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Anatomy

6.8

February 21, 2012


Dra. Bayaoa

Auditory Pathways


Outline
I. Auditory and Vestibular system
II. Auditory System
A. External Ear
B. Middle Ear
C. Inner Ear
III. Central Auditory Pathway
IV. Vestibular System
A. Inner Ear (Labyrinth)
B. Vestibular Functions of the ear
Macula
Objectives:
Define function of the cochlear system and receptors for hearing
Tracing the pathway of sound from the environment to the sense organ for hearing
Describing the origin, course, and termination of the cochlear nerve
Tracing the central auditory pathway from the organ of Corti until the nerve impulse
reaches the auditory cortex
Role of the olivocochlear bundle of Rasmussen in sound perception
Pathways of auditory reflexes
Differentiating between conductive and sensory deafness
Explaining tinnitus, Rinnes & Webers test
Function of the vestibular system
Parts of Static labyrinth vs kinetic labyrinth
Location of the receptors for vestibular control
Origin, course, and termination of the vestibular nerve
Describing the role of: MLF, medial vestibulospinal tract, lateral vestibulospinal tract
in the maintenance of equilibrium
Connections of the vestibular apparatus with the cerebellum
Define: vertigo and nystagmus
Tests for vestibular function
Clinical manifestations of disturbances in vestibular apparatus

I. AUDITORY AND VESTIBULAR SYSTEM


CN VIII/ Vestibulocochlear nerve
Has two distinct divisions
1. Vestibular position and movement of head; for equilibrium
2. Cochlear mediates auditory function
Grossly; it is divided into external ear, middle ear and inner ear
Stimulus: SOUND
o Sinusoidal waves of air molecules
o Frequency of waves (in hertz) -> PITCH of sound
o Amplitude of each wave (in decibels) LOUNDESS of sound
o The human ear can detect sound frequencies from 20 to 20, 000
Hz and 1-120 db
II. AUDITORY SYSTEM
A. External Ear
Consists of
Auricle/pinna/ear lobe
External auditory meatus ( ear canal)
Tympanic Membrane (ear drum; separates the external ear from
the middle ear)
Sound waves enter the external auditory meatus -> impinge on the
tympanic membrane -> tympanic membrane vibrates and transmits
sound into the middle ear
B. Middle Ear
Lies in the petrous part of temporal bone
Transmits the vibrations of the tympanic membrane to the inner
ear
RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

Air-filled cavity
Two parts:
o Tympanic cavity proper
o Attic/ epitympanic recess

Figure 1. Structures of the middle ear (Coronal Oblique Section)


Consists of the three auditory ossicles (MIS)


1. Malleus (hammer) attaches to the inner aspect of the
tympanic membrane
2. Incus (anvil) receives vibration from the malleus via
diarthrodial joint; articulates with stapes
3. Stapes (stirrup) sits on the membrane of the foramen ovale
(oval window) through which vibration is transmitted to the
fluid perilymph of the inner ear.
The 3 auditory ossicles serve as an amplifier and as an impedance-
matching device that decreases the amount of energy lost by by
the sound waves in going from the air to the fluid in the inner ear
Eustachian tube
o From the cavity of the middle ear to the posterior nasopharynx
o Equalizes air pressure inside and outside tympanic membrane
Contains two muscles:
1. Stapedius - innervated by CN VII (facial)
pulls on stapes and causes tightening of the membrane of
the oval window
2. Tensor tympani - innervated by CN V (mandibular branch of
trigeminal nerve)
pulls on malleus and causes the tightening of the tympanic
membrane
The two muscles contract to decrease transmission of vibrational
energy from external to inner ear to protect the inner ear from
loud sounds (attenuation reflex)

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Hyperacousis - sounds perceived as uncomfortable and louder.


