE 7.1 Skull 175 7.1a Views of the Skull and Landmark Features 176 7.1b Sutures 183 7.1c Bones of the Cranium 185 7 7.1d Bones of the Face 194 7.1e Nasal Complex 198 7.1f Paranasal Sinuses 199 7.1g Orbital Complex 200 Axial 7.1h Bones Associated with the Skull 201 7.2 Sex Differences in the Skull 201 7.3 Aging of the Skull 201 Skeleton 7.4 Vertebral Column 204 7.4a Divisions of the Vertebral Column 204 7.4b Spinal Curvatures 205 7.4c Vertebral Anatomy 206 7.5 Thoracic Cage 212 7.5a Sternum 213 7.5b Ribs 213 7.6 Aging of the Axial Skeleton 214 7.7 Development of the Axial Skeleton 214 MODULE 5: SKELETAL SYSTEM mck78097_ch07_173-219.indd 173 2/14/11 4:58 PM 174 Chapter Seven Axial Skeleton he bones of the skeleton form an internal framework to support The skeletal system is divided into two parts: the axial skele- T soft tissues, protect vital organs, bear the body’s weight, and ton and the appendicular skeleton. The axial skeleton is composed help us move. Without a bony skeleton, we would collapse into a of the bones along the central axis of the body, which we com- formless mass. Typically, there are 206 bones in an adult skeleton, monly divide into three regions—the skull, the vertebral column, although this number varies in some individuals. A larger number of and the thoracic cage (figure 7.1). The appendicular skeleton bones appear to be present at birth, but the total number decreases consists of the bones of the appendages (upper and lower limbs), with growth and maturity as some separate bones fuse.
    [Show full text]
  • Mechanisms of High Sensitivity and Active Amplification in Sensory Hair Cells a Dissertation Presented to the Faculty of The
    Mechanisms of High Sensitivity and Active Amplification in Sensory Hair Cells A dissertation presented to the faculty of the College of Art and Sciences of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Mahvand Khamesian August 2018 © 2018 Mahvand Khamesian. All Rights Reserved. 2 This dissertation titled Mechanisms of High Sensitivity and Active Amplification in Sensory Hair Cells by MAHVAND KHAMESIAN has been approved for the Department of Physics and Astronomy and the College of Art and Sciences by Alexander B. Neiman Professor of Physics and Astronomy Joseph Shields Dean of College of Arts and Sciences 3 Abstract KHAMESIAN, MAHVAND, Ph.D., August 2018, Physics Mechanisms of High Sensitivity and Active Amplification in Sensory Hair Cells (118 pp.) Director of Dissertation: Alexander B. Neiman Hair cells mediating the senses of hearing and balance rely on active mechanisms for amplification of mechanical signals. In amphibians, hair cells exhibit spontaneous self-sustained mechanical oscillations of their hair bundles. In addition to mechanical oscillations, it is known that the electrical resonance is responsible for frequency selectivity in some inner ear organs. Furthermore, hair cells may show spontaneous electrical oscillations of their membrane potentials. In this dissertation, we study these mechanisms using a computational modeling of the bullfrog sacculus, a well-studied preparation in sensory neuroscience. In vivo, hair bundles of the bullfrog sacculus are coupled by an overlying otolithic membrane across a significant fraction of epithelium. We develop a model for coupled hair bundles in which non-identical hair cells are distributed on a regular grid and coupled mechanically via elastic springs connected to the hair bundles.
    [Show full text]
  • Pathway of a Sound Wave
    Pathway of a Sound Wave 1. The sound waves arrive at the pinna (auricle), the only visible part of the ear. 2. Once the sound waves have passed the pinna, they move into the auditory canal (external acoustic meatus) before hitting the tympanic membrane (eardrum). 3. Once the sound waves reach the tympanic membrane, it begins to vibrate and they enter into the middle ear. 4. The vibrations are transmitted further into the ear via three bones (ossicles): malleus (hammer), incus (anvil), and the stapes (stirrup). These three bones form a bridge from the tympanic membrane to the oval window. 5. Once sound passes through the oval window, it enters into the cochlea in the inner ear. 6. Hair cells in the organ of Corti (within the cochlea) are stimulated which in turn stimulates the cochlear branch of the vestibulocochlear nerve. 7. The cochlear nerve then transmits electrical impulses to the auditory region of the brain in the temporal lobe. Pathway of a Sound Wave 1. The sound waves arrive at the pinna (auricle), the only visible part of the ear. 2. Once the sound waves have passed the pinna, they move into the auditory canal (external acoustic meatus) before hitting the tympanic membrane (eardrum). 3. Once the sound waves reach the tympanic membrane, it begins to vibrate and they enter into the middle ear. 4. The vibrations are transmitted further into the ear via three bones (ossicles): malleus (hammer), incus (anvil), and the stapes (stirrup). These three bones form a bridge from the tympanic membrane to the oval window.
