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CHAPTER 14

The Special Senses


(Eye and Ear)
Overview of the Eye
• Eye acts much like a camera
– Lens of eye adjusts to bring object into focus
– Pupil of eye constricts to allow less light to
enter in bright setting or dilates to allow more
light to enter in darker setting
– Through bending of light rays, image reaches
retina
• Sensitive nerve cell layer of eye
• Image is transmitted to brain for interpretation

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Structures of the Eye
(Front View)
• Sclera
– White portion of eye
• Tough, fibrous membrane
• Maintains shape of eyeball
• Serves as protective covering for eye
• Iris
– Colored portion of eye
• Pupil
– Opening in center of eye
– Controls amount of light entering eye
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Structures of the Eye
(Front View)
• Conjunctiva
– Thin mucous membrane layer that lines anterior part
of eye and inner part of eyelids
• Colorless, but appears white because it covers sclera
• Lacrimal gland
– Located at upper outer edge of each eye
• Produces tears
• Lacrimal duct
– Located at inner edge of eye
• Tears drain from eye through this duct

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Structures of the Eye
(Front View)

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Structures of the Eye
(Front View)
• Eyelids
– Continuous with skin and cover the eyeball
– Keep surface of eyeball lubricated and protected from
dust and debris through blinking motion
• Eyelashes
– Located along edges of eyelids
– Help protect eyeball by preventing foreign materials
and/or insects from coming in contact with surface of
eyeball

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Structures of the Eye
(Cross Section)
• Sclera
– “White of the eye”
– Thinnest over anterior surface of the eye
– Thickest at the back of the eye, near opening
for optic nerve
• Cornea
– Continuous with anterior portion of sclera
– Transparent, nonvascular layer covering
colored part of the eye

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Structures of the Eye
(Cross Section)
• Conjunctiva
– Mucous membrane lining inner surfaces of
eyelids and outer surfaces of eye
• Choroid
– Vascular middle layer of eye
• Just beneath sclera
• Contains extensive capillaries that provide blood
supply and nutrients to eye
• Contains the iris, ciliary body, and suspensory
ligaments

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Structures of the Eye
(Cross Section)
• Iris
– Colored portion of eye
• Can be seen through transparent corneal layer
• Pupil
– Located in center of iris
• Controls amount of light entering eye
• Lens
– Colorless biconvex structure that aids in
focusing images clearly on retina
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Structures of the Eye
(Cross Section)
• Ciliary body
– Located on each side of the lens
– Contains muscles responsible for adjusting lens to
view near objects
• Suspensory ligaments
– Radiate from ciliary body and attach to lens
– Hold lens in place
– Assist in adjusting shape of lens for proper focusing of
eye

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Structures of the Eye
(Cross Section)
• Retina
– Sensitive nerve cell layer
• Changes energy of light rays into nerve impulses
• Transmits nerve impulses via optic nerve to brain
for interpretation of image seen by eye
– Nerve cells of retina
• Rods are responsible for vision in dim light and for
peripheral vision
• Cones responsible for visualizing colors, central
vision, and vision in bright light
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Structures of the Eye
(Cross Section)
• Retina
– Macula Lutea
• Oval, yellowish spot near center of retina
– Fovea Centralis
• Small depression located within macula lutea
• Sharpest image is obtained when image focuses
directly on fovea centralis = central vision

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Structures of the Eye
(Cross Section)
• Optic nerve
– Receives impulses from retina and transmits
them to the brain
• Images are then interpreted as vision
• Optic disc
– Contains no rods or cones
– Known as the “blind spot” of the eye
– Center of optic disc serves as point of entry
for artery that supplies retina
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Structures of the Eye
(Cross Section)
Lateral Cross Section
of the Eye

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Structures of the Eye
(Cross Section)
• Anterior cavity of the eye
– Anterior chamber
• Located in front of lens
• Filled with clear, watery fluid called aqueous humor
– Posterior chamber
• Located behind lens
• Also filled with aqueous humor
• Flows back and forth between both chambers

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Structures of the Eye
(Cross Section)
• Posterior cavity of eye
– Posterior to lens
– Filled with vitreous humor
• Clear, jellylike substance that gives shape to the
eyeball
• Not constantly reproduced
• Blindness can result if vitreous humor escapes
from eye

