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Neurology and Neuroscience > Audio vestibular system > Flashcards

Audio vestibular system Flashcards

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1
Q

What does the vestibular organ do

A

capture low frequency motion (movements)

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2
Q

What does the hearing organ do

A

capture high frequency motion (sound)

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3
Q

What is sound made up of

A

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

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

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4
Q

Human range of hearing

A

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

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5
Q

What are the function of the outer ear

A

Ear and canal helps to
capture and amplify sound (amplifies it by 10db)
Protect ear from external threats

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6
Q

By how much is sound amplified in ear canal

A

Modest amplification (10DB) of upper range of speech frequencies by resonance in the canal

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7
Q

what is the middle ear

A

From tympanic membrane to oval window

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8
Q

What is outer ear

A

Upto tympanic membrane

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9
Q

What changes in the middle ear

A

vibrations in air change to mechanical movement in inner ear

Tympanic membrane moves at exact frequency as you are hearing sounds
Tympanic membrane connected to malleus , incus and stapes (3 smallest bones)

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10
Q

What is the main function of the inner ear

A

The main function of the middle ear is mechanical amplification (can provide an additional 20-30dB

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11
Q

What are the muscles in the ear

A

Tensor tympani
Stapedius muscle

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12
Q

What does tensor tympanii do

A

When sound is loud, tensor tymapni will contract and make the tympanic membrane stiff decreasing vibration

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13
Q

what does Stapedius muscle do

A

contracts and prevent stapes from vibrating fast (reduces vibrations)

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14
Q

What is the chochlea

A

Hearing part of inner ear

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15
Q

What is function of inner ear

A

Its function is to transduce vibration into nervous impulses
It does so in a way that captures the frequency (or pitch) and intensity (or loudness) of the sound,

(when stapes vibrates, it makes the fluid in the chochlea vibrate at the same frequency. THis now needs to be converted to nervous impulses)

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16
Q

How many compartments in cochlea

A

3 Scala vestibuli and scala tympani Scala media:

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17
Q

What do the 3 layers contain

A

Scala vestibuli and scala tympani: Bone structures, contain perilymph (high in sodium)

Scala media: Membranous structure, contains endolymph (high in potassium). Here is where the hearing organ or Organ of Corti is located.

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18
Q

Where is the Hearing organ or Organ of Corti located

A

Scala media

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19
Q

Wherr does the organ of corti lie

A

In the basilar membrane

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20
Q

How is the basilar membrane arranged

A

Tonotopically using th esame prinicple as a xylophone

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21
Q

What part of the membrane do high frequencies move

A

High frequencies move the first part of membrane that is narrow and tight (BAase)
Each part of the membrane hair cells that are connected to nerves so the signal that will go through that will correspond to the frequency that is heard

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22
Q

What part of the membrane do low frequencies move

A

Low frequencies move the laterpart of membrane that is wide and loose (APex)
Each part of the membrane hair cells that are connected to nerves so the signal that will go through that will correspond to the frequency that is heard

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23
Q

what is tonotopical

A

Arranged on a way that is frequency based

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24
Q

What types of hair cells are in the organ of Corti

A

The organ of Corti contains two types of hair cells:
Inner hair cells (IHC) and (arranged in one line)
Outer hair cells (OHC) (arranged in 3 lines)

