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Glossary of Otologic Terms

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Glossary of Otologic Terms Glossary of Otologic Terms. (A) (1) Acoustic reflex ( threshold) (ART). synonym : stapedial reflex ART is the measurement of the change in compliance in the tympanic membrane which occurs when the muscles of the middle ear (tensor tympani, the stapedius muscles) contract when stimulated by a tone at a particular frequency and intensity. Both are striated muscles. Though it is commonly referred to as the stapedial reflex, both the tensor tympani and stapedius muscle are thought to participate in this test. The acoustic reflex threshold (ART) is the sound pressure level (SPL) at which a sound stimulus with a given frequency will trigger the acoustic reflex. The ART is a function of sound pressure level( SPL) and frequency. This acoustic reflex threshold is performed during tympanometry. Persons who have normal hearing have an acoustic reflex threshold (ART) at around 70–100 dB SPL. Persons with conductive hearing loss ( caused by a defect in the middle ear sound transmission mechanism but with an intact tympanic membrane) will likely have an abnormal acoustic reflex threshold depending on the problem in the sound transmission mechanism of the middle ear. The tensor tympani ( nerve supply from the mandibular branch of the trigeminal nerve) pulls the tympanic membrane medially and the stapedius (supplied by a branch of the facial nerve) causes the tympanic membrane to move laterally. Features of the acoustic reflex. · The stapedius muscle contracts bilaterally in normal ears even if only one ear is exposed to sound. · The acoustic reflex protects the inner ear against the harmful effects of low frequency sounds. · When the acoustic reflex is set in motion by sounds of 20 dB above the reflex threshold, the stapedius reflex dampens the intensity of the sound transmitted to the cochlea by about 15 dB.] · Speaking causes the acoustic reflex to take place when a person vocalizes and dampens sound intensities reaching the inner ear by approximately 20 decibels. The reflex is initiated when vocalization is anticipated. · The organ of Corti is protected by the acoustic reflex against excessive harmful vibrational stimulation caused by harmful loud sounds especially in the low frequencies. The latency of contraction is about 10ms and thus because of this latency, the acoustic reflex is unable to provide protection against sudden intense sounds. The acoustic reflex is an objective test. It is useful to determine · Hearing thresholds. · Determine the status of the middle ear. · Topographical diagnostic test in the presence of facial nerve lesions. · Useful to confirm the diagnosis of myasthenia gravis and tetanus. (2) Aditus ad Antrum This is a passage that leads backwards from the upper attic space of the epitympanum into the mastoid antrum. Superiorly: formed by the tegmen antri Medial: lateral semi-circular canal, facial nerve Lateral: The posterior part of the external auditory canal The short process of the incus lies on its floor. Aditus in latin means ”approach to” or “access”. (3) Ampulla / e These are the normal dilated ends of the semi-circular canals. They contain the neuroepithelium that is responsible for equilibrium. · Annular ligament (synonym: stapediovestibular ligament). It is the ligament surrounding the stapedial footplate attaching it to the oval window. This joint is known as a syndesmotic joint. · Annulus The peripheral part of the pars tensa is thickened to form the annulus. The fibrous annulus sweeps forward anteriorly and posteriorly to form the anterior and posterior malleolar folds and is attached to the lateral (short) process of the malleus. The annulus contains no cartilage and is lodged in the sulcus of the tympanic part of the temporal bone. · Anterior epitympanic recess. It is located anterior to the head of the malleus. It contains no structures. Boundaries Inferior: Facial nerve, tensor tympani muscle and tensor tympani fold and its canal. Medial: Petrous apex Posterior: Cog Lateral: Scutum. Anterior: The root of the zygoma. Since the anterior border of the epitympanic space is formed by the root of the zygomatic arch, in a well pneumatized zygoma the recess may extend for some distance into the zygoma. Synonyms Anterior epitympanic space, supratubal recess, anterior epitympanic cell, anterior malleolar space and anterior compartment of the attic. · Antrum (Mastoid Antrum) It is the single largest air cell in the mastoid system of air cells. It communicates anteriorly with the tympanic cavity through the aditus. Its medial wall is formed by the posterior and lateral semi-circular canals and the petrous portion of the temporal bone.. The roof is formed by the tegmen antri, superior semi-circular canal. Its lateral wall is formed by the squamous part of the temporal bone. Posteriorly is located the sigmoid sinus and the posterior fossa. · Aqueduct Cochlear Aqueduct: This is a bony channel connecting the scala tympani of the basal turn of the of the cochlea (near the round window) with the subarachnoid