Primarily responsible for gathering sound waves and localization. (made entirely of cartilage)
Outer rim of the auricle that folds over outwardly
Small triangular protrusion, which points slightly backward and forms anterior portion of the auricle.
Middle-most- portion just before the opening into the head
Aids in localizing the sound sources that come from the front, below and above the head.
The auricle is more efficent at delivering ________ frequency sounds than ________ frequency.
The auricle helps in___________ of sounds delivered to the head.
It begins at the concha and extending inward at a slight upward angle for approximately 1 inch in adults.
EAC (External Auditory Canal)
The ________ portion of the EAC passes through cartilage.
The EAC contains ___________ _________ which secrete ________.
sebaceous glands, sebum
The product of the secretions of sebum is____________.
Cerumen exits the ear naturally during _________ or ___________.
chewing or speaking
The outer 1/3 of the EAC contains __________ _________.
The ___________ and the ____________ ________ keep foreign objects from passing into the inner 2/3 of the ear canal.
cerumen and hair follicles
The inner ____ of the EAC do not contain ___________ _________.
2/3, hair follicles
Where do the two portions of the EAC meet together at the _________ _____________.
The ____________ lies just below this junstion and when the mandible overrides its normal position, the __________ will press into the junction causing pain.
When the condyle presses into the osseocartilaginous junction and causese pain, this is called _____________ ______________ ___________.
temporomandibular joint syndrome (TMJ)
When TMJ syndrome produces a referred pain in the ear it is called ________________.
otalgia (ear pain)
The angle of an infants EAC angles ______________ rather than ___________ and is at a more ________ angle.
downward, upward, acute
An adult's pinna is pulled ______ and _______ for inspection.
An child's pinna is pulled ______ and _______ for inspection.
The EAC provides protection for the ___________.
(TM) tempanic membrane
The EAC filters sounds by reducing ________ frequencies and enhances between __________ and ________ Hz.
low, 2000, 7000
The TM marks the border between the ___________ and ________ ear.
The TM has how many layers?
The 3 layers of the TM are?
The outer layer of the TM is _________ from the EAC.
The layer of the TM that is a tough, fibrous, connective tissue that contributes the ability of the TM to vibrate sounds is the ________ __________.
This layer of the TM is lined with mucous membrane which is consistent with the middle ear.
the inner layer
T or F
The TM is very rich in blood supply?
The malleus is embedded in the _________ portion of the TM.
The tip of the ________ ends in the center of the TM and angles ____________ and __________.
malleus, downward, backward
The point of greatest retraction in the TM is the ________.
What are the 4 quadrants of the TM?
1. Anterior- superior
2. Posterior - superior
3. Anterior - inferior
4. Posterior - inferior
A ring of tissue at the end of the EAC that holds the TM in position.
Greatest surface area of the TM essentially the lower 2/3 of the TM?
Pars Tensa (most dense)
Above the malleus, the tissue is looser because they contain only the epidermal and mucous membrane layers?
Pars Flaccida (thinest layer)
______ days after conception, the tissue bulges into what will develop into the head and neck ___________ ___________.
28, Pharyngeal Arches
___ to ____ weeks of gestation hearing is fully developed?
What are the first 3 arches in the Outer ear are the?
Mandibular arch, the hyoid arch and glossopharyngeal arch.
The _________ develops from the first 2 arches, begins before the 2nd fetal month.
The _____ develops from the 1st pharyngeal grove.
Solid core canalizes around the _____ gestational week.
___________ forms the connective tissue as well as blood and lymphatic vessels.
TM is formed by the ____ embryonic month.
A _________ hearing loss results when the normal sound path through the EAC is blocked?
(loss of hearing is rarely severe and never exceeds a 60 dB air bone gap)
One or both ears may be very small size?
Microtia (cauliflower ear)
Complete absence of the pinna
a __________ or __________ may be performed when the pinna protrudes markedly from the head or when it is pressed tightly against the skull.