    [Show full text]
  • What You Should Know About Otosclerosis What Is Otosclerosis? the Term Otosclerosis Is Derived from the Greek Words for "Hard" (Scler-O) and "Ear" (Oto)
    What you should know about otosclerosis What Is Otosclerosis? The term otosclerosis is derived from the Greek words for "hard" (scler-o) and "ear" (oto). It describes a condition of abnormal bone growth around the stapes bone, one of the tiny bones of the middle ear. This leads to a fixation of the stapes bone. The stapes bone must move freely for the ear to work properly and hear well. Hearing is a complex process. In a normal ear, sound vibrations are funneled by the outer ear into the ear canal where they hit the tympanic membrane (ear drum). These vibrations cause movement of the ear drum, which transfers the vibrations to the three small bones of the middle ear, the malleus (hammer), incus (anvil), and stapes (stirrup). When the stapes bone moves, it sets the inner ear fluids in motion, which, in turn, start the process to stimulate the tiny sensory hair cells in the inner ear, which connect with the auditory (hearing) nerve. The hearing nerve then carries sound information to the brain, resulting in hearing of sound. When any part of this process is compromised, hearing is impaired. Who Gets Otosclerosis and Why? It is estimated that ten percent of the adult Caucasian population is affected by otosclerosis. The condition is less common in people of Japanese and South American decent and is rare in African Americans. Overall, Caucasian, middle-aged women are most at risk. The hallmark symptom of otosclerosis, slowly progressing hearing loss, can begin anytime between the ages of 15 and 45, but it usually starts in the early 20’s.
    [Show full text]
  • Medical Terminology Made Incredibly Easy Third Edition
    845500FM.qxd 8/19/08 7:17 PM Page i Medical Terminology made IncrediblyIncredibly® EaEasy!sy! 845500FM.qxd 8/19/08 7:17 PM Page ii Staff The clinical treatments described and recommended in this pub- lication are based on research and consultation with nursing, Executive Publisher medical, and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Neverthe- Judith A. Schilling McCann, RN, MSN less, they can’t be considered absolute and universal recom- Editorial Director mendations. For individual applications, all recommendations David Moreau must be considered in light of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light Clinical Director of the latest package-insert information. The authors and pub- Joan M. Robinson, RN, MSN lisher disclaim any responsibility for any adverse effects result- Art Director ing from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text. Mary Ludwicki Electronic Project Manager © 2009 by Lippincott Williams & Wilkins. All rights reserved. This John Macalino book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any Senior Managing Editor means—electronic, mechanical, photocopy, recording, or other- Jaime Stockslager Buss, MSPH, ELS wise—without prior written permission of the publisher, except Clinical Project Manager for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by the publisher to in- Lorraine M. Hallowell, RN, BSN, RVS structors whose schools have adopted its accompanying text- Editors book.
    [Show full text]
  • How Do Middle Ear Muscles Protect the Cochlea? Reconsideration of the Intralabyrinthine Pressure Theory
    HOW DO MIDDLE EAR MUSCLES PROTECT THE COCHLEA? RECONSIDERATION OF THE INTRALABYRINTHINE PRESSURE THEORY Andrew Bell Research School of Biology, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT 0200, Australia Abstract The middle ear muscles are part of a control system for regulating the acoustic input to a supersensitive detector, the cochlea, preventing overload and damage. Yet there is a long-standing paradox. When Békésy measured sound transmission through the middle ear of cadavers, he found that acoustic transmission was not affected when the annular ligament was stretched by pressure. Similarly, reflex activation experiments often show only a few decibels of attenuation, assumed to be due to stiffen- ing of middle ear joints and ligaments. In contrast, psychophysical experiments reveal attenuations of 30 dB or more when the middle ear muscles are voluntarily contracted. How can the difference be explained? This synthesis paper shows how the paradox can be resolved by reconsidering a theory put forward by Gellé in the 19th century. According to Gellé’s intralabyrin- thine pressure theory, which has long been dismissed, the purpose of the middle ear muscles is to press the stapes inwards and raise the hydraulic pressure in the labyrinthine fluids, thereby regulating cochlear sensitivity. The focus of this review is to re- visit the theory and show how it can explain a range of audiological findings. The theory is updated and the hypothesis made that static pressure in the cochlear fluids is sensed by the outer hair cells, which are in continuous hydraulic connection with the stapes. It is this factor which reduces the gain of the cochlear amplifier and provides rapid and effective overload protec- tion.
    [Show full text]