Special Senses

PowerPoint® presentation to accompany:

Medical Assisting
Third Edition

Booth, Whicker, Wyman, Pugh, Thompson

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Introduction
 Special senses
 Sensory receptors located in head
 Nose – smell
 Tongue – taste
 Eyes – vision
 Ears – hearing and equilibrium
 Touch is a generalized sense
 Stimulus  nervous system  brain  response

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Nose and Sense of Smell

 Olfactory receptors
 Chemoreceptors – respond
to changes in chemical
concentrations

 Chemicals must be
dissolved in mucus

 Located in the olfactory

organ

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Nose and Sense of Smell (cont)

Smell sensation
Activation of smell receptors 
information sent to olfactory nerves

that send the information along

olfactory bulbs and tracts

to different areas of the cerebrum;

cerebrum interprets the information as a

particular type of smell
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Nose and Sense of Smell (cont.)

 Sensory Adaptation
 Chemical can stimulate receptors for limited
time

 Receptors fatigue and stop responding to

chemical

 No longer smell order

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Apply Your Knowledge

You notice an odor coming from a patient when you

enter the exam room. Why would the patient not be
able to smell it?
ANSWER: After a few minutes, smell receptors undergo
sensory adaptation and no longer respond to the chemical,
and the patient can no longer smell the odor.

Very
Good!
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Tongue and Sense of Taste

 Gustatory receptors – located on taste
buds
 Taste buds
 Location
 Papillae of the tongue
 Roof of mouth
 Walls of throat
} fewer than on tongue

Tongue

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Tongue and Sense of Taste (cont.)

 Taste cells and supporting structures
 On taste buds
 Supporting structures fill in space
 Taste cells
 Chemoreceptors
 Chemicals in food and drink must be dissolved
in saliva to activate

Tongue

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Tongue and Sense of Taste (cont.)

 Taste sensation  Spicy foods
 4 primary  Activate pain
 Sweet – tip
receptors
 Sour – sides
 Salty – tip and
 Interpreted by brain
sides as “spicy”
 Bitter – back

Tongue

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Back

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Tongue and Sense of Taste (cont.)

Taste sensation

Activation of Cranial
taste cells nerves

Gustatory cortex of cerebrum

interprets information

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Apply Your Knowledge

What are the four primary taste sensations and where
are their corresponding taste cells located?
ANSWER: The four primary taste sensations are:
Sweet – concentrated on the tip of the tongue
Sour – concentrated on the sides of the tongue
Salty – concentrated on the tip and sides of the tongue
Bitter – concentrated on the back of the tongue

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Eye and Sense of Sight

 Vision system  Eye
 Eyes  Processes light to
 Optic nerves produce images
 Vision centers in  Three layers

the brain  Two chambers

 Accessory  Specialized parts

structures

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Eye and Sense of Sight (cont.)

 Outer – sclera
 White of the eye
 Protects the eye
 Sense receptors
 Cornea
 Front of eye
 “Window” that allows light into eye
 Bends light as it enters Eye

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Eye and Sense of Sight (cont.)

 Middle – choroid
 Contains blood vessels  Ciliary body
 Iris  Muscles
 Colored part of eye  Controls the shape
 Muscle that contracts of the lens
and relaxes to open or  Lens
close pupil  Posterior to iris
 Regulates the amount  Focuses light on retina
of light that enters the  Accommodation
eye
Eye

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Eye and Sense of Sight (cont.)

 Inner – retina
 Visual receptors
 Rods
 Sensitive to light
 Will function in dim
light – “limited”
night vision
 Do not provide
sharp image or
detect color
 Cones
 Function in bright
light
 Sensitive to color
and provide sharp
images
 Optic disc – optic
nerve enters retina
Eye

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Eye and Sense of Sight (cont.)