Otoplasty or pinnaplasty
Lack of canalization fo the EAC
Atresia (occurs in isolation or in combination with other anomalies)
Tiny folds of skin just in front of the pinna area, representing incomplete embryological development.
Preauricular Tags (moles)
A marked narrowing of the canal?
Stenosis (do not produce hearing loss like canals with atresia)
T or F
Valuable information from OAE's and ABR's cannot be obtained with atresia?
Collapsing the EAC:
Inspection of the ear prior to testing can prevent the finding of a __________ conductive loss?
(may occur in as many as 4% of a typical audilogy caseload.)
Outer portion of canal in kids is less rigid before the age of ___.
Foreign bodies in the EAC usually do not cause a hearing loss unless the EAC is completley ____________ or there is a significant closure due to ___________.
An infection that occurs in the skin of the EAC?
An external otitis is also known as
External Otitis is usually thought of as a _________ infection, although ____________ infections are more common.
__________ infection is rare and may be caused by overuse of eardrops.
External Otitis may also occur because of allergic reactions to _______ _______, ______ and other __________.
hearing protection, soaps, allergens
________ is common along with extreme ________, when you have an external otitits infection.
Bony tumors, both benign and malignant are called?
Osteomas (does not present hearing loss unless its a complete occlusion)
Outward projections for the surfaces of bone, often seen in people who have done a great deal of swimming in cold water.
T or F
If the EAC is blocked by ear wax, hearing will not be normal even if there is a tiny opening?
False, it will still be normal so long as there is a tiny opening.
Natural cleansing of the EAC can be disrupted if you excessively __________ your ears.
(this can push earwax (cerumen) into the inner 2/3 of the EAC)
What is the leading cause of wax being pushed into the EAC?
Wax deposited in the _______ _______ becomes itchy and dry, causing itching and encourages the indv. to push the wax fruther down while trying to remove it with cotton swabs.
________ _________, ________, and __________ are used for cerumen removal.
water irrigation, suction and curettes
Ear candling dates back nearly _______ years.
T or F
Ear Candling is suppose to create a partial vacuum to remove earwax?
T or F
There is scientific evidence to prove that candling works.
False (also can cause risk of mild and severe burns)
TM perforations are caused by excessive pressure __________, __________, ________ of the TM and the most common of trauma due to perforation.
build-up, infections, necrosis
TM perforations can be caused by this kind of activites?
2. Sudden pressure (hands claped over ear)
____________ perforations spontaneoulsy close better thatn do perforations resulting from disease.
Perforatons in the ___________ portion of the TM heal more rapidly than those in the ___________ portion.
Surgical repair of a perforated TM?
When calcium plaques appear, adding to the mass of the TM and interfering with its vibration.
When you have a TM perforation, measurements on acoustic immittance are sometimes________ because an airtight seal cannot be formed as a consequence of pressure leakage from the air pump of the meter through the perforation into the middle ear.
The middle ear is an ___ filled space roughly
The _______ of the middle ear is a thin layer of ________ separating the middle-ear cavity from the brain.
The floor of the middle ear contains the _______ _______.
Behind the anterior wall in the middle ear is the ______ ________.
Behind the medial wall in the middle ear is the _____________.
Behind the posterior wall in the middle ear is the ___________ ___________.
The middle ear is connected to the _______________.
nasopharynx (back of the throat and nose communicate)
The nasopharynx communicates via the
Eustachian Tube (ET)
The _______, _________, and _______ are all lined with mucous membranes, the same lining found in the nose and paranasal sinuses.
ET, middle ear, TM
Hair-like cells are called
Mucous membranes contain _______ that use a sweeping motion to clear out debris.
The Eustachian Tube in normally _________, but is opened by __________ in the nasopharynx.
Opening of the Eastachian Tube is caused by
yawning, sneezing, swallowing, or excessive air pressure applied to the nose.
In infants, the ET is ________, ________ and more __________ when compared to adults.
shorter, wider and horizontal
The nasopharynx orifice remains open in infants until the age of _____.
