The Basic Physiology of the Auditory Nerve
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Pathophysiological Mechanisms and Functional Hearing Consequences of Auditory Neuropathy
doi:10.1093/brain/awv270 BRAIN 2015: 138; 3141–3158 | 3141 REVIEW ARTICLE Pathophysiological mechanisms and functional hearing consequences of auditory neuropathy Gary Rance1 and Arnold Starr2 The effects of inner ear abnormality on audibility have been explored since the early 20th century when sound detection measures were first used to define and quantify ‘hearing loss’. The development in the 1970s of objective measures of cochlear hair cell Downloaded from function (cochlear microphonics, otoacoustic emissions, summating potentials) and auditory nerve/brainstem activity (auditory brainstem responses) have made it possible to distinguish both synaptic and auditory nerve disorders from sensory receptor loss. This distinction is critically important when considering aetiology and management. In this review we address the clinical and pathophysiological features of auditory neuropathy that distinguish site(s) of dysfunction. We describe the diagnostic criteria for: (i) presynaptic disorders affecting inner hair cells and ribbon synapses; (ii) postsynaptic disorders affecting unmyelinated auditory http://brain.oxfordjournals.org/ nerve dendrites; (iii) postsynaptic disorders affecting auditory ganglion cells and their myelinated axons and dendrites; and (iv) central neural pathway disorders affecting the auditory brainstem. We review data and principles to identify treatment options for affected patients and explore their benefits as a function of site of lesion. 1 Department of Audiology and Speech Pathology, The University of Melbourne, -
Common Urgent ENT Problems APRIL 4, 2019 GERARD MACDONALD MD FRCS
3/21/2019 Common Urgent ENT Problems APRIL 4, 2019 GERARD MACDONALD MD FRCS 1 Course Objectives A review of common Urgent ENT problems presenting to office and ER Clinical Pearls to help you manage in a timely fashion Knowing when to refer 2 1 3/21/2019 I do not have any Conflicts of Interest 3 Top Ten List Of Urgent Calls 1.Acute Otitis Externa 2. Sudden Hearing Loss 3.Facial Palsy 4.Salivary Gland Stone /Infection 5.Peritonsillar Abscess 6.Neck Abscess 7.Nosebleeds 8.Hoarseness 9.Foreign Bodies Ear/Nose 10. Acute Vertigo 4 2 3/21/2019 Acute Otitis Externa Commonly associated with swimming ( swimmer’s ear) Common in diabetics and habitual Q-tip Users Usual presenting symptoms are itching, discharge, pain and swelling. More severe symptoms can include severe pain, parotid swelling,trismus and cellulitiis Most common organism is Pseudomonas Aeruginosa May go on to develop secondary otomycosis if frequent use of topical antibiotics. Malignant External Otitis rare but serious 5 Acute Otitis Externa 6 3 3/21/2019 Acute Otitis Externa - Treatment Debridement/Suctioning ? Culture Avoid syringing Ototopicals : Tobradex, Sofracort, Ciprodex Otowick if canal swollen shut Oral Antibiotic ( Cipro ) and single dose Steroid if severe When to refer : Unrelenting pain and swelling, facial nerve weakness,dysphagia , fever 7 Sudden hearing Loss UNEXPLAINED sudden sensorineural hearing loss occurring over 3 days Not AOM, trauma, acoustic trauma , ototoxicity Often confused with ETD , “fluid” Poorer outcome if not recognized -
Acoustic Trauma and Hyperbaric Oxygen Treatment
Acoustic Trauma and Hyperbaric Oxygen Treatment Mesut MUTLUOGLU Department of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Haydarpasa Teaching Hospital 34668, Uskudar, Istanbul TURKEY [email protected] ABSTRACT As stated in the conclusions of the HFM-192 report on hyperbaric oxygen therapy (HBOT) in military medical setting, acoustic trauma is a frequent consequence of military activity in operation. Acoustic trauma refers to an acute hearing loss following a single sudden and very intense noise exposure. It differs from chronic noise induced hearing (NIHL) loss in that it is usually unilateral and causes sudden profound hearing loss. Acoustic trauma is a type of sensorineural hearing loss affecting inner ear structures; particularly the inner and outer hair cells of the organ of Corti within the cochlea. Exposure to noise