 Chambers of the eye
 Anterior chamber
 Front of lens
 Filled with aqueous humor – nourishes and bathes
anterior eye
 Posterior chamber
 Behind lens
 Contains vitreous humor – maintains shape of
eyeball and holds retina in place Eye

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Back

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Eye and Sense of Sight:

Visual Accessory Organs
 Eye orbits  Eyelids
 Eye sockets  Skin, muscle, and
 Form a protective connective tissue
shell around the  Blinking
eyes  Prevents surface
 Eyebrows protect from drying out
eyes  Keeps foreign
material out of eye

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Eye and Sense of Sight:

Visual Accessory Organs (cont.)
 Conjunctivas  Lacrimal apparatus
 Mucus membranes  Lacrimal glands
 Line inner surfaces  Lateral edge of
of eyelids eyeballs
 Produce tears
 Nasolacrimal ducts
 Medial aspect of
eyeballs
 Drain tears into nose

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Eye and Sense of Sight:

Visual Accessory Organs (cont.)

 Extrinsic eye muscles

 Six per eye move the eyeball
 Superiorly
 Inferiorly

 Laterally

 Medially

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Eye and Sense of Sight:

Visual Pathways
 Eye works like a camera
 Light enters the eye through the lens
 Refraction – cornea, lens, and fluids bend light to focus it on
the retina

Image upside
Image turned
down on retina
right-side up
Retina converts Occipital
light to nerve Optic Optic lobe of
impulse nerve chiasm cerebrum

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Eye Safety and Protection

 90% of eye injuries are preventable
 Eye safety practices
 Adequate lighting / handrails
 Pad or cushion sharp edges on furniture

 Toys should be age-appropriate

 Do not mix chemicals

 Proper protective wear

 Goggles
 Sports eye guards

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Apply Your Knowledge

Matching: ANSWER:
___ Middle layer of eye A. Lacrimal glands
___ Eye sockets B. Aqueous humor
___ Control shape of lens C. Retina
___ Outer layer of eye
___ Anterior chamber
D.
E.
Sclera
Vitreous humor
Out
___ Tears
___ Bending of light
F.
G.
Ciliary body
Choroid
of
___ Posterior chamber
___ Inner layer of eye
H.
I.
Orbits
Refraction Sight
!
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The Aging Eye
 Eyelids may droop
 Quality and quantity of
tears decrease
 Conjunctiva thins and
eyes may become dryer
 Cornea yellows, fat
deposits around it
 Brown spots on sclera
 Pupils become smaller
35-25
 Lens denser and more
rigid
 Lens yellows
 Retinal changes – vision
fuzzy
 Changes in ability of eye
to adapt to light
 Impaired night vision
 Decreased peripheral
vision; depth perception
 Floaters or flashes of light
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Preventing Falls in the Elderly

 Falls can result in fractures of major bones
 Complications of falls can lead to death
 Prone to falling
 Vision problems  Equilibrium problems
 Poor health  Medication
 Slower reflexes
 Patient education
 Safety checklist
 Precautions

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Apply Your Knowledge

What vision changes can occur in the elderly patient?

ANSWER: An elder patient may have difficulty seeing

because of drooping eyelids. Focusing may be more
difficult because less light enters the eye. He may have
difficulty distinguishing colors due to yellowing of the lens.
Vision may be fuzzy because of changes in the retina.
Night vision can become impaired. The patient may see
floaters or “sparks.”

Nice job!
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Vision Testing
 Professionals include
 Ophthalmologist – medical doctor who is an eye
specialist

 Optometrist – provides vision screening and

diagnostic testing

 Opticians – fills vision prescriptions for glasses

and contacts

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Vision Testing: Screening Tests
 Myopia – impairment of
distance vision
 Eyeball is too long
 Light focuses anterior to
retina
 Snellen chart
 Normal vision
 20/20
35-29
 Hyperopia – impairment
of near vision
 Eyeball is shorter
 Light focused posterior to
retina
 Test using a handheld chart
with various sizes of print
 Presbyopia
 Impairment due to aging
 Loss of lens elasticity
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Vision Testing: Screening Tests (cont.)

 Contrast sensitivity
 Color vision
 Color-blindness
 Distinguish shades of gray  May be inherited
 Testing  More common in
males
 PelliRobson contrast
sensitivity chart
 Tests
 Ishihara color system
 Vistech Consultants vision  Richmond
contrast system pseudoisochromatic
color test
 Detect cataracts or retinal  Difficulties may
problems before sharpness indicate retinal or optic
is impaired nerve disease

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Apply Your Knowledge

What is the difference between myopia and hyperopia and what is
presbyopia? What effect does each have on vision?
ANSWER: If the patient has myopia, the eyeball is elongated
and light focuses in front of the retina. She will have
difficulty seeing far away. If she has hyperopia, the eyeball is
shorter than normal and light focuses behind the retina.
With presbyopia, the lens loses elasticity due to aging,
resulting in the inability to see things close up.