May be experienced by person with paralysis of these 2 muscles or
of the stapedius alone (as in Bells facial palsy)
C. Inner Ear
Two components:
o Cochlea - organ for hearing, where cochlear nerve attaches
o Vestibular apparatus (3 semicircular canals, utricle and saccule)
where vestibular nerve attaches
The oval window/foramen ovale, to which the stapes
communicates, opens to the vestibule portion which contains
perilymph
Bony Labyrinth (contains perilymph) is made up of the:
o Cochlea
o Semicircular canals
o Vestibule
Membranous labyrinth (with endolymph) is found within the bony
labyrinth and is made up of the:
o cochlear duct (in bony cochlea)
o utricle and saccule (in vestibule)
o semicircular ducts (in semicircular canals)
1. Cochlea

Figure 2. The cochlea


Resembles a snail
Contains helicotrema which is the apical connection between the
scala vestibuli and scala tympani. It is also the base of cochlea
Turns at its conical central axis called modiolus.
2 and turns
Consists of three parallel filled channels:
o Scala vestibuli (w/ perilymph)
o Scala tympani (w/ perilymph)
o Scala media or cochlear duct (w/ endolymph)
*Perilymph is similar to CSF while endolymph is similar to
intracellular fluid.
Vestibular membrane divides scala vestibuli into another space
called scala media or cochlear duct
RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

Contains a spiral lamina (ridge of bone dividing scala vestibuli and


scala tympani)
Scala media/cochlear duct - a membranous labyrinth within the
cochlea, completes the separation of scala vestibuli and scala
tympani
Basilar membrane - where the cochlea sits. It is narrower at base
than at the apex.
2. Organ of Corti
Within the cochlear duct/scala media
Generates action potentials in the bipolar neurons of the spiral
ganglion of the cochlear division of the vestibulocochlear nerve
when hair cells vibrate due to sound.
Functions as an audiofrequency analyzer/organizer
o Highest tones stimulate hair cells near the basal cochlea which
contains the narrowest segment of basilar membrane
o Lowest tones stimulate hair cells in the apical portion of the
cochlea which contains the widest segment of the basilar
membrane
o Intermediate tones stimulate hair cells on the intermediate
portion of the basilar membrane
Consists of two receptor cells:
a. Inner hair cells
Auditory receptor cells
Base
o attached to basilar membrane
o synapses with dendrites of spiral ganglion cells (10 spiral
ganglion cells innervate 1 hair cell and its axons form the
cochlear division of CN VIII)
o inner hair cells + spiral ganglion = produce frequency-
dependent responses to sound
Apex
o contains stereocilia which lie just below the tectorial
membrane
o Stereocilia touch the tectorial membrane when sound waves
enter the cochlea bending of the stereocilia open ionic
channels causes changes of potential in hair cell
membrane

Figure 3. Organ of Corti

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(N1) spiral ganglion

b.Outer Hair cell


Stereocilia is found embedded in the tectorial membrane
Possesses contractile properties
Controls sensory response properties of the organ of Corti by
regulating apposition of tectorial membrane to inner hair cells

III. CENTRAL AUDITORY PATHWAY
1. Receptor (Organ of Corti)
2. N1 (spiral ganglion)
3. N2 (ventral and dorsal cochlear nuclei)
*fibers form 3 acoustic striae (in bold letters)
a. Dorsal cochlear nucleus dorsal acoustic stria (most of
them cross to join) contralateral lateral lemniscus
b.Ventral cochlear nucleus intermediate acoustic stria
(course similar to that of the dorsal acoustic stria)
contralateral lateral lemniscus
Dorsal and intermediate acoustic striae constitute the
central monaural auditory pathway, carrying information
about the frequency of auditory signals.
c. Ventral cochlear nucleus ventral acoustic stria terminate
in ipsilateral and contralateral nuclei of the trapezoid body
and superior olivary nuclei ipsilateral and contralateral
lemnisci
Ventral acoustric stria forms a binaural pathway which
analyzes the location of origin, or direction, of auditory
stimuli.
4. N3 (inferior colliculus)
Sends axons to medial geniculate nucleus through the
brachium of the inferior colliculus
5. N4 (medial geniculate body)
Final sensory relay station of hearing pathway
Special sensory nuclei of the thalamus
Auditory radiation through the sublenticular portion of the
internal capsule will go to the transverse temporal gyri (of
Heschl) and to planum temporal
6. Primary auditory cortex
Heschls gyrus or anterior transverse temporal gyrus or
Brodmann areas 41 and 42
*When impulses reach areas 41 and 42, sound is heard. It is at area
22 (auditory association area) where interpretation occurs.
Commissural fibers exist between the following nuclei in the
auditory pathway:
Superior olivary nuclei
Nuclei of trapezoid body
Nuclei of lateral lemniscus
Inferior colliculi






RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J



(N2)



dorsal cochlear nucleus



(ipsilateral)

ventral cochlear nucleus



(ipsilateral)

Dorsal acoustic stria Intermediate acoustic stria Ventral acoustic stria






trapezoid nuclei superior olivary nuclei


(contralateral and ipsilateral)


Lateral Lemniscus Lateral Lemniscus
(contralateral) (ipsilateral)



(N3)
Inferior colliculus Inferior colliculus


(N4)
MGB MGB


Primary auditory complex (BA 41 & 42)

Tonotopic Representation in the Auditory System



Low Tones
High Tones
Organ of Corti
Upper
Lower
Cochlear Nuclei
Ventral
Dorsal
MGB
Lateral
Medial
Heschls gyrus
Anterolateral
Posteromedial

A. Efferent Transmission
Heschls gyrus medial geniculate body inferior colliculus
superior olive cochlear nuclei organ of Corti
Efferent cochlear bundle/olivocochlear bundle = terminates at
organ of Corti where fibers end in synaptic relationship to hair
cells
Feedback mechanism to sharpen tone of perception
For modulation, suppression, selection of impulses arising in
organ of Corti
B. Auditory Reflexes
Involuntary responses to sound mediated by branches of main
auditory pathway
1. Audiomotor reflexes
o High-intensity sound stimulus stapedius and tensor
tympani muscles of the ossicles contract (stapedius pulls
the stapes (stirrup) of the middle ear away from the oval
window of the cochlea and the tensor tympani muscle pulls
the malleus (hammer) away from ear drum) diminish
vibration of middle ear ossicles decreased transmission of
vibrational energy to the cochlea
o Impulse goes to cochlear nuclei R and L superior olive
reticular formation CN V (for tensor tympani ms) and CN
VII (for stapedius ms)

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For the succeeding pathways, follow:


o Inferior colliculus superior colliculus tectospinal tract
lower motor neurons in the brain stem and cervical spinal
cord, and supply the oculomotor system and muscles of the
head and neck that respond to sound
2. Head and neck turning in response to sound
3. General acoustic muscle reflex
o Generalized jerking of the body in response to a loud,
sudden sound
4. Auditory-oculogyric reflex
o Deviation of the eyes in the direction of the sound
5. Auditory palpebral reflex
o Blinking of the eyelids in response to a loud sound
6. Cochleopupillary reflex
o Dilation of the pupils in response to a loud sound

C. Hearing Defects
1.Nerve deafness
Destruction of cochlear portion of CN VIII
Lesion of lateral lemniscus = partial deafness only since
pathways are bilateral
2.Occlusion deafness
When conduction of sound is impaired before receptor is
reached
Due to impacted cerumen, otitis media (infection in middle ear)
or otosclerosis (arthritis of auditory ossicles)
3.Tinnitus
hissing, roaring, buzzing, humming sounds due to acoustic
neuroma, streptomycin, aspirin
may lead to nerve deafness
E. Screening for hearing loss
1. Weber test
Reflects conduction loss in the ipsilateral ear
o Conduction problem of the middle ear (incus, malleus,
stapes, and eustachian tube) masks the ambient noise of the
room, making the sound appear louder
o The well-functioning inner ear (cochlea with its basilar
membrane) picks the sound up via the bones of the skull
causing it to be perceived as a louder sound than in the
affected/abnormal ear (ipsilateral sensorineural hearing
heard as louder)
Patient with unilateral conductive hearing loss would hear the
tuning fork loudest in the affected ear
Normal Weber = sound is loudest in midline
2. Rinne Test
Used in cases of unilateral hearing loss and establishes which
ear has the greater bone conduction by comparing perception
of sounds transmitted by air conduction to those transmitted
by bone conduction (mastoid process) .
o A "positive" result indicates the healthy state, in contrast
to many other medical tests; so avoid using the term
'positive' or 'negative', and simply state if the test was
normal or abnormal, to avoid confusion.
o Normal / positive Rinne: air conduction > bone conduction
Conductive deafness in Weber and Rinne:
o Sound lateralizes/is louder in affected ear
o In Weber: abnormality in the middle ear structures leads
to increased sound perception in abnormal ear

RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

o In Rinne: perceptions by bone conduction (via undamaged


inner ear) is enhanced compared to air conduction
(because of damaged middle ear)
Sensorineural deafness in Weber and Rinne:
o Sound is louder in normal ear (Weber)
o Bone conduction is ineffective in stimulating damaged
nerve
o Both bone conduction and air conduction are diminished
but air conduction is slightly > bone conduction (Rinne)

IV. VESTIBULAR SYSTEM
Functions:
Maintenance of body balance
Coordination of eyes, head and body movement
Permits eyes to remain fixed on a point in space as the head
moves

Consists of:
Receptors located in the inner ear
vestibular hair cells
Peripheral nerves of the vestibular division of CN VIII
Central connections that analyze information about the position
and movement of head in space

A. Inner Ear (Labyrinth)
1. Bony Labyrinth
Consists of the cochlea, vestibule, semicircular canals
Series of interconnected cavities in the petrous portion of
temporal bone
Contains perilymph which fills the space between the bony and
the membranous labyrinth


2. Vestibular/Membranous Labyrinth
Consists of the saccule, utricle, semicircular ducts, cochlear
duct
Where the peripheral receptors of the vestibular system, the
vestibular hair cells, are located
Contains endolymph
2 swellings within the vestibule
o Utricle
o Saccule
3 semicircular canals within the vestibule
o Anterior
o Lateral/Horizontal
o Posterior

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Vestibular Hair Cells


Peripheral receptors of the vestibular system
Reside inside specialized receptor areas within the
membranous labyrinth
Sense both dynamic and static functions
Dynamic Function: detects linear (translational) and angular
(rotational) motion of head in space
o Mediated by the semicircular ducts
Static Function: detection of position (tilt) of the head
o Mediated by the utricle
The apical portion contains numerous long, rigid, unbranched
stereocilia, and on one side, a single kinocilium
o arranged in rows of increasing length

B. Vestibular Functions of the Ear
Movement of the head causes movement of the endolymph and
likewise movement of the otolithic membrane (over the macula) and
cupula (over the crista ampullaris). This causes bending of the
stereocilia.

1. If Hair bundle/ stereocilia bends toward the kinocilium
Tip links (very small strand of protein that connect the
+
stereocilia) are pulled cation channels open influx of K
+
ions depolarization of hair cells opening of Ca channels
near base of the cell stimulates release of neurotransmitter

2. If hair bundle/ stereocilia bends away from the kinocilium
Causes tip links to be slack closure of apical cation channels
+
hyperpolarization closure of Ca channels reduce
neurotransmitter release

C. Macula

Specialized receptor region found in the utricle and saccule


The hair cells within it respond to linear acceleration, gravity and
tilt of the head
Contains hair cells that synapse with the peripheral nerves/
distal branches of the vestibular ganglion cells
The tips of the stereocilia and kinocilium are embedded in thick,
gelatinous layer of proteoglycans called the otolithic membrane,
the outer part of which is filled with calcified structures (calcium
carbonate) called otoliths (or otoconia) which increases the
specific gravity of the otolithic membrane to about twice that of
the endolymph.
otolithic membranes move when subjected to acceleration.
2 types: macula sacculi and macula utriculi
o Macula sacculi (lies in the floor of the saccule) lies in a plane
perpendicular to macula utriculi (occupies the lateral wall of
the utricle), but both are similar histologically.
Utricle: located on the floor of the vestibule
Saccule: medial wall
The arrangement of hair cells in the macula creates a response
to acceleration in any direction.

1. Striola

Figure 6. Striola
Figure 4.Movement of stereocilia

RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

Figure 5. Macula

Specialized strip through the middle of the macula


o Curved equatorial line

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Defines the site of change in orientation of the hair cells


Zone that runs the length of macula of both utricle and saccule
Because striola curves through the macula, hair cells are polarized
in different directions
o Utricular and saccular hair cells are directionally sensitive to a
wide variety of head positions and linear movements
2. Macula Utricli
Responds to changes in head position with respect to gravity/
tilt and to earth-horizontal linear acceleration
Each hair cell is oriented with the kinocilium toward the striola
o hair cells of either sides of striola are organized as mirror
images
o horizontal acceleration depolarizes one sector of the macula
regardless of the direction of movement
hair cells are polarized toward the stiola