Not really hair just look like hair

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25
where is the tectorial membrane
The tectorial membrane is above the hair cells and allows hair deflection, which in turn will depolarise the cell. (basically rubs against the hair cells
26
where is the tectorial membrane
The tectorial membrane is above the hair cells and allows hair deflection, which in turn will depolarise the cell.
27
What is the function of IHC
IHC carry 95% of the afferent information of the auditory nerve. Their function is the transduction of the sound into nerve impulses (so sound has now gone from motion to a neuronal signal) IHC- Spiral ganglion-Auditory Nerve-brain
28
What is the function of OHC
OHC carry 95% of efferents of the auditory nerve. Their function is modulation of the sensitivity of the response.
29
What are sterocilia
The hairs of the hair cells are called stereocilia.
30
What is the function of the sterocilia
The deflection of the stereocilia towards the longest cilium (kinocilium) will open K+ channels This depolarises the cell releasing the neurotransmitter to the afferent nerve which then depolarises. Higher amplitudes (louder) of sound will cause greater deflection of stereocilia and K+ channel opening When potassium channels open, influx of potassium into cell and tthen there is influx of calcium into the cell which then releases excitatatory transmitter Glutamate
31
what is the kinocilium
logest cilium IF hairs move towards kinocilium tehn different effect to if they move away from kinocilium
32
Transduction: How does deploarisation happen
when basilar membrane goes up, the tectoral membrane goes forwards due to shearing force causes depolarisation sending a signal so you here a sound
33
what happens in hyperpolarisation
When the membrane goes down, shearing makes the tectoral membrane go backwards causing hyperpolarisation and decreasing the sound. Hyperpolarisation closes the K chhannels
34
Auditory pathway
Auditory nerve combines with the vestibular nerve to make the vestibulocochlear nerve (8th cranial nerve) nerve . the auditory parts from the cochlea go to the ipsilateral cochlear nucleus in the pons in the brainstem From the cochlear nucleus sends message to the other side of the brain and to the superior olive which then communicate bilaterally Clinical implication: if you have brain damage that involves small part of brainstem, very rare to loose hearing because if this bilateral communication. Hearing very rarely lost on bath sides in stroke.
35
which neuclei are present in the midbrain
3 rd and 4th
36
which neuclei are present in the pons
5, 6, 7, 8
37
which neuclei are present in the medulla
9, 10, 11, 12
38
In which part of the thalmus relates to hearing
Medial geniculate body
39
where do the auditory projections go
Auditory cortex in temporal lobe, next to Brocas and Wernickes areas
40
What are the different types of anatomical hearing loss
Conductive hearing loss: Problem is located in outer or middle ear. Sensorineural hearing loss: The sensory organ (cochlear) or the nerve (auditory nerve). (90% of all hearing loss!) Central hearing loss: Very rare and originates in the brain and brainstem
41
What is the timing of hearing loss
Sudden hearing loss minutes to days Progressive hearing loss months to years
42
What are the causes of conductive hearing loss
Outer Ear: wax, foreign body Inner ear Otitis Otosclerosis
43
What does this image show
Otitis. Bubbles can be seen through the ear drum, suggesting there is liquid inside the middle ear.
44
What does this image show
45
What are the causes of sensorineural hearing loss
Inner ear Noise Presbycusis (old age) Ototoxicity (chemotherapy, antibiotic like gentamycin) Nerve acoustic neuroma (vestibular schwannoma) (unilateral)
46
What is hearing loss due to old age called
Presbycusis
47
Name one antibiotic that can cause hearing loss
gentamycin
48
Name one class of antibiotics that can cause hearing loss
aminoglycosides
49
A patient presents with unilateral hearing loss what is the arrow point to?
acoustic neuroma (vestibular schwannoma
50
How do you assess for hearing loss if you have no tools (bedside test)
Whisper in ipsilateral ear whilst rubbing fingers in contralateral ear
51
Bedside tests for hearing loss with tuning fork
Assess gross hearing loss Weber test Rinne test Use tuning fork on top of head and they should hear in th emiddle (Weber) Using tune fork on mastoid and then in air in front of ear. IF its Lounder from bone than air then its a problem with the conduction so outer or inner ear problem
52
How is Audiometry done
Patient clicks when they hear a sound 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
53
What is more common hearing loss with high frequency Hearing loss with low frequency
Hearing loss with high frequency
54
What does this pictiure demonstrate
Hearing loss at high frequency but one ear is worse than other so more likely to be sensorineural hearing loss
55
What do these patterns show
do hearing test with audiology with headphones and then putting it on bone. If there is a disparity in line then its conductive hearing loss
56
what is - Otoacoustic Emissions (OAEs
