THE EAR

 

 

Sound waves---           > outer ear -----> special receptor cells-->       

Nerve fibers-----> auditory region of brain (sound)

 

Regions of the ear:

 

·        Outer (external) ear

 

·        Pinna/auricle (outer flap)

 

·        External auditory meatus/canal - carries sound waves

 

·        Middle ear

 

·        Inner ear

 

Middle ear figure

 

Tympanic membrane (eardrum) 

 

            sound waves pass through auditory canal

 

            vibrations move ossicles (bones) that conduct waves through middle ear:

 

§         malleus (hammer)

§         incus (anvil)

§         stapes (stirrup)

 

Eustachian (auditory) tube - canal leading from middle ear to pharynx

 

Inner ear (labyrinth) 

 

·        Circular, maze-like structure

 

·        Oval window - separates middle and inner ear

 

·        Cochlea - snail shaped

 

·        Contains fluid through which sound waves travel

 

·        Organ of corti - auditory receptor area relaying sound to auditory nerves: contains structures that help maintain equilibrium


 

The ear: abnormal and pathological conditions

 

 

Meniere's disease - disorder of the inner ear(labyrinth) due to elevated endolymph pressure in the cochlea.

 

·        Symptoms: tinnitus, progressive loss of hearing, cephalgia, nausea,vertigo.

 

Otosclerosis - ankylosis (hardening) of the bony tissue in the labyrinth (inner ear); bony tissue forms around the oval window and can fuse with the stapes preventing passage of sound vibrations.

 

·        Treatment: stapedectomy with tissue graft and wire.

 

Serous otitis media - noninfectious inflammation of the middle ear with accumulation of serum (fluid).

 

·        Treatment: myringotomy and aspiration plus tympanostomy tubes.

 

Suppurative otitis media - bacterial infection of middle ear with pus formation.

 

·        Treatment:  antibiotics, myringotomy.

 

Tinnitus (tinkling) - noise in the ear caused by presbycusis, Meniere's disease, otosclerosis, chronic otitis, etc.

 

 

Vertigo - irregular or whirling sensation of self or external objects resulting from disease in labyrinth or nerve carrying messages to the brain.  Affects equilibrium and balance, possible nausea.

 

 

Clinical procedures

 

Audiometry - use of an instrument (audiometer) to determine ability to hear at different frequencies.  Results are plotted on an audiogram.

 

Otoscopy - use of an otoscope to visually examine the ear.


THE EYE

 

Receptors receive stimuli à nerve à impulses à brain à through afferent sensory neurons, which produces sensations of light (vision).

 

Anatomy of Anterior of Eye

 

 

Pupil – light enters eye.

 

Conjunctiva – mucus membrane lining eyelids and covers interior portion of the eye.

 

Cornea – bends (refracts) light rays.

 

Sclera – tough, white outer cover of eyeball.

 

Choroid – vascular layer between sclera and retina.

 

Iris – colored part of eye; has muscles to dilate or constrict pupil.

 

Ciliary body

 

 

Posterior Eye Anatomy

 

 

Optic disk – blind spot at back of eye where optic nerve meets the retina.

 

Fovea centralis – region of clearest vision; located within macula lutea.

 

Macula lutea – yellowish area of retina near the optic disk.

Anatomy Related to Focus

 

 

Crystalline lens – transparent body behind the pupil which bends light rays (refraction).

 

            Distant object – lens is flattened; rays slightly bent.

            Near object – lens becomes thicker; rays bend more.

 

Vitreous chamber – area behind the lens containing vitreous humor (not constantly reformed).

 

Retina – light-sensitive nerve cell layer (inner layer).

 

Optic nerve – cranial nerve carrying impulses from retina to brain.

 

Visual Pathway

 

Optic chiasma (crossing) – point where medial fibers of optic nerve cross in the brain.  All fibers from right half of each retina form an optic track.  Left fibers do the same.

 

All fibers from right half of each retina form an optic track.  Left fibers do the same. 

 

Binocular vision – left and right images are fused, resulting in single, 3-dimensional vision.

 

Presbyopia – visual impairment due to old age.  Ciliary body is less elastic, impairing vision.

 

 


THE EYE:  PATHOLOGICAL CONDITIONS

 

Cataract – clouding of the lens, resulting in decreased vision. 

 

 

Diabetic retinopathy – hemorrhages, etc. in the retina, leading to edema, scarring and blurred vision.

 

 

Glaucoma – increased intraocular pressure due to:

 

 

Macular degeneration – degeneration of yellowish region at back of retina causes severe loss of central vision.  Peripheral vision is retained.

 

Retinal detachment – separation of layers due to eye trauma, head injuries, bleeding, scarring from infection, shrinkage of vitreous humor.  Patients may see flashes of light. 

 

 

 

Clinical Procedures

 

Diagnostic

 

Ophthalmoscopy – visual exam of the interior of the eye.

 

Fluorescein angiography – fluorescein dye injected IV to detect movement of blood … diabetic or hypertensive retinopathy, lesions in macular area.

 

Tonometry – measure pressure within eye … glaucoma.

 

 

Treatment

 

Cataract surgery – removal of all or part of lens; generally with an intraocular lens implant.

 

·        Aspiration-irrigation – withdraw lens material with a hollow needle.

·        Phacoemulsification – use of ultrasound to break up lens; particles are aspirated.

 

Keratoplasty – also called corneal transplant.  Replacement of cloudy (opaque) cornea with normal transplant cornea.

 

Laser photocoagulation – use of lasers (high energy light) to coagulate blood vessels within the eye.  Useful for diabetic retinopathy and age-related macular degeneration.

 

 

 

 

 

 

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