space of the posterior cranial cavity. Within the aqueduct there is a loose network of fibrous tissue continuous with the arachnoid. Usually in humans the cranial opening is not patent. The cranial opening lies between the jugular fossa and the orifice of the carotid canal on the inferior surface of the pyramid of the petrous bone. Vestibular aqueduct: It extends from the vestibule to the posterior fossa. Its cranial end lies lateral to the meatus of the internal auditory canal. It is usually covered by scale of bone. It transmits the endolymphatic duct and an accompanying vein. · Arcuate eminence : This is a bulge on the superior surface of the petrous part of the temporal bone denoting the location of the superior semi circular canal. An important landmark in the floor of the middle cranial fossa during middle fossa surgery. The vertical plane of the superior semi-circular is set obliquely in an anterolateral direction and makes an angle of 600 with the long axis of the internal auditory canal meatus. The arcuate eminence is situated at a distance of approximately 24mm from the outer table of the squamous portion of the temporal bone. · Arnolds Nerve: (synonym: Aldermans nerve) It is the auricular branch of the 10th cranial nerve which supplies the posterior half of the tympanic membrane. · Attic :(synonym : Epitympanum): It is located in the middle ear just behind the pars flaccida. Its boundaries are: Medial: Petrous apex, the facial nerve and the geniculate ganglion. Superior: Tegmen tympani. Lateral: Scutum Pars Flaccida. Inferior : Tympanic diaphragm Anterior: The petrous apex, The middle cranial fossa and in well pneumatised bones the root of the zygoma. Posterior Aditus ad antrum. Contents of the epitympanum: Head of the malleus, body of the incus and their associated ligaments and folds. The epitympanum is divided into Anterior and Posterior compartments. The compartment anterior to the cog is known as the anterior epitympanic recess and the space behind is the posterior epitympanic recess. The head of the malleus and the body of the incus lie in the posterior epitympanic recess. The anterior epitympanic recess does not contain any of the ossicles. When viewing the tympanic membrane from the external auditory canal, the epitympanum is that portion of the middle ear that lies above the level of the short process of the malleus. Communications: The epitympanum communicates with the mesotympanum through the isthmus tympani anticus and the isthmus tympani posticus. These openings breach the tympanic diaphragm. The epitympanum also communicates with the mastoid via the aditus ad antrum. · Auditory canal / meatus. · External auditory canal / meatus : abbreviation (EAC) / (EAM): It is approximately 2.5 cms in length. It consists of 2 parts, an outer cartilaginous part and an inner bony part. The cartilaginous part is one third its length and is directed inwards, upwards and backwards. The bony part is formed by the tympanic and squamous portions of the temporal bone. The junction of the bony and cartilaginous portions of the EAC forms the isthmus and this is the point at which the EAC is narrowest ( constriction). The tympanic membrane closes the EAC obliquely and its obliquity is such that the anterior wall and floor are slightly longer than the posterior wall and roof. The EAC is the only cul de sac in the human body to be lined by skin (stratified keratinizing squamous epithelium). Internal Auditory canal (IAC) : is a neurovascular channel which places the labyrinth in communication with the posterior cranial fossa. It lies within the petrous bone. It makes an angle of approximately 450 with the long axis of the petrous pyramid. It is approximately 1 centimetre long in adults. Its contents are the meninges and with their associated spaces, the facial nerve, the nervus intermedius ( nerve of wristberg), the cochlear and vestibular nerve and its branches and blood vessels. It consists of 3 parts (a) the porus, through which the facial, cochlear and vestibular cranial nerves enter the canal (2) canal and (3) fundus which is applied to the labyrinth. The IAC is divided into a superior and inferior compartment by a transverse crest of bone (Crista falciformis). The superior compartment is divided into 2 compartments by a vertical crest of bone known as Bills bar. In the anterior compartment lies the facial nerve and in the posterior compartment lies the superior vestibular nerve. B · Basilar Papilla (synonym: Papilla of Huschke, spiral ganglion) The organ of corti. · Battle’s sign: Bruising occurring over the mastoid process . Characteristically associated with fractures of the middle cranial fossa. · Bezold’s abscess: is an abscess situated deep in the neck (behind { deep to} the sternocleidomastoid muscle) which occurs as a complication of Otitis media and associated with acute coalescent mastoiditis. Perforation of the medial aspect of the mastoid tip into the digastric groove produces a deep seated abscess in the neck. The carotid sheath, parapharyngeal space and the mediastinum may be involved in the process.
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