The normal cochlea produces low-intensity sounds called OAEs These sounds are produced specifically by the outer hair cells as they expand and contract This test is often part of the newborn hearing screening and hearing loss monitoring.
57
What are otoliths
utricle and saccule The hair cells are located on the maculae, placed horizontally in the utricle and vertically in the saccule
58
What are the parts of the vestibular organ
The utricule and saccule are located in the vestibule and are joined by a conduit. The saccule is also joined to the cochlea There are three semicircular canals on each ear, anterior, posterior and lateral The semicircular canals have an ampulla on one side, and they are connected to the utricle. The hair cells sit on the ampulla
59
What movement do the hair cells of the utricle pick up
Linear movements horizontally
60
What movement do the hair cells of the saccule pick up
Linear movements up and down (vertical)
61
What do the maculae contain
The maculae contain the hair cells, a gelatinous matrix and the otoliths on top. These otholiths are carbonate crystals that help the deflection of the hairs.
62
What do the maculae contain
The maculae contain the hair cells, a gelatinous matrix and the otoliths on top. These otholiths are carbonate crystals that help the deflection of the hairs.
63
What do the semicircular canals contain
Hair cells in ampulla, The rest of the canal only has a liquid high in potassium called endolymph
64
Describe the ampulla
The ampulla has the crista, where the hair cells are located. The cells are surrounded by the cupula which helps the hair cell movement
65
How are the canals oriented
The canals are arranged in a way to detect angular movement The orientation of the canals in the head defines three planes. Anterior and posterior canals form a 90° angle. Lateral canals are horizontal to the other canals. Therefore they work in pairs
66
What are the two types of hair cells in the vestibule
Type 1 and type 2 . they both produce afferent signals Vestibular hair cells have a kinocilium (the biggest cilium) and stereocilia. Cilia allows the cells to depolarise the cell with movement of the endolymph generated by head movement
67
Hair cells have a resting potential which has a basal discharge to the nerve Hairs moving towards the kinocilium generates depolarization and an increase in nerve discharge. Hairs moving away from the kinocilium generates hyperpolarization and a reduction in nerve discharge.
68
Pathway
Primary afferents end in vestibular nuclei in the brainstem (pons) Goes to the vestibular nucleus. After this it goes to various parts: 1.cerebellum 2.down to vestibulospinal tract (spinal reflexes to keep postural balance) 3. Nuclei of the eye movements (3. 6, 4 nerve) that control the muscles of the eyes
69
Vestibular system functions
To keep images fixed in the retina during head movements To detect and inform about head movements Balance
70
What is the Vestibular Ocular reflex (VOR)
Keeps images fixed in the retina Connection between vestibular nuclei and oculomotor nuclei Eye movement in opposite direction to head movement, but same velocity and amplitude
71
What is Vestibulo spinal reflex (VsR)
Maintains posture and balance. Eg if you slip on ice the movemetns to keep the body upright
72
How do you test the VOR Vestibulo ocular reflex
Ask person to fix sight on an object and then move the head from side to side while the the eyes are fixated on the object. IF the VOR is intact the eyes will remain fixated on the object while the head moves. IF not intact then eyes will move with the head and then do a quick saccade back to the object. The image is of an intact VOR
73
How do you categorise Vestibular disorders
By timing (acute or slow onset) and by laterality (unilateral or bilateral)
74
What happens In acute AND unilateral vestibular disorder
Main complaints - imbalance, dizziness, vértigo and nausea
75
what happens in In slow AND unilateral or any bilateral loss
Main complaints – imbalance and nausea – NO vertigo
76
When do you not have vertigo in a vestibular disorder
In slow AND unilateral or any bilateral loss:
77
What is Peripheral vestibualr disorders and give examples
disorder in Vestibular organ and/or VIII nerve Vestibular neuritis Benign Paroxysmal Positional Vertigo (BPPV) Meniere’s disease
78
What are Central vestibular disorders
Disorders in the CNS (brainstem/cerebellum) Stroke (posterior circulation stroke) Multiple Sclerosis Tumours
79
What are the main diagnoses of vestibular problems
BPPV Vestibular Neuritis Vestibular Migraine Stroke (cerebellar)
80
What is the core exam you will do
Examine eyes, ears, legs, Look for red flags: Headache Gait problems Hyper-acute onset Hearing loss Prolonged symptoms (>4 days)
81
Look at slide 40 and 41 for skew
82
What are the acute Balance disorders
Vestibular Neuritis Stroke
83
How do you distinguish between Vestibular neuritis and stroke
HINTS exam
84
What are the intermittent Balance disorders
Benign Paroxysmal Positional Vertigo (BPPV)
85
How do you distinguish between Benign Paroxysmal Positional Vertigo (BPPV)
Dix-Hallpike test
86
What are the recurrent Balance disorder
Migraine (Meniere’s Disease
87
What are the recurrent Balance disorder
Schwannoma vestibular (VIIIth nerve) Degenerative conditions (MS)

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