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Process of Vision
• Process begins as light rays enter eye
– Transmitted through cornea, aqueous humor,
pupil, lens, and vitreous humor to retina
• Sensitive nerve cells of retina transmit image
through optic nerve to brain
• Brain interprets image as vision

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Process of Vision
• Refraction
– Process of bending of light rays as they pass
through the various structures of the eye to
produce a clear image on the retina
• Errors of refraction
– Occur when eyeball is abnormally shaped
– Occur when lens has lost ability to
accommodate to near vision
• Vision will be blurred
• Can be adjusted with corrective lenses
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PATHOLOGICAL CONDITIONS

The Eye
Astigmatism
• Pronounced
– (ah-STIG-mah-tizm)
• Defined
– Refractive error causing light rays entering the
eye to be focused irregularly on the retina due
to an abnormally shaped cornea
• Correction: contact lenses or eyeglasses to
neutralize defect

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Blepharitis
• Pronounced
– (blef-ah-RYE-tis)
• Defined
– Inflammation of the eyelid margins stemming
from seborrheic, allergic, or bacterial origin

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Blepharoptosis
(Ptosis)
• Pronounced
– (blef-ah-roh-TOH-sis)
• Defined
– Occurs when eyelid partially or entirely covers
the eye as a result of a weakened muscle

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Blepharoptosis
Blepharoptosis

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Blindness
• Pronounced
– (BLINDNESS)
• Defined
– Absence of vision or the need for assistive
devices and/or assistance from others to
accomplish daily activities due to inability to
see

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Monochromatism (Color Blindness)
• Pronounced
– (mon-oh-KROH-mah-tizm)
• Defined
– Inability to sharply perceive visual colors
• Daltonism
– Unable to distinguish greens from reds
• Achromatic Vision
– Cannot distinguish any color; perceives only white, gray,
and black

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Cataract
• Pronounced
– (KAT-ah-rakt)
• Defined
– Lens in the eye becomes progressively cloudy
losing its normal transparency
• Alters perception of images due to interference of
light transmission to retina

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Chalazion
• Pronounced
– (kah-LAY-zee-on)
• Defined
– Cyst or nodule on eyelid resulting from an
obstruction of a meibomian gland, which is
responsible for lubricating margin of the eyelid

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Conjunctivitis, Acute
• Pronounced
– (kon-junk-tih-VYE-tis acute)
• Defined
– Inflammation of mucous membrane lining the
eyelids and covering the front part of the
eyeball
– Also called “Pinkeye”

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Corneal Abrasion
• Pronounced
– (COR-nee-al ah-BRAY-zhun)
• Defined
– Disruption of the cornea’s surface epithelium
commonly caused by an eyelash, a small
foreign body, contact lenses, or a scratch
from a fingernail

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Diabetic Retinopathy
• Pronounced
– (dye-ah-BET-ik reh-tin-OP-ah-thee)
• Defined
– Condition that occurs as a consequence of an
8 to 10-year duration of diabetes mellitus in
which the capillaries of retina experience
scarring

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Diabetic Retinopathy
• Causes of retinal capillary scarring
– Abnormal dilation and constriction of vessels
– Hemorrhages
– Microaneurysms
– Abnormal formation of new vessels causing
leakage of blood into the vitreous humor
• Leakage causes permanent decline in sharpness
of vision

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Ectropion
• Pronounced
– (ek-TROH-pee-on)
• Defined
– “Turning out” or eversion of the eyelash
margins from the eyeball leading to exposure
of the eyelid and eyeball surface and lining
• Occurs especially in the lower eyelid

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Entropion
• Pronounced
– (en-TROH-pee-on)
• Defined
– “Turning in” of the eyelash margins resulting
in the sensation similar to that of a foreign
body in the eye (redness, tearing, burning,
and itching)
• Occurs especially in the lower margins

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Exophthalmia
• Pronounced
– (eks-off-THAL-mee-ah)
• Defined
– Abnormal protrusion of the eyeball(s) usually
with the sclera noticeable over the iris
– Typically due to an expanded volume of
orbital contents

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Glaucoma
• Pronounced
– (glau-KOH-mah)
• Defined
– Ocular disorders identified as a group due to
the increase in intraocular pressure

