ENT

Anatomy and physiology

Friday, 25 August 2017 10:06 pm

Anatomy of the ear

 • External ear:
○ Pinna
○ External ear canal
○ Tympanic membrane
• Middle ear:
○ Ossicles: malleus, incus, stapeus
○ Eustachian tube orifice
○ Facial n. and chorda tympani
• Inner ear:
○ Cochlea
○ Labyrinth: vestible (utricle and saccule) + semicircular canals (lateral,
posterior, superior)

Pinna anatomy:
 • 6 x 3.5 cm in adults
• 85% of adult size by 3 yrs old
• Single plate of elastic cartilage
• Juts out 15-20 degrees
• 3 ligaments attach to bone
• Nerve supply:
○ Auriculotemporal nerve (V3)
○ Posterior auricular branch VII
○ Auricular branches IX and X
○ Lesser occipital (C2)
○ Greater auricular nerve (C2-3)

Ear canal:
• External ear:
○ 25 mm long (posterior), 31 mm (anterior)
○ Diameter 3-5 mm (antero-posterior)
○ Elliptical in cross-section
○ Slight “S” bend
○ Volume 1 cm3
○ Cartilaginous portion:
○ Outer 2/3
○ Skin thick, contains apocrine, exocrine and ceruminous glands
○ Bony portion:
○ Inner 1/3
○ Skin thin and adherent to periosteum (only area in body where it
happens)

Tympanic membrane anatomy:

 • Elliptical
○ 9 x 10 mm
○ Surface area: 85 mm2
○ 0.1 mm thick
○ Semitransparent
○ Pars flaccida and pars tensa
○ Layers:
○ Outer: squamous epithelium
○ Middle: fibrous layer
○ Inner: respiratory epithelium

Middle ear anatomy:

• 15 x 15 mm x 4 mm (depth)
• Volume 15 cm3
• Subsites:
• 15 x 15 mm x 4 mm (depth)
• Volume 15 cm3
• Subsites:
○ Epitympanum: = attic
○ Above line of EAC
○ Contents: head of malleus, body of incus, ligaments
○ Mesotympanum = middle ear proper
○ In line with EAC
○ Contents: handle of malleus, long process of incus, stapes, chorda
tympani
○ Hypotympanum:
○ Below line of EAC
○ Contents: jugular bulb
• Boundaries:
○ Lateral: tympanic membrane, scutum
○ Medial: promontory, oval and round windows, fallopian canal, LSCC
○ Anterior: eustachian tube, tensor tympani canal, carotid canal
○ Posterior: facial recess, sinus tympani, stapedius muscle and pyramidal
process
○ Superior: tegmen tympani (MCF)
○ Inferior: jugular bulb
• Nerve supply:
○ Similar to Pinna/EAC except no C2 or C2-3 branches

Ossicles:
○ Malleus:
○ Head, manubrium (handle) (130o), neck, anterior and lateral processes
○ 23 g, 9 mm long
○ Incus:
○ Body, short process, long process, lenticular process
○ 27g, 7 x 5 mm
○ Stapes:
○ Head, anterior and posterior crura, footplate
○ 3 mm
○ Ligaments/folds: 10 in total
○ Muscles:
○ Stapedius: smallest muscle in human body, pyramidal process to stapes
○ Tensor tympani: continuation of TVP, cochleariform process to malleus

Eustachian tube anatomy:

 Eustachian tube anatomy:

○ 45o angle to horizontal plane in adults (10o in infants)

○ 37 mm in adults, 18 mm in kids
○ Runs from anterior middle ear to nasopharynx
○ Bony portion: posterior 1/3
○ Cartilaginous portion: anterior 2/3
○ Respiratory epithelium
○ Functions:
§ Middle ear pressure regulation
§ Drainage of middle ear secretions
§ Opens every minute for < 1 second by TVP, LP, and
salpingopharyngeus muscles

Inner ear anatomy:

 Cochlea:

○ Organ of hearing
○ 9 x 5 mm
○ 2 ¾ turns
○ 3 compartments:
○ Scala vestlbuli, scala media, scala tympani
○ Fluid filled (perilymph and endolymph)
○ Basilar and Reissner’s membranes
○ Organ of Corti (inner and outer hair cells)

Labyrinth:
○ Organ of balance
○ Vestibule:
○ Utricle (horizontal plane)
○ Saccule (vertical plane)
○ Linear acceleration
○ Semicircular canals:
○ Lateral, superior, posterior
○ Angled 90o degrees from each other
○ Rotational acceleration

Hearing:
○ Sound waves collected by pinna and transferred down ear canal to TM
○ TM moves in/out which moves ossicles (malleus-incus-stapes)
○ Stapes footplate movement causes hydraulic effect on cochlear fluids
○ Fluid shift within cochlea stimulates hair cells
○ Inner hair cells stimulate spiral ganglion nerve cells
○ Nerve impulses transmitted along auditory nerve to brainstem
○ ECOLI: eighth nerve, cochlear nuclei, olivary complex, lateral lemniscus,
inferior colliculus
○ Auditory cortex: Brodmann’s areas 41 and 42 (temporal lobe)
○ Cross over

Balance:
○ Linear acceleration:
○ Linear motion causes maculae of utricle and saccule to move before
otolithic membranes (inertia), which causes increase/decrease in firing
rate of hair cells
○ Receptor cells have cilia orientated in different directions, so every
angle of head tilt activates some fibres and inhibits other fibres.
○ Torsional acceleration:
○ When the head rotates, the SCCs rotate also, but because of inertia, the
endolymph does not (inertia), which causes a pressure difference
between the 2 sides of the cupola, deflecting the cupola, changing the
afferent activity of the fibres.
○ Pitch, roll, yaw (3 different planes)
 endolymph does not (inertia), which causes a pressure difference
between the 2 sides of the cupola, deflecting the cupola, changing the
afferent activity of the fibres.
○ Pitch, roll, yaw (3 different planes)