Reyeght
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Treating Eye Problems

 Delicate organ – caution and sterile technique
necessary
 Patient education on preventive care
 Administration  Eye irrigation
of medications  Sterile solution

 Only ophthalmic  Purpose

medications  Remove foreign
 Avoid touching material
dropper or ointment  Relieve discomfort
tube to the eye

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Common Diseases and Disorders

Disorder / Disease Description
Amblyopia Lazy eye; one eye is not used regularly;
poor depth perception; often concurrent
with strabismus
Astigmatism Cornea or lens has abnormal shape;
blurred images
Cataracts Opaque structures in lens prevent light
from passing through; vision fuzzy
Conjunctivitis Pink eye; highly contagious bacterial
infection
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Common Diseases and Disorders

(cont.)

Disorder / Disease Description

Dry eye syndrome Common problem; decreased production
of oil in tears
Entropion Inversion of lower eyelid
Glaucoma Increase in intraocular pressure due to a
buildup of aqueous humor in anterior
chamber
Hyperopia Farsightedness

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Common Diseases and Disorders

(cont.)

Disorder / Disease Description

Macular Progressive disease; inadequate blood
degeneration supply to retina; most common cause of
vision loss; affects people over 50 years
Myopia Nearsightedness

Nystagmus Rapid, involuntary eye movements

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Common Diseases and Disorders

(cont.)

Disorder / Disease Description

Prespyopia Loss of lens elasticity; develops with age

Retinal Layers of retina separate; medical

detachment emergency

Strabismus Misalignment of eyes

Convergent Crossed eyes; one or both eyes turn
inward
Divergent Wall eye; one or both eyes turn outward
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Apply Your Knowledge

It is okay to use any solution or medication in the eye?
ANSWER: Only medications or solutions specifically
designated for ophthalmic use may be used in the eyes.
Medications not designated for the eye may be too
concentrated or contain substances that can injure the eye.
Solutions should be sterile and care must be taken not to
contaminate the tip of the dropper or bottle.

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The Ear and the Senses of Hearing

and Equilibrium: Structures
 External ear
 Auricle (pinna)
 Collects sound waves
 External auditory canal
 Guides sound wave to tympanic membrane
 Tympanic membrane
 Separates external canal and middle ear
 Vibrates when sound hits it Ear

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The Ear and the Senses of Hearing

and Equilibrium: Structures (cont.)
 Middle ear
 Ear ossicles  Eustachian tube
 Malleus  Connects middle ear
 Incus to throat
 Stapes  Equalizes pressure on
 Ossicles vibrate in eardrum
response to vibration  Oval window
of tympanic  Separates middle ear
membrane from inner ear Ear

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The Ear and the Senses of Hearing

and Equilibrium: Structures (cont.)
 Inner ear – labyrinth of communicating
chambers
 Semicircular canals – detect balance of
the body
 Vestibule – equilibrium

 Cochlea
 Hearing receptors
 Organ of Corti – organ of hearing
Ear

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The Ear and the Senses of Hearing

and Equilibrium: Structures (cont.)
 Equilibrium
 Head movement causes fluid in
semicircular canals and
vestibule to move

 Equilibrium receptors transmit

information along vestibular
nerves to cerebrum

 Cerebrum determines if body needs to make

adjustments

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The Ear and the Senses of Hearing

and Equilibrium: Hearing Process
 Sound waves collected
 Waves cause tympanic membrane
to vibrate
 Ossicles amplify vibrations, which
enter inner ear
 Movement of hairs lining cochlea trigger nerve
impulses
 Impulses are transmitted by auditory nerve to the
brain for interpretation

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The Ear and the Senses of Hearing

and Equilibrium: Hearing Process (cont.)
 Bone conduction
 Alternative pathway
 Bypasses external and
middle ear directly to
inner
 Useful in determining
cause of hearing
problem