The air pressure in the middle ear must ________ that of the EAC to keep pressure ________ on both sides of the TM to maximize mobility for optimal sound transmission.
The Eustachian tube will lock shut at ________ _________ making pressure equalization impossible.
The _________ is honeycombed with hundreds of air cells and the cells are lined with __________ membrane similar to the middle ear.
mastoid, mucous membrane
The bony protuberance behind the auricle is the
mastoid process - used for placement of the bone oscillator
What are the two windows in the middle ear?
oval and round windows
________ is filled by a membrane that supports the base of the stapes
The tiniest bone in the human body is the
__________ Allows for transmission of sound to be carried out in the middle ear air space
Bones in the middle ear
The bones in the ear are termed?
The ossicles are comprised of the
stapes, malleus, incus
The __________ of the malleus is embedded in the middle (fibrous) layer of the TM and extends to the ________ of the TM of the area of greatest retraction (Umbo).
manubriuml (handle), center
What is the primary responsibility of the bones?
sound transmission to the inner ear
Sound hits the TM and transfers to the ______ and _______ as they move in an inward outward motion causing them to rotate. The sound is then transferred to the __________ and causes it to move in and out of the oval window.
malleus, incus. stapes
The area of the TM is _____ times that of the oval window. This allows for a sound pressure increase in the middle ear to transfer the presure to the inner ear via the ________ ________.
17, oval window
The increase in pressure in the middle ear is needed due to a transfer of sound from ______ to ________ in the inner ear.
T or F
The TM is a 100% efficient as an impedance matcher?
False it is NOT
Increased pressure and the lever action of the __________ result in a pressure increase of _____ times that of an airborne tranmission alone. Approximatley a ____ dB increase?
malleus, 23 times. 30 dB
A ____ dB loss would result due to the air to fluid impedance mismatch without the ossicles.
Contains a portion of the facial nerve(VIIth cranial nerve) and passes through the middle ear via a medial wall.
A branch of the facial nerve.
Chorda Tympani Nerve- get hit in surgery a lot, causes a loss of sensation(metallic taste)
Carries information about the sensation of taset from the anterior 2/3 of one side of the tongue.
Chorda Tympani Nerve
May serve as a minor protection to loud sounds and contraction may also serve to decrease internal sounds such as chewing or speaking.
Middle Ear Muscles
Tendon attaches to the neck of the stapes, may aid in word recognition in noise by attenuating ___ frequency components of the noise.
Stapedius Muscle, low
Inserts in the manubrium of the malleus and contraction may cause the TM to become tense.
Tensor Tympani Muscle
Innervation of the Tensor Tympani is via the ______ _______.
trigeminal nerve (Vth cranial nerve)
Abnormalities of the middle ear produce a __________ hearing loss.
CHL may show alteration of the ______ conduction thresholds even without sensory/neural involvement.
The sensory/neural component in ______ hearing losses may be exaggerated by artifacts of bone conduction.
Negative Middle Ear Pressure:
Many middle ear disorders arise from ________ function of the Eustachian Tube (ET)
Common causes of ET dysfunction include:
- swelling of the ET due to infection or blockage of the orifice by overgrown adenoids.
A _______ in pressure in the middle ear occurs due to the air trapped being absorbed by the tissues that line the middle ear without normal air replenishment through the ET.
The _________ pressure in the EAC causes the TM to be retracted.
Resolution of a closed ET may sometimes be resolved by 2 methods:
Valsalva and Toynbee maneuver
The patient may auto inflate the ET by increased pressure on forced expiration with the nostrils held shut.
Accomplishes ET opening when the patient closes the jaw, holds the nostrils shut and swallows.
Any infection of the mucous membrane lining of the middle ear cleft.
Suppurative Otitis Media
Is highly resistant to antibiotics possilby due to overuse of antibiotics.
