Anat, Fizio, Expl Ureche
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Transcript of Anat, Fizio, Expl Ureche
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CURS DE OTOLOGIE
Clinica ORL “Sf. Maria”Facultatea de Medicina Dentara
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Analizatorul acustico-vestibular
Segmentul periferic : UE + UM + UI Segmentul intermediar : n.VIII Segmentul central : centrii auditivi
corticali si subcorticali + centrii echilibrului
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Segmentul periferic: urechea interna , medie si externa
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Pavilionul auricular Pavilion auricular
Schelet cartilaginos elastic
Acoperit de tegument, aderent la pericondru pe fata externa
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Conductul auditiv extern CAE(25-30 mm)
Tegument, foliculi pilosi si glande ceruminoase
Osteocartilaginos Curburi in plan
orizontal si frontal
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Raporturile CAE
Anterior – ATM Posterior – apofiza mastoida Superior – scuama temporalului Inferior – loja glandei parotide
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Vascularizatie, inervatie
Arteriala : ATS, a auriculara posterioara Venoasa :vena temporala superficiala,
auriculare posterioare Limfatica : gg preauriculari,
retroauriculari, cervicali profunzi Inervatia senzitiva :
V : n. auriculo-temporal X (peretele posterior) VII : rr. senzitive
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Urechea medie
Casuta timpanului : Lentila biconcava 6 pereti 3 regiuni : atica, mezotimpanul,
hipotimpan Lant osicular Anexe : trompa lui Eustachio, sistemul
celular mastoidian
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Urechea medie
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Peretele extern al CT
Zona osoasa peritimpanica Membrana timpanica
4/5 inferioare se insera in santul osului timpanal
1/5 sup se insera la nivelul periostului Forma conica Diametru ~ 10 mm Inclinatie(adult) 40-45 Structura diferita
Pars tensa 5 straturi Pars flaccida 2 straturi
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Membrana timpanica
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Peretele intern (labirintic)
Promontoriul FO (vestibulara) FR (cohleara) Relieful canalului VII Relieful canalului semicircular lateral Relieful canalului muschiului
ciocanului
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Peretele superior (tegmen tympani)
Desparte UM de fosa cerebrala medie Uneori este dehiscent Aici se insera ligamentele si mezourile
ciocanului si nicovalei
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Perete inferior – anterior In raport cu golful
venei jugulare Orificiul timpanic al
trompei Cotul canalului
carotic Canalul muschiului
ciocanului
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Peretele posterior
Aditus ad antrum Cotul al II-lea si prima portiune din
segmentul mastoidian al canalului facialului
Eminenta piramidala – cu tendonul muschiului scaritei
Proeminenta stiloidiana (baza apofizei stiloide)
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Lantul osicular
Ciocanul (malleus) Nicovala (incus) Scarita (stapes)
Sint unite intre ele prin articulatii, iar de peretii cavitatii timpanice prin ligamente
Muschiul ciocanului (trage spre interior ty)
Muschiul scaritei (trage scarita inafara)
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Lant osicular
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Trompa lui Eustachio Uneste CT cu rinofaringele Forma de 2 trunchiuri de con unite la
nivelul istmului Structura osteo-cartilaginoasa Lungime ~ 35mm Inclinare (adult) ~ 30-40 grade La nou-nascut – trompa este mai scurta,
fara angulatii si istm, inclinare doar de 10 grade
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Trompa eustachio
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Functiile trompei
Echipresiva si de drenaj Deschiderea lumenului tubar –
asigurata de: Muschii principali ai trompei
Muschiul tensor al valului palatin Muschiul ridicator al valului palatin
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Consecintele disfunctiei tubare
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Mastoida
Osul temporal Suprafata externa
Creasta temporala Spina Henle Zona ciuruita Chipault
Sistem celular aeric : antrul + sistemul celular mastoidian
Tipuri de structuri mastoidiene Pneumatica, peumatodiploica,
scleroeburnata
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Mastoida
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Urechea interna Labirint osos
( osul temporal): Cohlee