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Glaucoma
• Chronic open-angle glaucoma
– Primary disorder
– Breakdown in drainage system of the
circulation of aqueous humor
• Gradual elevation of internal pressure leads to
decreased blood supply to optic nerve and retina
• Peripheral vision is gradually lost when untreated

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Glaucoma
• Acute closed-angle glaucoma
– Mouth of drainage system is narrow and
closes completely
– Allowing no flow of aqueous humor
• Rapid occurrence characterized by severe pain,
blurred vision, photophobia, redness, and seeing
“halos” around light
• If untreated, person can lose his or her sight within
several days

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Hemianopia
• Pronounced
– (hem-ee-an-NOP-ee-ah)
• Defined
– Loss of vision or blindness in one-half of the
visual field

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Hordeolum (Stye)
• Pronounced
– (hor-DEE-oh-lum)
• Defined
– Bacterial infection of an eyelash follicle or
sebaceous gland
– Originating with redness, swelling, and mild
tenderness in margin of eyelash

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Hyperopia
• Pronounced
– (high-per-OH-pee-ah)
• Defined
– Refractive error in which the lens of the eye
cannot focus on an image accurately
– Results in blurred vision due to light rays
focused behind the retina because eyeball is
shorter than normal
• Also called farsightedness

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Hyperopia
Hyperopia (Farsightedness)

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Hyphema (Hyphemia)
• Pronounced
– (high-FEE-mah)
• Defined
– Bleed into anterior chamber of eye
– Resulting as a postoperative complication or
from a blunt eye injury

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Keratitis
• Pronounced
– (kair-ah-TYE-tis)
• Defined
– Corneal inflammation caused by a
microorganism, trauma to eye, a break in
sensory innervation of cornea, hypersensitivity
reaction, or a tearing defect
– May be due to dry eyes or ineffective eyelid
closure

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Myopia
• Pronounced
– (my-OH-pee-ah)
• Defined
– Refractive error in which the lens of the eye
cannot focus on an image accurately
– Resulting in blurred distant vision due to light
rays focused in front of retina because eyeball
is longer than normal
• Also known as nearsightedness

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Myopia
Myopia (nearsightedness)

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Nyctalopia
(Night Blindness)
• Pronounced
– (nik-tah-LOH-pee-ah)
• Defined
– Inadequate vision at night or in faint lighting
following reduction in synthesis of rhodopsin
– Compound in rods of retina that enables the
eye to adjust to low-density light

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Nystagmus
• Pronounced
– (niss-TAG-mus)
• Defined
– Vertical, horizontal, rotary, or mixed rhythmic
involuntary movements of the eye(s)
• Caused by use of alcohol or certain drugs, lesions
on the brain or inner ear, congenital abnormalities,
nerve injury at birth, or abnormal retinal
development

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Ophthalmia Neonatorum
• Pronounced
– (off-THAL-mee-ah nee-oh-nay-TOR-um)
• Defined
– Purulent (contains pus) inflammation of
conjunctiva and/or cornea in newborn
• Cause of the keratitis and conjunctivitis results
from newborn’s exposure to viral, bacterial,
chemical, or chlamydial agents

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Presbyopia
• Pronounced
– (prez-bee-OH-pee-ah)
• Defined
– Refractive error occurring after age of 40
– Lens of the eye(s) cannot focus on an image
accurately due to loss of elasticity
• Also called farsightedness due to better clarity of
distant objects

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Pterygium
• Pronounced
– (ter-IJ-ee-um)
• Defined
– Irregular growth developing as a fold in the
conjunctiva
– Usually on nasal side of the cornea
– Disrupts vision if it extends over pupil
• Can be caused by allergies and excessive
ultraviolet light exposure

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Pterygium
Pterygium

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Retinal Detachment
• Pronounced
– (RET-in-al detachment)
• Defined
– Partial or complete splitting away of the retina
from the pigmented vascular layer called the
choroid, interrupting vascular supply to the
retina and thus creating a medical emergency

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Retinal Tear
• Pronounced
– (RET-in-al tear)
• Defined
– Opening in retina that allows leakage of
vitreous humor

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Scleritis
• Pronounced
– (skleh-RYE-tis)
• Defined
– Presence of inflammation in the white,
outside covering of the eyeball, the sclera
• Symptoms include intense redness with dull pain
and possibly some loss of vision