levels above 85 decibel (dB) may cause hearing loss. While long-term exposure to repetitive or continuous noise above 85 dB may cause chronic NIHL, a single exposure above 130-140 dB, as observed in acoustic trauma, may cause acute NIHL. The loudest sound a human ear may tolerate without pain varies individually, but is usually around 120dB. Military personnel are especially at increased risk for acoustic trauma due to fire arm use in the battle zone. While a machine gun generates around 145dB sound, a rifle generates 157- 163dB, a 105 mm towed howitzer 183dB and an improvised explosive device around 180dB sound. Acoustic trauma displays a gradually down-slopping pattern in the audiogram, particularly after 3000Hz and is therefore described as high-frequency hearing loss. Tinnitus is almost always associated with acoustic trauma. -
ICD-9 Diseases of the Ear and Mastoid Process 380-389
DISEASES OF THE EAR AND MASTOID PROCESS (380-389) 380 Disorders of external ear 380.0 Perichondritis of pinna Perichondritis of auricle 380.00 Perichondritis of pinna, unspecified 380.01 Acute perichondritis of pinna 380.02 Chronic perichondritis of pinna 380.1 Infective otitis externa 380.10 Infective otitis externa, unspecified Otitis externa (acute): NOS circumscribed diffuse hemorrhagica infective NOS 380.11 Acute infection of pinna Excludes: furuncular otitis externa (680.0) 380.12 Acute swimmers' ear Beach ear Tank ear 380.13 Other acute infections of external ear Code first underlying disease, as: erysipelas (035) impetigo (684) seborrheic dermatitis (690.10-690.18) Excludes: herpes simplex (054.73) herpes zoster (053.71) 380.14 Malignant otitis externa 380.15 Chronic mycotic otitis externa Code first underlying disease, as: aspergillosis (117.3) otomycosis NOS (111.9) Excludes: candidal otitis externa (112.82) 380.16 Other chronic infective otitis externa Chronic infective otitis externa NOS 380.2 Other otitis externa 380.21 Cholesteatoma of external ear Keratosis obturans of external ear (canal) Excludes: cholesteatoma NOS (385.30-385.35) postmastoidectomy (383.32) 380.22 Other acute otitis externa Excerpted from “Dtab04.RTF” downloaded from website regarding ICD-9-CM 1 of 11 Acute otitis externa: actinic chemical contact eczematoid reactive 380.23 Other chronic otitis externa Chronic otitis externa NOS 380.3 Noninfectious disorders of pinna 380.30 Disorder of pinna, unspecified 380.31 Hematoma of auricle or pinna 380.32 Acquired -
EXAMINATION of PATIENTS with ACUTE ACOUSTIC TRAUMA Umar B
EXAMINATION OF PATIENTS WITH ACUTE ACOUSTIC TRAUMA Umar B. Bobodzhanov, Jamol I. Kholmatov, Ravshan U. Bobodzhonov Department of Otorhinolaryngology of the Tajik Medical University of the name Abuali ibni Sino Corresponding author: Jamal I. Kholmatov, Department of Otorhinolaryngology of the Tajik Medical University of the name Abuali ibni Sino, e-mail: [email protected] Abstract The acute acoustic trauma leads to further injuries of various structures of the middle and inner ear. Complex audiological examination of hearing in order to reveal posttraumatic sensorineural hearing loss and timely rehabilitation is required to re- veal injuries. It is especially necessary in case of suspicion of integrity damage of labyrinthine windows. In order to evaluate posttraumatic hearing loss, we consider complete audiological examination, including audiomentry in the expanded range of frequencies of air-conduction and bone-conduction, and also urgent rehabilitation actions necessary. Background All patients with ear trauma reported decrease of hear- ing and tinnitus in the ears which was perceptible from According to different authors ear traumas make 32–70% the moment of trauma. The majority of patients suffered of all injuries both in war and a peace times. Decrease of from abrupt hearing loss. the tinnitus was of various in- their number is hard to estimate in the near future be- tensity and character. cause of constant development of manufacture, increase of speed, instability of living standards and growth of house- Other implications of diseases were noted, such as pain hold violence [1,3,6–8]. and feeling of heaviness in the injured ear. 98 (32.7%) pa- tients noted a short-term loss of consciousness immediate- Occurring diagnostic difficulties, especially in cases of ly after trauma, later on they experienced dizziness, nausea polytrauma of various ear structures and posttraumat- and vomiting. -