Columela, canal osos, lama spirala
Vestibul osos Canale
semicirculare : Lateral (orizontal,
extern) Posterior Anterior (superior)
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Labirintul membranos
Este separat de cel osos de perilimfa Cavitate ce contine endolimfa In canalul cohlear :
Organul Corti – receptorii acustici Vestibulul membranos :
Utricula, sacula Macule - receptorii acceleratiei liniare
In interiorul canalelor semicirculare ; Ampule – receptorii acceleratiei angulare
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Urechea interna -labirintul
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Segmentul intermediar Calea acustica
Nervul cohlear – nucleii cohleari (TC) Portiune centrala
Lemniscul lateral Radiatiile acustice
Calea vestibulara Nervul vestibular – nucleii vestibulari (TC) Releu vestibulocortical (trece prin talamus)
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Segmentul central
Pentru analizatorul acustic : In profunzimea scizurii laterale (Sylvius) Pe fata superioara a lobului temporal
Pentru analizatorul vestibular : Zona adiacenta regiunii senzitive
somatice anterioare postcentrale, linga aria vizuala
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Nervul Facial (VII)
Nerv mixt Traiect
Intracranian Trunchi acustico-vestibular (fosa cerebrala
posterioara + CAI) Portiune intratemporala
Segment labirintic (portiunea I) Segment timpanic (portiunea II) Segment mastoidian (portiunea III)
Extracranian (dupa gaura stilomastoidiana)
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Nervul facial
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Ramurile colaterale ale nervului facial Nerv petros superficial Nervul muschiului
scaritei Nervul coarda
timpanului Nervul auricular
posterior Ramul digastric si stilo-
hioidian Ramul temporofacial Ramul cervicofacial
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Topodiagnosticul leziunilor VII
Testul Schirmer – secretia glandei lacrimale
Impedancemetria – reflex stapedian Examenul secretiei salivare pentru
glanda submaxilara Examenul calitativ al gustului si
electrogustometria – 2/3 anterioare ale limbii
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Fiziologia auzului Sunetul - vibratia
particulelor unui mediu Sunete percepute de
urechea umana: 16-18000 Hz
Frecventele “conversationale”: 500-2000Hz
Unitatea audiometrica decibel
Sunetele ajung la cohlee pe 2 cai : Calea aeriana Calea osoasa
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TIPURI DE HIPOACUZIE HIPOACUZIE TIP TRANSMISIE
HIPOACUZIE TIP PERCEPTIE (TIP NEUROSENZORIAL)
HIPOACUZIE TIP MIXT
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Fiziologia echilibrului Cerebel Proprioceptorii Analizatorul vizual Labirintul vestibular
Ampulele CSC – acceleratia angulara
Macule utriculo-saculare – acceleratia liniara
Cortexul
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EXPLORAREA FUNCTIONALA A APARATULUI ACUSTICO-VESTIBULAR
EXAMENUL FUNCTIONAL AL AUDITIEI-examenul acumetric-examenul audiometric-impedancemetrie, potentiale evocate,
electrocohleografie, audiometria cu raspuns cortical,otoemisiuni acustice
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ACUMETRIA Acumetria fonica Acumetria
instrumentala: RINNE SCHWABACH WEBER
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WEBER 512 HZ
Lateralizat U sanatoasa HNS U bolnava HT
Indiferent
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SCHWABACH NORMAL 512 HZ 20 SEC
PRESCURTAT HNS
PRELUNGIT HT
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RINNE NORMAL pozitiv CO/CA=20/40=1/2
HNS pozitiv prescurtat CO/CA=10/20=1/2
HT negativ CO/CA=40/20=2/1
FALS RINNE NEGATIV
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AUDIOMETRIA Audiometria tonala liminala
Audiometria supraliminalaTestul LuscherTestul FowlerSISI-test
Audiometria vocala
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AUDIOGRAMA TONALA LIMINALA
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AUDIOGRAMA TONALA LIMINALAAUDIOGRAMA VOCALA
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Hipoacuzie tip neurosenzorial
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Hipoacuzie tip mixt
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Audiometria la copil
Peep-show 3-6 ani
Otoemisiuni acustice – nou-nascut screening
BERA brainstem electrical response audiometry
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EXPLORAREA APARATULUI VESTIBULAR
Anamneza – caracterul vertijului Examenul clinic vestibular-nistagmusul-deviatia segmentara-deviatia tronculara-proba mersului pe loc Electronistagmografia, videonistagmografia Posturografia dinamica computerizata