Nbs 7

Front 1

Sensory innervation of auricula

Back 1

Sensory innervation
-nn. auriculares ant. from n. auriculotemporalis (superior -anterior 2/3)
-n. auricularis post.
-r. auricularis n. X. (concha + meatus) – irritation of n.X

Front 2

Meatus acusticus externus
- Constists of what?

Back 2

outer 2/3 – cartilage opened ventrocaudally (incisurae), lamina tragi (ventrally)
inner 1/3 – bone

Front 3

Where is paracentesis done?

Back 3

Paracentesis: lower dorsal quadrant

Front 4

Tympanic cavity is drained by what lymphnodes?

Back 4

retropharyngei

Front 5

Sensory innervation of tympanic cavity? (3)

Back 5

1. n. tympanicus (n.IX)
2. r. pharyngeus (V2) for cartilagineous aprt of tuba auditiva
3. sympathetic - nn. caroticotympanici

Front 6

Ossicula aditus cosists of which bones?

Back 6

Hammae (malleus)
Anvil (incus)
Stirrup (stapes)

Front 7

What ligament in tympanic cavity is sensitive to otosclerosis?

Back 7

lig. anulare stapediale

Front 8

By which nerves are these innervated?
-m. tensor tympani
-m. stapedius

Back 8

-m. tensor tympani – n.V3
-m. stapedius – n.VII

Front 9

Antrum mastoideum has close relation to what structure?

Back 9

Antrum mastoideum has close relation to sinus sigmoideus

Front 10

Which muscles opens auditory tube and when?

Back 10

opened in swallowing
(m. tensor tympani (v3)+ m. salpingopharyngeus)

Front 11

What can be found in the bony labyrith?

Back 11

porus acusticus internus - beginning

fundus meatus acustici interni - end
-crista transversa + verticalis
-area n. VII.
-area cochlearis – tractus spiralis foramisosus
-area vestibularis sup. + inf.
-foramen singulare

Front 12

What can be found in the membraneus labyrith?

Back 12

Utriculus + Sacculus
-Maculae (otholits CaCO3) – linear movements
Ductus semicirculares (ampullae, crura)
- Crista ampullaris – angular acceleration
Ductus utriculosaccularis, reuniens
Ductus + saccus endolyphaticus
Ductus cochlearis

Front 13

Auris interna
– blood supply
-Lymph

Back 13

-a. basilaris -> a. inf. ant. cerebelli -> a. labyrinthi
(Vasodilating drugs)
-Lymph: replaced with endo- and perilympha

Front 14

Auris interna - nerves (4)

Back 14

1.Nervus vestibularis
– ggl. vestibulare Scarpae
-n. utriculoampullaris, saccularis, ampullaris posterior
2. Nervus cochlearis
– ggl. cochleare Corti

3. angulus pontocerebellaris - with n. VII
4. neurinom of n. VIII

Front 15

Auditory pathway
-How many neurons?
-Describe the pw

Back 15

4-neuron crossed pathway)

1st neuron: bipolar cell in the ganglion cochleare - n. cochlearis - n. VIII - the pathway is divided in two parts and continues to cochleares nuclei

2nd neuron: cells in the nucleus cochlearis posterior (axons continue as striae medulares ventriculi quarti and submerge in the median sulcus) et anterior (axons pass deep in the matter of myeencephalon through trapezoid body), their axons meet and join in the lemniscus lateralis and enter the colliculus inferior

3rd neuron: cells in the colliculus inferior

4th neuron: cells in the corpus geniculatum mediale , axons radiate in the thalamus and in the lobus temporalis - gyrus temporalis transversus Heschli, area 41, 42

Front 16

Vestibular pathway
-How many neurons?
-Describe pw

Back 16

3-neuron crossed pathway

1st neuron: bipolar cells in the ganglion vestibulare - n. vestibularis - n.. VIII (some fibres form tractus vestibulocerebellaris directus pasnig without any interpolation to the cerebellum)

2nd neuron: cells in the nuclei vestibulares pontis, their axons radiate to various structures (interpolated fibres as the tractus vestibullaris indirectus to the cerebellum, tractus vestibulospinalis to the medulla spinalis, tractus vestibulonucleares to the nuclei of cranila nerves, fasciculus longitudinalis medialis, and tracts to the reticoular formation and thalamus)

3rd neuron: cells in the nuclei ventrales thalami - to brain cortex (lobus temporalis, area 41,42 - gyrus temporalis transversus /Heschl/, lobus parietalis - area 3, gyrus postcentralis

Front 17

Development of auris media
-When is antrum mastoideum formed?

Back 17

antrum mastoideum
-cellulae mastoideae are formed in 2nd year

Front 18

What is done before hearing test?

Back 18

Before testing:
Otoscopy
Mikrootoscopy

Front 19

What is part of the Conductive Part of hearing?
(Conductive Hearing Loss)

Back 19

External Ear
- Middle Ear – Tympanic Membrane Ossicles
- Liquid Filled Space

Front 20

What is part of the Perceptive Part ? (Sensorineural Hearing Loss )
What is the hearing loss of each part called?

