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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4455_Библиотеки_им_академика_М_И_Перельмана
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Appendix 4A
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An example of a normal tympanic membrane. From Atlas of Otoscopy (p. 3), by J. Touma and B.
Touma, 2006, San Diego, CA: Plural Publishing. Copyright © 2006 by Plural Publishing, Inc. All
rights reserved.
Appendix 4B
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An example of an eardrum revealing serous otitis media. From Atlas of Otoscopy (p. 11), by J.
Touma and B. Touma, 2006, San Diego, CA: Plural Publishing. Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
Appendix 4C
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An example of an eardrum showing air bubbles in the middle ear related to otitus media. From Atlas
of Otoscopy
right © 2006 by Plural Publishing, Inc. All rights reserved.
(p. 12), by J. Touma and B. Touma, 2006, San Diego, CA: Plural Publishing. Copy-
Appendix 4D
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An eardrum with a Shepard-Grommet tube for ventilation of the middle ear space. From Atlas of
Otoscopy
© 2006 by Plural Publishing, Inc. All rights reserved.
(p. 35), by J. Touma and B. Touma, 2006, San Diego, CA: Plural Publishing. Copyright
Appendix 4E
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An example of a tympanic membrane with cholesteatoma. From Atlas of Otoscopy (p. 102), by J.
Touma and B. Touma, 2006, San Diego, CA: Plural Publishing. Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
Appendix 4F
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An example of a glomus tumor (note bluish hue). From Atlas of Otoscopy (p. 153), by J. Touma
and B. Touma, 2006, San Diego, CA: Plural Publishing. Copyright © 2006 by Plural Publishing,
Inc. All rights reserved.
Appendix 4G
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An example of ossicular discontinuity related to head trauma. From Atlas of
Otoscopy
Publishing. Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
(p. 95), by J. Touma and B. Touma, 2006, San Diego, CA: Plural
Appendix 4H
An example of exostoses of the ear canal (at 11 and 12 o’clock). From Atlas of
Otoscopy
Publishing. Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
(p. 148), by J. Touma and B. Touma, 2006, San Diego, CA: Plural
Appendix 4I
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An example of a large perforation in the posterior tympanic membrane and
tympanosclerosis in the anterior part of the eardrum. From Atlas of Otoscopy
(p. 64), by J. Touma and B. Touma, 2006, San Diego, CA: Plural Publishing.
Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
Appendix 4J
An example of tympanosclerosis covering most of the eardrum. From Atlas of
Otoscopy
Publishing. Copyright © 2006 by Plural Publishing, Inc. All rights reserved.
(p. 44), by J. Touma and B. Touma, 2006, San Diego, CA: Plural
5
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Inner Ear Disorders
intRoduction
This chapter covers a number of pathologic conditions that affect auditory function due to their effects on the inner ear.
A brief overview of inner ear anatomy
will orient the reader of auditory sciences
to the specific site of dysfunction, as well
as to the treatment of these conditions.
Recall from Chapter 2, “Structure and
Function of the Auditory and Vestibular
Systems,” that the cochlea is a sensory
auditory organ encased in the dense bone
of the petrous portion of the temporal
bone. The bone surrounding the cochlea
is formed via an endochondral ossification process and is referred to as the otic
capsule. This bone is extremely dense
compared with the surrounding temporal bone; however, it has poor reparative
capacity. The cochlea is a bony canal that
spirals 2.5 times around the modiolus,
which contains the spiral ganglion and
myelinated and unmyelinated cochlear
nerve fibers. This canal contains three distinct fluid-filled channels: the scala media,
the scala tympani, and the scala vestibuli.
The perilymph-filled flanking channels,
which include the scala tympani and
the scala vestibuli, are confluent at the
cochlear apex, the helicotrema. The central channel, referred to as the scala media
or cochlear duct, is filled with endolymph, a fluid that is secreted by the stria
vascularis. This channel contains the acoustic sensory apparatus called the organ of
Corti. The organ of Corti rests on the basilar membrane, which separates the scala
media and scala tympani. This structure is
lined with one row of inner hair cells and
three rows of outer hair cells along the entire length of the cochlea. A second membrane, Reissner’s membrane, separates the
scala media from the scala vestibuli and
facilitates the translation of a cochlear fluid
wave between the two compartments.
Sound waves within the external
auditory canal are converted to vibratory
mechanical energy by the tympanic membrane and the ossicles. This mechanical
energy is conducted by the stapes into the
scala vestibuli. A fluid wave is then propagated within the cochlea, which travels
from the base to the apex. The fluid wave
leads to deflection of the hair cells’ stereocilia, which results in depolarization
of the hair cells and neural transmission
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