Methicilin-resistant staphylococcus aureus
Suppurative Otitis Media:
Organisms gain access to the middle ear through the ______ from the nasopharynx.
Suppurative Otitis Media:
Often the infection is literally blown through the _______ by a stifled _______ or by blowing the ______ too hard.
ET, sneeze, nose
Initial Suppurative Otitis Media:
- initially the ET swells, causing occlusion
- negative middle ear pressure builds up
- TM may appear retracted (sucked in)
- Normal hearing with a Type C tymp
Progression of Suppurative Otitis Media:
Middle ear mucosa becomes_________.
Progression of Suppurative Otitis Media:
As condition worsens, suppurative (pus) like fluid may may accumulate. Enzymes from the bacteria infection can have a __________ effect on the middle ear structures.
Progression of Suppurative Otitis Media:
pain and fever
Progression of Suppurative Otitis Media:
If the condition progressess the TM will ___________.
Pus, due to infection, that cannot escape may invade the mastoid causing ___________. Breaks down the wall separtating the air cells and can cause ___________ and sometimes death.
What are the 2 types of Chronic Suppurative OM?
A condition of long standing duration of OM?
Develops rapidly and includes swelling, redness and bleeding.
Suppurative OM reveal a ________ tymp, __________ loss and ________ reflexes.
Type B, conductive, absent
The amount of hearing loss is directly related to the accumulation of _____ in the middle ear. Usually ______ in configuration and ____ results are normal.
Fluid, flat, BC
Treatment of OM:
- majority treated with antibiotics
T or F
Due to patient compliance, resistant bacteria, excessive build up of bacteria or the wrong precp. of antibiotics, OM may not be treatable with antibiotics alone and the condition may worsen.
When the antibiotics are not completed, OM may lay _______ and __________ stronger.
T or F
Sometimes when dealing with OM, in the initial stages, a wait and watch treatment may be employed?
When fluids normally secreted by the mucous-membrane lining of the middle ear literally be sucked into the midde ear space resulting in ___________ _______.
Usually ____________ to a poorly functioning ET. Reveals a _______ tymp.
secondary, Type B
Initially shows a greater loss for ______ than for _________ frequencies.
Surgical treatment of OM:
Primary purpose of surgery is to eliminate ___________.
(incision in the TM) is used to relieve the fluid pressure and the remaining fluid is suctioned out.
Myringotomy or Myringostomy
__________ _________ tubes may be inserted to keep the TM patent.
(used for chronic OM)
What is the primary function of P.E. tubes is to
allow for direct ventilation of the middle ear and secondary fluid drainage.
When thick mucoid secretions, ofter forced through the ET by sneezing or excessive pressure when blowing the nose, accumulate in the middle ear.
Mucous Otitis Media (aka glue ear)
When the TM has ruptured and imperfect healing results in calcium deposits.
Whenever skin is introduced to the middle ear, the results may be a ___________.
Cholesteatoma form as a
- sac with onion like rings made up of keratin mixed with squamous(scaly) epithelium and with fats such as cholesterol.
- May occur when the par flaccida of the TM is sucked into the middle ear cavity and opens
- May occupy the entire middle ear
- Highly erosive and may cause destruction of bone
- produces a foul smelling discharge that drains from the ears
A foul smelling discharge that drains from the ears is called __________.
Results when the mastoid is chronically infected.
May result in a large "bowl" that results from removal of a portion of the mastoid bone.
Mastoidectomy (removal of bone is avoided as much as possible, because of the negative effects)
Requires frequent cleaning and is more susceptible to infection.
Surgical reconstruction of the middle ear auditory apparatus.
The simplest form of repair of the TM is called ____________?
During some chronic OM, the bony covering of the fallopian canal becomes eroded, exposing the facial nerve to the disease process called
______________ may result causing a unilateral facial paralysis, possibly due to decreased blood supply to the nerve or a viral infection.
When the ET is chronically patent (open) this is called?
Patulous Eustachian Tube (PET)
Having a Patulous Eustachian tube can result in ______________.