Back 20

Perceptive Part = Sensorineural Hearing Loss (H.L.)
- Organ of Corti = Cochlear H.L.
- Auditory Nerve = Neural H.L.
- Hearing Pathway = Supracochlear H.L.
- Cerebral Cortex = Central H.L.

Front 21

Subjective Tests of Hearing without Special Devices

Back 21

-Whispering x Conversational Speech
-Tuning Force
Weber´s
Rinne´s
Schwabach
Gelle

Front 22

Tests of Hearing Subjective
Hearing Thresholds
What is tested?
-Machines operates with which frequencies?

Back 22

Hearing Thresholds
- Air Conduction Thresholds
- Bone Conduction Thresholds
Audiometer – Electronic Instrument Generate Pure Tone Frequency 125 – 8000 Hz

Front 23

Tests of Hearing Subjective
Speech Audiometry
-Which are the thersholds of understanding?

Back 23

Speech Audiometry – Determined Understanding Highly Usefful for Diagnosis.

Special Words from CD
50 % Correctly understood Word = Speech Receptual Thershold

100 % Correctly understanding Word = 100 % Speech Discrimination

Front 24

Tests of Hearing Objective
Impedance Measuremant
-which are the different types and what do they test?
-What els is tested?

Back 24

TYMPANOMETRY
A Tympanogram = Normal Middle Ear and Eardrum
B Tympanogram = Fluid in the Middle Ear
C Underpressure in the Tympanic Cavity

STAPEDIUS REFLEX Changes:
Present x Notpressent
Decay

Front 25

Test of Hearing Objective
ERA – Evoked Response Audiometry
-What is it?
-Which parts are tested and what is it called?

Back 25

Registration Electrical Charges Generated on Presentation of Sound
in Cochlea ( Cochleography )
In Brainstem ( BERA, BAEP )
In Cortex ( CERA )

Front 26

Test of Hearing Objective
OAE – Otoakustic Emission
-What is it?
-When is it done?

Back 26

The Ear, when stimulated can emit Sound (prof.Kemp).
This Sound can be Measured when Hearing is Normal
Usefful in Screening of Infants (Newborns)

Front 27

Therapy
-Cerumen

Back 27

Cerumen:Preferency of Otomikroscopic Menagement

Front 28

Therapy
-Sekretoric otitis

Back 28

Sekretoric otitis:
endoskopic adenotomy
Transmyringing Drainege (Tubes)

Front 29

Therapy
-Chronic Otitis, otosklerosis

Back 29

Chronic Otitis, otosklerosis:
Otosurgery (Excelent Results )

Front 30

Therapy
-Deafnes:

Back 30

Deafnes: Cochlear Implants (Condition: Functional Auditory Nerve)

Front 31

Therapy
-Sudden Hearing Loss

Back 31

Sudden Hearing Loss: Corticoids + Vasoactive Drug Imidiately (in 24 hours)

Front 32

Therapy
-Progressive Sensorineural H.L.

Back 32

Progressive Sensorineural H.L.: Binaural Hearing Aids (Digital)

Front 33

Summary of hearing testing and therapy?
-GP
-ENT
-Therapy

Back 33

G.P: Otoscopy
Whisper and Normal Speech
Tuning Fork
ENT:
Audiometry: Bone and Air Conduction Thresholds
Speech Audiometry
Objective Audiometry
Impedance Measurment (Tympanometry + Stapedius rfl.)
Evoked Potentials, OAE

Therapy: Digital Hearing Aids
Cochlear Implant

Front 34

Diagnostic protocol for tinitus

Back 34

Subjective data - patient´s evaluation of tinnitus, history
Otomicroscopy

Audiometry-vestibulometry:
PTA, SA
BERA
Tinnitometry - intensity (dB) and frequency (Hz)
Facultative/additional:
ENG, calorimetry, rotatory tests, CCG, CPG

Complementary Examinations:
Neurology
Internal
Labs
X-ray (CT, NMR), etc.

Front 35

Type of hearing loss (tinnitus combined with hearing loss in 75 %):
apicocochlear:
basocochlear:
pancochlear:

Back 35

apicocochlear: 4 %
basocochlear: 50 %
pancochlear: 21 %

Front 36

Therapeutic Methods tinnitus
Most used combinations:

Back 36

PTXF (Vinca Minor) + RHB
LIDOCAIN + RHB

Front 37

Therapeutic methods (9)

Back 37

Pharmacotherapy
Rehabilitation of cervical spine
Soft technics, postisometric relaxation, mobilisation, exercise
Laser
Surgery (IEC)
Hyperbaric oxygenation
Psychoterapy
Alternative (acupuncture),Chinese Medicine
Combined therapy

Front 38

Is it worth treating tinnitus?
What treatment is the most effective?
What is most effective in acute tinnitus?
What is most effective in chronic tinnitus?

Back 38

According to results is worth to treat both chronic and acute tinnitus
Most effective is combination of methods
In acute tinnitus treatment was the most effective Pentoxiphyllin
In chronic tinnitus treatment was the most effective Corticosteroids