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Scotoma
• Pronounced
– (skoh-TOH-mah)
• Defined
– Defined area in one or both eyes
– Decreased visual function

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Strabismus
• Pronounced
– (strah-BIZ-mus)
• Defined
– Failure of eyes to gaze in same direction due
to weakness in muscles controlling position of
eye
• Most common type is nonparalytic strabismus
• Inherited defect in which the eye position of the
two eyes has no relationship

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Strabismus
• Convergent Strabismus
– Also known as “Crosseye”
– Also known as “Esotropia”
– Affected eye turns inward
• Usually develops in infancy or early childhood

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Strabismus
• Divergent Strabismus
– Also known as “Walleye”
– Also known as “Exotropia”
– Affected eye turns outward

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Strabismus
Strabismus
(A) Convergent
(B) Divergent

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Synechia
• Pronounced
– (sin-EK-ee-ah)
• Defined
– Adhesion in eye that develops as a
complication of trauma or surgery
– Secondary condition of one of the following
pathological conditions: cataracts, glaucoma,
keratitis, or uveitis
• Adhesion causes the iris to adhere to lens or
cornea

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Trachoma
• Pronounced
– (tray-KOH-mah)
• Defined
– Infectious eye disease caused by Chlamydia
trachomatis
– Chronic and will lead to blindness without
treatment
• Early symptoms include tearing, pain,
photophobia, and inflammation

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Uveitis
• Pronounced
– (yoo-vee-EYE-tis)
• Defined
– Inflammation of all or part of middle vascular
layer of eye made up of the iris, ciliary body,
and choroid
• Characterized by blurred vision, pain, redness,
pupillary constriction, and intense photophobia

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DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES

The Eye
Diagnostic Techniques,
Treatments, and Procedures
• Corneal transplant
– Surgical transplantation of a donor cornea
(cadaver’s) into the eye of a recipient
usually under local anesthesia
• Electronystagmography
– Group of tests used in evaluating vestibule-
ocular reflex
• Normal reflex produced by stimulation of
vestibular apparatus in which eye position
compensates for motion of the head
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Diagnostic Techniques,
Treatments, and Procedures
• Electroretinogram (ERG)
– Recording of changes in electrical potential of
retina after stimulation of light
• Extracapsular Cataract Extraction (ECCE)
– Surgical removal of anterior segment of lens
capsule along with lens allowing for insertion of
an intraocular lens implant

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Diagnostic Techniques,
Treatments, and Procedures
• Fluorescein staining
– Application of a fluorescein-stained sterile
filter paper strip moistened with a few drops of
sterile saline or sterile anesthetic solution to
the lower cul-de-sac of the eye to visualize a
corneal abrasion

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Diagnostic Techniques,
Treatments, and Procedures
• Gonioscopy
– Process of viewing anterior chamber angle of
eye for evaluation, management, and
classification of normal and abnormal angle
structures
– Intraocular lens implant
• Surgical process of cataract extraction and
insertion of an artificial lens in patient’s eye
– Restores visual acuity and provides improved depth
perception, light refraction, and binocular vision
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Diagnostic Techniques,
Treatments, and Procedures
• Iridectomy
– Extraction of a small segment of the iris to
open an anterior chamber angle and permit
the flow of aqueous humor between the
anterior and posterior chambers
– Relieves person’s intraocular pressure

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Diagnostic Techniques,
Treatments, and Procedures
• Keratoplasty
– Transplantation of corneal tissue from one
human eye to another to improve vision in
affected eye
• Also called corneal grafting

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Diagnostic Techniques,
Treatments, and Procedures
• Laser in situ Keratomileusis (LASIK)
– LASIK procedure is a form of laser vision
correction for nearsightedness (myopia)
• Ophthalmoscopy
– Examination of external and internal structures
of the eye
– Utilizes an ophthalmoscope

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Diagnostic Techniques,
Treatments, and Procedures
• Pachymetry
– Measures thickness of cornea
• Patient’s eyes are numbed
• Uses an ultrasonic-wave instrument to gauge
thickness of each cornea