Cranial Nerve VIII
Cranial Nerve VIII Color Code Important (The Vestibulo-Cochlear Nerve) Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of the lecture, the students should be able to: ✓ List the nuclei related to vestibular and cochlear nerves in the brain stem. ✓ Describe the type and site of each nucleus. ✓ Describe the vestibular pathways and its main connections. ✓ Describe the auditory pathway and its main connections. Due to the difference of arrangement of the lecture between the girls and boys slides we will stick to the girls slides then summarize the pathway according to the boys slides. Ponto-medullary Sulcus (cerebello- pontine angle) Recall: both cranial nerves 8 and 7 emerge from the ventral surface of the brainstem at the ponto- medullary sulcus (cerebello-pontine angle) Brain – Ventral Surface Vestibulo-Cochlear (VIII) 8th Cranial Nerve o Type: Special sensory (SSA) o Conveys impulses from inner ear to nervous system. o Components: • Vestibular part: conveys impulses associated with body posture ,balance and coordination of head & eye movements. • Cochlear part: conveys impulses associated with hearing. o Vestibular & cochlear parts leave the ventral surface* of brain stem through the pontomedullary sulcus ‘at cerebellopontine angle*’ (lateral to facial nerve), run laterally in posterior cranial fossa and enter the internal acoustic meatus along with 7th (facial) nerve. *see the previous slide Auditory Pathway Only on the girls’ slides 04:14 Characteristics: o It is a multisynaptic pathway o There are several locations between medulla and the thalamus where axons may synapse and not all the fibers behave in the same manner. -
Anatomy of the Ear ANATOMY & Glossary of Terms
Anatomy of the Ear ANATOMY & Glossary of Terms By Vestibular Disorders Association HEARING & ANATOMY BALANCE The human inner ear contains two divisions: the hearing (auditory) The human ear contains component—the cochlea, and a balance (vestibular) component—the two components: auditory peripheral vestibular system. Peripheral in this context refers to (cochlea) & balance a system that is outside of the central nervous system (brain and (vestibular). brainstem). The peripheral vestibular system sends information to the brain and brainstem. The vestibular system in each ear consists of a complex series of passageways and chambers within the bony skull. Within these ARTICLE passageways are tubes (semicircular canals), and sacs (a utricle and saccule), filled with a fluid called endolymph. Around the outside of the tubes and sacs is a different fluid called perilymph. Both of these fluids are of precise chemical compositions, and they are different. The mechanism that regulates the amount and composition of these fluids is 04 important to the proper functioning of the inner ear. Each of the semicircular canals is located in a different spatial plane. They are located at right angles to each other and to those in the ear on the opposite side of the head. At the base of each canal is a swelling DID THIS ARTICLE (ampulla) and within each ampulla is a sensory receptor (cupula). HELP YOU? MOVEMENT AND BALANCE SUPPORT VEDA @ VESTIBULAR.ORG With head movement in the plane or angle in which a canal is positioned, the endo-lymphatic fluid within that canal, because of inertia, lags behind. When this fluid lags behind, the sensory receptor within the canal is bent. -
Acoustically Responsive Fibers in the Vestibular Nerve of the Cat