The "head in a barrel" feeling resulting in a persons own voice being percieved as loud is?
-causes an echoing effect that interferes with their speech production
Autophony often occurs in
pregnancy, loss of weight, TMJ syndrome, decongestant medications and stress.
Originates in the bony labyrinth and appears as the formation of a new growth of spongy bone, usually over the stapedial footplate of one or both ears.
- causes the footplate to become partially fixed, limiting the transmission of sound to the inner ear
- hereditary in 70% of cases
-may show up during pregnancy or menopause
-presence of tinnitus
When patients with a CHL feel that speech is easier to understand in the presence of background noise this is called?
The fact that we speak louder naturally in the presence of noise is called the ____________.
Lombard Voice Reflex
First appears as a low frequency air bone gap due to the stiffness component is ?
May involve an incision in the TM, then the stapes is rocked back and forth until it is loosened?
(effectiveness is dependent on regrowth of the spongy bone)
The actual removal of the stapes and a prosthesis is connected to the incus to replace the crura of the stapes (horseshoe portion of the stapes)
On Average, the BC thresholds appear poorer than the true sensory/neural sensitivity in what?
Otosclerosis Audiometric Findings
Otosclerosis Audiometric Findings:
BC thresholds appear the worst at 2000Hz, this is referred to as __________ _______.
__________ __________ probably occurs as a mechanical aritfact because the loss of inertial mode of BC and a shift of the normal resonant frequency of the middle ear.
(all produced by the immobility of the oval window.)
Tymp results are Typs As due to stiffness (impedance high and compliance low)
The inner ear functions as a ____________ of the signal from the middle ear and is responsible for creating/transferring the energy into a signal that is readable by the __________ __________.
receiver, auditory nerve
Then inner ear is also responsible for reporting information regarding the body's ________ and __________.
position and movement
The _______ is the transducer that converts sound waves into an energy form useful to the auditory nerve.
Resembles the action of a microphone and converts pressure waves issuing from a speaker's mouth into an alternating electrical current.
Cochlear Microphonic (CM)
The primary ending place for balance/spatial orientation is the ______________.
Means common area?
The _____________ receives information from the visual, proprioceptive and vestibular systems.
Depends on the visual input and depends on the ability of the eyes to see in the presence of sufficient light.
Involves the sense of touch.
Relies on the forces of gravity and inertia.
What term means share the same fluid?
The ____________ is the immediate entryway after the oval window.
The vestibule house the ____________ and __________ which are the end organs for balance.
The ___________ is the beginning of the semicircular canals (SCC)?
The Semicircular Canals are:
The semicircular canals are at _____ degree angles.
The semicircular canals contain ________ and are surrounded by a bony cavern of ____________.
The __________ are at the beginning of the SCC and contain an end organ (_______) that provides a sense of equilibrium.
The SCC's are arranged ____________ to one another to cover all dimersions in space.
The _____________ mechanism responds to __________ ___________. (elevator, car accelerating)
utriculosaccular, linear acceleration
The SCC's respond to ________ ___________. (increase/decrease of the body's revolutions)
Damage to the vestibular system may result in ___________ and _________.
The sensation of whirling or spinning and they experience true turning?
A rapid rocking movement of the eyes (always comes with vertigo)
True or False
It is important to differentiate vertigo from dizziness, light-headedness or falling tendencies because they are not the same?
Stimulation of the labyrinth is accomplished by "washing" cold or warm water or air against the TM?
Measures the changes in potential produced by nystagmus and measures the rate and direction of nystagmus?
The vestibule, just past the oval window, also communicates with the ________.
The _________is a twisting bony shell, and has several compartments filled with perilymph and endolymph.
Connected to the oval window and contains perilymph?
Begins at the round window contains perilymph?
A passage located at the apex of the cochlea that allows perilymph to transfer from the Scala Vestibuli to the Scala Tympani.
Audiology Test #3
Chapter 8 & 9 & part of chapter 10