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Diagnostic Techniques,
Treatments, and Procedures
• Phacoemulsification
– Removing a lens by using ultrasound
vibrations to split up lens material into tiny
particles that can be suctioned out of the eye
• Photo Refractive Keratectomy
– Surgical procedure in which a few layers of
corneal surface cells are shaved off by an
“excimer laser beam” to flatten cornea and
reduce myopia or nearsightedness
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Diagnostic Techniques,
Treatments, and Procedures
• Retinal Photocoagulation
– Surgical procedure using an argon laser to
treat conditions such as retinal detachment,
and diabetic retinopathy
• Retinal Detachment – argon laser used to create
an area of inflammation, which will develop
adhesions, causing a welding of the layers
• Diabetic Retinopathy – argon laser used to seal
microaneurysms and areas of leakage, and to
reduce risk of hemorrhage
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Diagnostic Techniques,
Treatments, and Procedures
• Slit-Lamp exam
– Examination of external and internal
structures of the eye using a low power
microscope combined with a high-intensity
light source focused to shine as a slit beam
• Also known as biomicroscopy

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Diagnostic Techniques,
Treatments, and Procedures
• Tonometry
– Process of determining intraocular pressure
by calculating resistance of eyeball to an
applied force causing indentation
• Trabeculectomy
– Surgical excision of a portion of corneoscleral
tissue to decrease intraocular pressure in
persons with severe glaucoma

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Diagnostic Techniques,
Treatments, and Procedures
• Trabeculoplasty
– Surgical creation of a permanent fistula used to
drain fluid (aqueous humor) from the eye’s
anterior chamber
– Usually performed under general anesthesia
• Laser trabeculoplasty is an outpatient plastic
surgery approach used in management of glaucoma

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Overview of the Ear
• Two important functions of the ear
– Enables us to hear
– Sensory organ of balance or equilibrium
• Location of one ear on each side of head
produces binaural hearing
– Hearing from both sides

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Structures of the Ear
• External ear
– Visible portion not contained within the head
– Auricle or pinna
• Cartilaginous flap or ear lobe
– External auditory canal
• Tube leading from auricle to the middle ear
• Lined with tiny hairs called cilia to aid in transmitting
sound waves inward
– Tympanic membrane (eardrum)
• Separates external ear from middle ear
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Structures of the Ear
• Middle ear
– Three tiny bones known as auditory ossicles
– Malleus
• Resembles shape of a hammer
• Connected to tympanic membrane and transmits
sound vibrations to second auditory ossicle
– Incus
• Resembles shape of an anvil
• Transmits sound vibrations from malleus to third
auditory ossicle

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Structures of the Ear
• Middle ear
– Stapes
• Shaped like a tiny stirrup
• Transmits sound vibrations from incus to inner ear
– Eustachian tube
• Connects middle ear to pharynx
• Auditory tube
– Oval window
• Separates middle ear from inner ear
• Base of stapes fits into oval window
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Structures of the Ear
• Inner ear
– Vestibule
• Central portion of inner ear
• Located next to stapes and between cochlea and
semicircular canals
• Contains utricle and saccule-membranous
pouches or sacs that aid in maintaining balance
– Cochlea
• Snail-shaped bony structure
• Contains endolymph and perilymph
• Auditory fluids that aid in transmission of sound
vibrations
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Structures of the Ear
• Inner ear
– Organ of Corti
• True organ of hearing
• Contained within the cochlea
• Here, sound vibrations are converted into nerve
impulses that are transmitted to the brain for
interpretation as hearing
– Semicircular canals
• Located behind the vestibule
• Three bony, fluid-filled loops that help to maintain
one’s balance

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Structures of the Ear

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The Process of Hearing
Pathway of
sound
vibrations

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PATHOLOGICAL CONDITIONS

The Ear
Cholesteatoma
• Pronounced
– (koh-lee-stee-ah-TOH-mah)
• Defined
– Slow-growing cystic mass made up of
epithelial cell debris and cholesterol found in
the middle ear
• Occurs as a congenital defect or as a result of
chronic otitis media

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Deafness, Conductive
• Pronounced
– (Deafness kon-DUK-tiv)
• Defined
– Hearing loss caused by breakdown of the
transmission of sound waves through the
middle and/or external ear

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Deafness, Sensorineural
• Pronounced
– (Deafness sen-soh-ree-NOO-ral)
• Defined
– Hearing loss caused by inability of nerve
stimuli delivered to brain from inner ear due to
damage in auditory nerve or cochlea