The Journal of Neuroscience, October 1994, 74(10): 6056-6070 Acoustically Responsive Fibers in the Vestibular Nerve of the Cat Michael P. McCue1v2*a and John J. Guinan, Jr.r.2.3-4 ‘Eaton-Peabody Laboratory of Auditory Physiology, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, 2Harvard-MIT Division of Health Science and Technology and Research Laboratory of Electronics, and 3Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, and 4Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02115 Recordings were made from single afferent fibers in the and levels within the normal range of human hearing. We inferior vestibular nerve, which innervates the saccule and suggest a number of auditory roles that these fibers may posterior semicircular canal. A substantial portion of the fi- play in the everyday life of mammals. bers with irregular background activity increased their firing [Key words: saccule, otoliths, auditory system, mamma- in response to moderately intense clicks and tones. lian sound reception, middle-ear muscles, cochlear nucleus] In responsive fibers, acoustic clicks evoked action poten- tials with minimum latencies of I 1 .O msec. Fibers fell into The vertebrate inner ear contains several senseorgans involved two classes, with the shortest latency either to condensation in the maintenance of equilibrium and the detection of vibra- clicks (PUSH fibers) or to rarefaction clicks (PULL fibers). tion. The precise sensory role assumedby homologous organs Low-frequency (800 Hz) tone bursts at moderately high sound varies among species.For example, the sacculeis thought to act levels (>80 dB SPL) caused synchronization of spikes to asa linear accelerometerin mammals(Fernindez and Goldberg, preferred phases of the tone cycle. -
Anatomic Moment
Anatomic Moment Hearing, I: The Cochlea David L. Daniels, Joel D. Swartz, H. Ric Harnsberger, John L. Ulmer, Katherine A. Shaffer, and Leighton Mark The purpose of the ear is to transform me- cochlear recess, which lies on the medial wall of chanical energy (sound) into electric energy. the vestibule (Fig 3). As these sound waves The external ear collects and directs the sound. enter the perilymph of the scala vestibuli, they The middle ear converts the sound to fluid mo- are transmitted through the vestibular mem- tion. The inner ear, specifically the cochlea, brane into the endolymph of the cochlear duct, transforms fluid motion into electric energy. causing displacement of the basilar membrane, The cochlea is a coiled structure consisting of which stimulates the hair cell receptors of the two and three quarter turns (Figs 1 and 2). If it organ of Corti (Figs 4–7) (4, 5). It is the move- were elongated, the cochlea would be approxi- ment of hair cells that generates the electric mately 30 mm in length. The fluid-filled spaces potentials that are converted into action poten- of the cochlea are comprised of three parallel tials in the auditory nerve fibers. The basilar canals: an outer scala vestibuli (ascending spi- membrane varies in width and tension from ral), an inner scala tympani (descending spi- base to apex. As a result, different portions of ral), and the central cochlear duct (scala media) the membrane respond to different auditory fre- (1–7). The scala vestibuli and scala tympani quencies (2, 5). These perilymphatic waves are contain perilymph, a substance similar in com- transmitted via the apex of the cochlea (helico- position to cerebrospinal fluid. -
Processing in the Cochlear Nucleus
Processing in The Cochlear Nucleus Alan R. Palmer Medical Research Council Institute of Hearing Research University Park Nottingham NG7 2RD, UK The Auditory Nervous System Cortex Cortex MGB Medial Geniculate Body Excitatory GABAergic IC Inferior Colliculus Glycinergic DNLL Nuclei of the Lateral Lemniscus Lateral Lemniscus Cochlear Nucleus DCN PVCN MSO Lateral Superior Olive AVCN Medial Superior Olive Cochlea MNTB Medial Nucleus of the Trapezoid Body Superior Olive The cochlear nucleus is the site of termination of fibres of the auditory nerve Cochlear Nucleus Auditory Nerve Cochlea 1 Frequency Tonotopicity Basilar membrane Inner hair cell Auditory nerve Fibre To the brain Each auditory-nerve fibre responds only to a narrow range of frequencies Tuning curve Action potential Evans 1975 2 Palmer and Evans 1975 There are many overlapping single-fibre tuning curves in the auditory nerve Audiogram Palmer and Evans 1975 Tonotopic Organisation Lorente - 1933 3 Tonotopic Organisation Base Anterior Cochlea Characteristic Basilar Membrane Frequency Hair Cells Auditory Nerve Apex Cochlear Nucleus Spiral Ganglion Posterior Tonotopic projection of auditory-nerve fibers into the cochlear nucleus Ryugo and Parks, 2003 The cochlear nucleus: the first auditory nucleus in the CNS Best frequency Position along electrode track (mm) Evans 1975 4 stellate (DCN) Inhibitory Synapse Excitatory Synapse DAS to inferior colliculus cartwheel fusiform SUPERIOR OLIVARY giant COMPLEX INFERIOR COLLICULUS granule vertical vertical OCB AANN to CN & IC via TB golgi DORSAL -