3. Macula Sacculi
Similar in structure with that of the macula utriculi
Responds to gravitational pull
Oriented vertically, approximately in a parasagittal plane.
The kinocilia are oriented away from striola
Linear acceleration in the vertical direction stimulates the macula
o Occurs in response to gravity or against gravity (e.g.
acceleration or deceleration in an elevator)
Hair cells are polarized away from the striola

D. Semicircular Canals
Anterior (superior) - Kinocilia faces away from the utricle
Lateral (horizontal) - Kinocilia faces the utricle
Posterior - Kinocilia faces away from the utricle
Each semicircular canal has an enlarged end, called the ampulla
Within the ampulla is the ampullary crest or crista ampullaris, a
ridge that bears hair cells like those of the maculae


o React to rotational acceleration or angular movement (kinetic
equilibrium)
o Covered with a gelatinous capsule, the cupula
Extends almost to the roof of the ampulla
Has the same specific gravity as the endolymph, therefore, it
cannot sense the effect of gravity
RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

When the head undergoes angular acceleration, the viscous


endolymph in the semicircular ducts pushes in the cupula
o Distortion of the cupula evokes a receptor potential in the hair
cells of the ampullary crest, alters the level of activity in
the peripheral fibers of CN VIII, innervating the hair cells
o The vestibular nerve fibers to each duct respond with an
increase in impulse frequency to rotation in one direction and
with a decrease in impulse frequency to rotation in the
opposite direction
Lodged within the canals are the semicircular ducts :
1. Superior semicircular canal
o Vertical
o Perpendicular to the long axis of the petrous bone
2. Posterior semicircular canal
o Vertical
o Parallel with the long axis of the petrous bone
3. Lateral semicircular canal
o Horizontal
o Lies in the medial wall of the aditus to the mastoid antrum
above the facial nerve canal

Figure 8. Movement of the cristae ampullaris


E. Vestibular Pathways
Afferent fibers of the vestibular nerve have their cell bodies in the
vestibular ganglion (of Scarpa)
Axons of bipolar cells of the vestibular ganglion pass through the
internal auditory canal and reach the upper medulla in company
with the cochlear nerve
o Most of the fibers of the vestibular nerve bifurcate into
ascending and descending branches and terminate in the
vestibular nuclei, which are clustered in the lateral floor of the
fourth ventricle
o Inferior vestibular nucleus (descending spinal)
Receives input from the semicircular ducts and from the
utricle and the saccule
Nucleus projects into the ascending medial longitudinal
fasciculus (MLF)
o Superior vestibular nucleus (of Bechterew)
Receives input chiefly from the cristae of semicircular canals
Neurons project into the ascending part of the MLF, where
they participate in vestibuloocular reflexes
o Medial vestibular nucleus (of Schwalbe)
Receives input chiefly from the cristae of semicircular canals
Neurons project into the ascending part of the MLF, where
they participate in vestibuloocular reflexes
o Lateral vestibular nucleus (of Deiter)
Receives input chiefly from the macula of the utricle
Neurons project to the ascending portion of the MLF and to
the spinal cord through the lateral vestibulospinal tract

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Neurons of the lateral vestibular nucleus are inhibited


monosynaptically by the Purkinje cells in the cerebellum.

From the vestibular nuclei, secondary axons distribute this


information to 4 sites: spinal cord (muscle control),
reticular formation (vomiting center), extraocular muscles,
and cortex (conscious perception).
Some primary fibers of the vestibular nerve pass directly to the
cerebellum, ending in the cortex of the flocculonodular lobe

1. Vestibulospinal Tracts
Both tracts have a strong facilitating effects on motor neurons
innervating antigravity muscles
Assists the local myotactic reflexes
Reinforce the tonus of the extensor muscles of the trunk and
limbs
Produces enough strength to support the body against gravity
and maintain an upright posture
Both terminate along their course almost exclusively upon
interneurons in laminae VII and VIII synapse on the alpha and
gamma lower motorneurons in Lamina IX
Two major projections into the spinal cord arise from the
vestibular nuclei: lateral (maintains upright posture) and medial
(coordinated movements of neck & eye) vestibulospinal tract

Lateral vestibular nucleus uncrossed lateral vestibulospinal
tract cervical to the lumbosacral spinal cord antigravity ms,
neck ms that control gaze
Medial vestibular nucleus crossed and uncrossed medial
vestibulospinal tract descending portion of MLF (medial
longitudinal fasiculus) cervical spinal cord only antigravity ms