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Impacted Cerumen
• Pronounced
– (Impacted seh-ROO-men)
• Defined
– Excessive accumulation of waxlike secretions
from glands of external ear canal

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Labyrinthitis
• Pronounced
– (lab-ih-rin-THIGH-tis)
• Defined
– Infection or inflammation of the labyrinth or
the inner ear
– Specifically, the three semicircular canals in
the inner ear
– Fluid-filled chambers and control balance

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Mastoiditis
• Pronounced
– (mass-toyd-EYE-tis)
• Defined
– Inflammation of mastoid process
– Usually an acute expansion of an infection in
the middle ear
– Otitis media

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Ménière's Disease
• Pronounced
– (may-nee-ARYZ dih-ZEEZ)
• Defined
– Chronic inner ear disease
– Over accumulation of fluid in the labyrinth
– Characterized by recurring episodes of
vertigo, hearing loss, feeling of pressure or
fullness in the affected ear, and tinnitus

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Otitis Externa (O.E.)
(Swimmer’s Ear)
• Pronounced
– (oh-TYE-tis eks-TER-nah)
• Defined
– Inflammation of outer or external ear canal
• Result of growth of bacteria or fungi in external ear
• Major symptom is pain, especially when the ear is
tugged on, along with a red swollen ear canal

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Otitis Media, Acute (A.O.M.)
• Pronounced
– (oh-TYE-tis MEE-dee-ah)
• Defined
– Middle ear infection
– Predominately affects infants, toddlers, and
preschoolers

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Serous Otitis Media (S.O.M.)
• Pronounced
– (SEER-us oh-TYE-tis MEE-dee-ah)
• Defined
– Collection of clear fluid in middle ear that may
follow acute otitis media or be due to an
obstruction of eustachian tube

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Suppurative Otitis Media
• Pronounced
– (SOO-per-ah-tiv oh-TYE-tis MEE-dee-ah)
• Defined
– Purulent collection of fluid in the middle ear
– Person may experience pain (possibly
severe), an elevation in temperature,
dizziness, decreased hearing, vertigo, and
tinnitus
– Also called acute otitis media

96
Otosclerosis
• Pronounced
– (oh-toh-sklair-OH-sis)
• Defined
– Condition in which footplate of stapes
becomes immobile and secured to oval
window
– Results in a hearing loss

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Perforation of
Tympanic Membrane
• Pronounced
– (per-for-AY-shun of the tim-PAN-ik
membrane)
• Defined
– Rupture of tympanic membrane or eardrum

98
DIAGNOSTIC
TECHNIQUES, TREATMENTS,
AND PROCEDURES

The Ear
Diagnostic Techniques,
Treatments, and Procedures
• Audiometry
– Process of measuring how well an
individual hears various frequencies of
sound waves
• Otoscopy
– Use of an otoscope to view and examine
tympanic membrane and various parts of
outer ear

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Diagnostic Techniques,
Treatments, and Procedures
• Tuning Fork Test (Rinne Test)
– Examination that compares bone
conduction and air conduction
• Tuning Fork Test (Weber Test)
– Examination used to evaluate auditory
acuity as well as discover whether a
hearing deficit is a conductive loss or a
sensorineural loss

101
Diagnostic Techniques,
Treatments, and Procedures
• Otoplasty
– Removal of a portion of ear cartilage to bring
pinna and auricle near head
• Stapedectomy
– Microsurgical removal of stapes diseased by
otosclerosis
– Typically under local anesthesia

102
Diagnostic Techniques,
Treatments, and Procedures
• Hearing aids
– Devices that amplify sound to provide
precise perception and interpretation of
words
• In-canal style – fits completely into ear canal
• In-ear style – worn in external ear
• Behind-ear style – placed behind ear
• Body hearing aid – sound delivered to ear canal
by way of microphone

103
Diagnostic Techniques,
Treatments, and Procedures
• Myringotomy
– Surgical procedure with insertion of a small
ventilation tube into inferior segment of
tympanic membrane
• Tympanotomy
– Also called a myringotomy

104
Diagnostic Techniques,
Treatments, and Procedures
• Myringoplasty
– Surgical repair of the tympanic membrane
with a tissue graft after a spontaneous rupture
that results in hearing loss
• Tympanoplasty
– Also called a myringoplasty

105

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