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Apply Your Knowledge

Matching: ANSWER:
___ Pinna A. Organ of Corti
___ Malleus, incus, and stapes B. Cerumen
___ Hearing receptors C. Ear ossicles
___ Inner ear D. Tympanic membrane
___ Organ of hearing E. Auricle
___ Earwax F. Cochlea
___ Eardrum G. Labyrinth
___ Detect balance of body H. Semicircular canals

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How to Recognize Hearing Problems

in Children
 Guidelines
 Infants to 4 months
 Startled by loud noises
 Recognize mother’s voice
 4 to 8 months
 Regularly follow sounds
 Babble at people
 8 to 12 months
 Respond to the sound their name
 Respond to “no”

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The Aging Ear

 External ear larger / earlobe longer
 Cerumen dryer and prone to impaction
 Ear canal narrower
 Eardrum shrinks and appears dull and gray
 Ossicles do not move as freely
 Semicircular canals less sensitive to
changes in position – affects balance

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Apply Your Knowledge

What problem with the aging ear makes the elderly
more prone to falls?
ANSWER: The semicircular canals become less sensitive
to change in position, which affects balance. This problem
with equilibrium results in increased chance of falls in the
elderly.
Great
Answer!

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Hearing Loss
 Symptom of a disease, not a normal part of aging
 Conductive hearing loss  Sensorineural hearing loss
 Interruption in  Sound waves not perceived
transmission to inner ear by brain as sound
 Causes  Causes
 Obstruction of ear canal  Hereditary

 Infection of middle ear  Repeated exposure to

 Reduced movement of loud noises / viral

stirrup infections
 Side effect of medication

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Hearing Loss (cont.)

 Noise pollution – causes damage to sensitive cells
in cochlea
 Working with the hearing-impaired patient
 Speak at a reasonable volume, in clear, low-pitched
volumes
 Face the person; use hand gestures, if appropriate
 Do not overemphasize lip movements
 Have patient repeat message to verify understanding
 Treat hearing-impaired patients with patience and
respect

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Hearing and Diagnostic Tests

 Hearing tests
 Tuning forks – differentiate between types of
loss
 Audiometer – measures hearing acuity
 Diagnostic testing
 Tympanometry
 Measures the ability of the eardrums to move
 Detects diseases and abnormalities of the middle ear

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Apply Your Knowledge

Identify the types of hearing loss based on the description
below. What can be used to differentiate between the two?
Answer: A tuning fork is a simple test to distinguish between types of
hearing loss.

Conductive hearing loss Sensorineural hearing loss

 Interruption in transmission to  Sound waves not perceived by brain as

inner ear sound
 Causes  Causes
 Obstruction of ear canal
 Hereditary
 Repeated exposure to loud noises /
 Infection of middle ear
viral infections
 Reduced movement of  Side effect of medication
stirrup
Bravo!
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Treating Ear and Hearing

Problems
 Patient education
 Preventative ear care
 Administer ear medications

 Medications and Irrigation

 Relieve inflammation or irritation of canal
 Loosen and remove impacted cerumen or
foreign body

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 35-54

Treating Ear and Hearing

Problems (cont.)
 Hearing aids
 Obtaining a hearing aid
 Otologist – medical doctor
specializing in health of ear
 Audiologist – evaluates and
corrects hearing problems
 Other devices / strategies
 Amplifiers
 Closed-captioning
 Appliances that light up as
well as ring

 Care and use

 Batteries
 Routine cleaning
 Keep dry and avoid hair sprays

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 35-55

Common Diseases and Disorders

Disorder / Description
Disease
Cerumen Build up of wax within external auditory
impaction canal

Hearing loss Deafness

Meniere’s disease Disturbance in equilibrium characterized

by vertigo and tinnitus

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Common Diseases and Disorders

Disorder / Description
Disease
Otitis Inflammation of the ear
Otitis externa Swimmers’ ear
Otitis media Middle ear infection; common infection
Otitis interna Labyrinthitis; inner ear infection
Osteosclerosis Immobilization of the stapes; common
cause of conductive hearing loss
Presbycusis Hearing loss due to aging process

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End of Chapter

Every closed eye

is not sleeping,
and every open
eye is not
seeing.
~ Bill Cosby

© 2009 The McGraw-Hill Companies, Inc. All rights reserved