Figure 9. Vestibulospinal tract


RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

V. CENTRAL CONNECTIONS & VESTIBULAR NUCLEI


1. Conjugate Eye Movement: in response to head movement &
position of head in space

Vestibular nuclei via MLF (crossed and uncrossed)

Nuclei of CNs III, IV, VI: EOMs (conjugate eye movement)
and
Nucleus of CN XI and anterior horn cells of cervical spinal cord
(medial vestibulospinal tract: maintains the position of the head)

2. Maintain upright posture
Lateral vestibular nucleus

Lateral vestibulospinal tract of spinal cord to sacral level: extensor
muscles of the trunk and limits

3. Fastigial nuclei of the cerebellum
0
0
- Vestibulocerebellar fibers (1 and 2 ) enter cerebellum via
juxtarestiform body (a portion of the inferior cerebellar
peduncle). Uncrossed efferent fibers from the fastigial
nucleus of the cerebellum project to the brainstem also
through the juxtarestiform body.

Secondary vestibulocerebellar fibers

Fastigial nuclei & cortex of cerebellar vermis,
sends efferent fibers to

Lateral vestibular nucleus: facilitating influences on extensor muscle
tone via vestibulospinal tract

4. Reticular formation of brainstem
o Vomiting center (group of reticular neurons in medulla near
dorsal motor nucleus of vagus)
Parasympathetic motor impulses to thoracic & abdominal
viscera
Connections from vestibular nuclei to the vomiting center
probably account for the vomiting associated with motion
sickness
o RAS (Reticular Activating System) or Reticular centers
Vestibuloreticular connections to the RAS may alert
individual to sleep (rocking chair for babies)

5. MGB (Medial geniculate body)
o Vestibular influences project rostrally via the MGB to a
vestibular cortical area near the auditory cortex
o Related to objective sensations, e.g. dizziness associated
with the vestibular system






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A. Test of Vestibular Functions


1.

2.

Rotation test
0
Subject will sit on a rotating chair with head tilted 30
forward which will then be stopped after 10-12 rotations
Induces nystagmus, which lasts about 30 seconds in
neurologically normal persons
Caloric/Thermal Test
Subject will be tested on both sides
0
Lying down with head tilted forward about 30 or sitting with
0
head tilted backward 60 to bring the horizontal SCC into a
vertical plane
Ear will be irrigated with warm/cold water which will cause a
convection current on endolymph which will stimulate the
hair cells and cause nystagmus
COWS direction of nystagmus
o Cold on Opposite, warm on Same Side

Reference:
2014A trans
Lansang Notes
Snell
Moore
Berne & Levy

Everybody is a genius. But if you judge a fish by its ability to climb a tree,
it will live its whole life believing that it is stupid.

-- Albert Einstein

"If you don't go after what you want, you'll never have it. If you don't ask,
the answer is always no. If you don't step forward, you're always in the
same place."

J

CLINICAL CORRELATIONS
A. Nystagmus


Persistent stimulation of hair cells in cristae ampullaris will draw
eyes slowly to one side until a limit is reached then jerk quickly
to opposite side. (involuntary back and forth, up and down
rotational movement of the eyeball)
its direction is designated according to the direction of the fast
component which is the basis for tests in vestibular function
this results from a lesion of the vestibular system, its peripheral
and central connection and also from lesions in brainstem and
cerebellum
this can also be caused by chronic visual impairment or toxic
substances
if unbalanced:
o Unilateral damage to the vestibular nuclei or their connections
tonic deviation of the eyes to one side + vertigo +
nystagmus
o Destruction of the vestibular receptors or section of the nerve:
(-) tonic deviation
Fast case: nystagmus diagnosis
o Ex. Lesion on R
o Caloric/thermal test:
Cold water-direction of nystagmus is opposite the lesion
Warm water-direction of nystagmus is to the same side
B. Vertigo


Sensation of whirling, dizziness due to disturbance of
equilibrium
Stimulation or damage to the vestibular end organ (prolonged or
excessive stimulation of vestibular apparatus - motion sickness)











RG, SOPIE, KEIFER, TASIE, FILLE, ELIZ, MAY, JANNA J

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