耳的应用解剖学生理学耳功能检查医学课件.ppt

1、1.耳外科的业务范畴耳聋的手术治疗传导性耳聋：鼓室成形术、听骨链重建、人工镫骨神经性耳聋：植入式助听器、人工耳蜗植入听神经瘤、颈静脉球体瘤等侧颅底肿瘤面神经外科：面瘫、面肌痉挛眩晕的外科治疗三叉神经痛脑脊液耳鼻漏的修补2.3.4.外耳的解剖5.外耳的解剖6.外耳的解剖7.中耳的解剖8.中耳的解剖鼓室9.10.中耳的解剖鼓室11.中耳的解剖鼓膜（外壁）12.中耳的解剖外壁13.中耳的解剖内壁14.中耳的解剖前壁15.中耳的解剖后壁16.中耳的解剖上壁17.中耳的解剖下壁18.中耳的解剖鼓室内容物19.中耳的解剖听骨链20.中耳的解剖咽鼓管21.22.中耳的解剖鼓窦与乳突23.中耳的解剖颞骨CT扫

2、描24.内耳的解剖25.26.内耳的解剖前庭27.内耳的解剖骨半规管28.29.内耳的解剖膜迷路30.内耳的解剖膜迷路31.内耳的解剖膜迷路32.内耳的解剖膜迷路33.内耳的解剖膜迷路膜蜗管位于骨螺旋板与骨蜗管外壁之间，亦在前庭阶与骨阶之间，内含内淋巴。基底膜：起自骨螺旋板游离缘。其上的螺旋器(Corti器)是由内、外细胞等组成的听觉感受器。34.35.36.37.耳的生理学38.声音传入内耳的途径39.40.41.声音传入内耳的途径骨传导42.外耳的生理43.中耳的生理44.中耳的生理鼓膜的生理功能45.Function Middle earamplification from area r

3、atioPressure=Force/areaArea of tympanic membrane 17 area stapesGain of area ratio 24 dB46.中耳的生理听骨链的生理功能47.48.中耳的生理鼓室肌的生理功能49.中耳的生理咽鼓管的生理功能50.听觉生理51.52.Basilar membrane displacement for a 1 kHz toneBasilar membrane displacement for a 250 Hz toneBasilar membrane displacement for a 4 kHz tone 53.Mass-i

4、ncreases from base(stapes)to apexStiffness-increases from apex to base1234Envelope of traveling waveCharacteristic frequency54.Stereocilia on OHCs attached to tectorial membraneStereocilia on IHCs free standingMotion of basilar membrane towards scala vestibuli deflects stereocilia in excitatory dire

5、ctionTectorial membrane deflects OHC stereociliaViscous fluid drag of fluid deflects IHC stereocilia55.Model:OHC contraction cause organ of Corti to distort as shown herer Cell motility feeds back enhancing basilar membrane motion thereby increasing traveling wave amplitude and making the“cochlea ac

6、tive”Model of organ of Corti Responds to OHC Electromotility56.OHC contracts in-phase with deflection of the hair bundle toward the tallest stereocilia.The current through the cell increases with deflection in this direction.If the current is modulated slowly(compared to 1 kHz),then the voltage acro

7、ss the lateral membrane will be in-phase with the current.Conformational changes in many voltage sensitive molecules situated within the lateral membrane cause the length of the cell to change.The diameter of the cell increases slightly as the cell contracts to maintain constant cell volume.57.平衡生理5

8、8.半规管的生理功能59.球囊及椭圆囊的生理功能60.61.咽鼓管功能检查鼓膜完整者吞咽试验法咽鼓管吹张法瓦尔萨尔法波利策法导管吹张法声导抗仪检查法咽鼓管纤维内镜检查法62.咽鼓管功能检查鼓膜穿孔者鼓室滴药法荧光素试验法咽鼓管造影术鼓室内镜检查法声导抗仪检查法63.听功能检查音叉试验RINNE试验-骨气导比较试验WEBER试验-骨导偏向试验SCHWABACH试验-骨导比较试验GELLE试验-气导波动试验64.纯音听力计检查纯音听阈测试传导性聋感音神经性聋混合性聋65.纯音听力计检查纯音阈上功能测试响度重振试验双耳交替响度平衡试验METZ重振试验法短增量敏感指数试验法病理性听觉适应现象测试音衰变试验BEKESY字描听力计测试镫骨肌声反射衰减试验66.言语测听 言语接受阈（SRT）言语识别率（SDS）67.声导抗检测法 鼓室导抗测量静态声顺鼓室导抗图 A B C 镫骨肌声反射68.耳声发射检测法 TEOAEDPOAE婴幼儿听力筛查蜗性聋的早期诊断蜗性聋、蜗后性聋的鉴别诊断69.听性诱发电位检测法 耳蜗电图（ECOCHG）耳蜗微音电位（CM）和电位（SP）听神经复合动作电位（AP）70.听性诱发电位检测法 听性脑干反应测听（ABR）71.