The Vestibulo-Cochlear Nerve (Cranial Nerve 8) (Vestibular & Auditory Pathways)
The Vestibulo-cochlear Nerve (Cranial Nerve 8) (Vestibular & Auditory Pathways) By : Prof. Ahmed Fathalla & Dr. Sanaa AlShaarawy OBJECTIVES At the end of the lecture, the students should be able to: qList the nuclei related to vestibular and cochlear nerves in the brain stem. qDescribe the type and site of each nucleus. qDescribe the vestibular pathways and its main connections. qDescribe the auditory pathway and its main connections. BRAIN – VENTRAL SURFACE Ponto-medullary Sulcus (cerebello- pontine angle) Vestibulo-Cochlear Nerve • Type: Special sensory (SSA) • Conveys impulses from inner ear to nervous system. • Components: § Vestibular part: conveys impulses associated with body posture ,balance and coordination of head & eye movements. § Cochlear part: conveys impulses associated with hearing. • Vestibular & cochlear parts leave the ventral surface of brain stem through the pontomedullary sulcus ‘at crebellopontine angle’ (lateral to facial nerve), run laterally in posterior cranial fossa and enter the internal acoustic meatus along with 7th nerve. Vestibular Nerve • The cell bodies (1st order neurons) are Vestibular nuclei belong to located in the vestibular ganglion special somatic afferent within the internal auditory meatus. column in brain stem. • The Peripheral processes (vestibular nerve fibers) make dendritic contact with hair cells of the membranous labyrinth (inner ear). 2 • The central processes (form the vestibular nerve) ‘’Efferent Fibres’’ : 1. Mostly end up in the lateral, medial, inferior and superior 1 vestibular nuclei (2nd order neurons) of the rostral medulla, located beneath the lateral part of the floor of 4th ventricle 2. Some fibers go to the cerebellum through the inferior cerebellar peduncle • Other Efferents from the vestibular nuclei project to other regions for the maintenance of balance, conscious awareness of vestibular stimulation , co-ordination of head & eye movements and control the posture. -
Cranial Nerve Disorders: Clinical Manifestations and Topographyଝ
Radiología. 2019;61(2):99---123 www.elsevier.es/rx UPDATE IN RADIOLOGY Cranial nerve disorders: Clinical manifestations and topographyଝ a,∗ a b c M. Jorquera Moya , S. Merino Menéndez , J. Porta Etessam , J. Escribano Vera , a M. Yus Fuertes a Sección de Neurorradiología, Hospital Clínico San Carlos, Madrid, Spain b Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain c Neurorradiología, Hospital Ruber Internacional, Madrid, Spain Received 17 November 2017; accepted 27 September 2018 KEYWORDS Abstract The detection of pathological conditions related to the twelve cranial pairs rep- Cranial pairs; resents a significant challenge for both clinicians and radiologists; imaging techniques are Cranial nerves; fundamental for the management of many patients with these conditions. In addition to knowl- Cranial neuropathies; edge about the anatomy and pathological entities that can potentially affect the cranial pairs, Neuralgia; the imaging evaluation of patients with possible cranial pair disorders requires specific exami- Cranial nerve palsy nation protocols, acquisition techniques, and image processing. This article provides a review of the most common symptoms and syndromes related with the cranial pairs that might require imaging tests, together with a brief overview of the anatomy, the most common underlying processes, and the most appropriate imaging tests for different indications. © 2018 SERAM. Published by Elsevier Espana,˜ S.L.U. All rights reserved. PALABRAS CLAVE Sintomatología derivada de los pares craneales: Clínica y topografía Pares craneales; Resumen La detección de la patología relacionada con los doce pares craneales representa Nervios craneales; un importante desafío, tanto para los clínicos como para los radiólogos. Las técnicas de imagen Neuropatía de pares craneales; son fundamentales para el manejo de muchos de los pacientes.