Anatomy of the nose:

○ Nasal pyramid:
○ Upper 1/3: nasal bones
○ Middle 1/3: upper lateral cartilages
○ Lower 1/3: lower lateral cartilages
○ Dorsum
○ Tip
○ Septum:
○ Quadrangular cartilage
○ Vomer and perpendicular plate ethmoid
○ Lateral nasal wall:
○ Turbinates:
○ Inferior, middle, superior (and supreme)
○ Meati:
○ Inferior, middle, superior

Paranasal sinuses:
 ○ Maxillary sinuses:
○ Large
○ Drain into middle meati
○ Ethmoidal sinuses:
○ Anterior and posterior
○ 4-10 air cells
○ Frontal sinuses:
○ Variable size
○ Complex drainage pathways
○ Sphenoid sinuses:
○ Variable size
○ Pituitary gland, optic nerves, ICAs

Sinusoidal physiology:
○ Functions:
○ Airway
○ Air-conditioning
○ Olfaction
○ Immune defence
○ Filtering
○ Mucociliary system:
○ 1 – 1.5 L/day mucus production
○ Vibrissae: filter out large particles
○ Particles < 10 nm trapped by mucus, transported to nasopharynx and
swallowed, 3-25 mm/minute
○ Cilia: beat 8-20 beats/sec
○ Definite pathways

Olfaction:
Olfaction:

○ Requires nasal airflow (antero and retrograde)

○ 15% of nasal airflow through olfactory region (superior nasal cavities)
○ Odours dissolve through mucus to stimulate olfactory receptors (>10 x 106
cells), which are attached to bipolar neurons, which pass through the
cribriform plate, along the floor of the anterior cranial fossa, to the olfactory
bulbs

Oral cavity anatomy:

○ Stratified squamous non-keratinizing epithelium

○ Minor salivary glands
 ○ Stratified squamous non-keratinizing epithelium
○ Minor salivary glands
○ Subunits:
○ Upper and lower lips
○ Upper and lower gingiva
○ Buccal mucosae
○ Hard palate
○ Oral tongue (anterior 2/3)
○ Floor of mouth
○ Retromolar trigones

Pharynx anatomy:

○ = Throat
○ Conduit for passage of air and food/fluid
○ Stratified squamous non-keratinizing epithelium
○ Pharyngeal constrictors:
○ Superior, middle, inferior
○ Overlap, creating a funnel from the skullbase superiorly to the
oesophagus inferiorly
○ Stylopharyngeus, palatopharyngeus, and salpingopharyngeus muscles
also
○ Nasopharynx:
 ○ Superior, middle, inferior
○ Overlap, creating a funnel from the skullbase superiorly to the
oesophagus inferiorly
○ Stylopharyngeus, palatopharyngeus, and salpingopharyngeus muscles
also
○ Nasopharynx:
○ Lateral wall: eustachian tube orifices, fossae of Rosenmuller
○ Roof and posterior wall: clivus (skullbase), adenoids
○ Floor: soft palate
○ Oropharynx:
○ Lateral wall: tonsils, anterior and posterior pillars
○ Roof: soft palate
○ Inferiorly: tongue base (posterior 1/3 tongue)
○ Hypopharynx:
○ Anterior midline: post-cricoid region
○ Laterally: pyriform sinuses
○ Posterior pharyngeal wall

Larynx anatomy:

○ Organ of airway protection (and voice)

○ Stratified squamous non-keratinizing epithelium
○ Skeleton:
○ Hyoid bone
○ Thyroid cartilage
○ Cricoid cartilage
○ Epiglottis
○ Arytenoid, corniculate and cuneiform cartilages
○ 3 compartments:
○ Supraglottis (above VCs)
 ○ Cricoid cartilage
○ Epiglottis
○ Arytenoid, corniculate and cuneiform cartilages
○ 3 compartments:
○ Supraglottis (above VCs)
○ Glottis (VCs)
○ Subglottis (below VCs)
○ Innervation:
○ Supraglottis: superior laryngeal nerve (X)
○ Glottis and subglottis: recurrent laryngeal nerve (X)

Neck anatomy:

○ Lateral:
○ Level 1:
○ Submandibular gland and duct
Lymph nodes
○ Levels 2-4:
○ Carotid sheath: ICA, IJV, CN X and XII
○ Lymph nodes
○ Level 5:
○ CN XI
○ Lymph nodes
○ Anterior:
○ Level 6:
○ Thyroid
○ Lymph nodes
 ○ Lymph nodes
○ Anterior:
○ Level 6:
○ Thyroid
○ Lymph nodes

Gustation:

○ Flavour = gustation + olfaction + somatosensory (temperature and

consistency)
○ Chemicals stimulate taste receptors (non-specific nerve receptors, 8000
present on taste buds
○ Mainly occurs on anterior tongue (also posterior tongue, pharynx, larynx)
○ 5 taste sensations:
○ Sweet, salty, sour, bitter, umami

Voice:

○ = Phonation
 ○ = Phonation
○ Larynx serves as an acoustic wave regenerator, producing a tone that can be
modulated by supraglottic anatomy
○ The frequency of vocal cord vibration and hence the frequency of the
phonated tone are related mathematically to subglottic air pressure, airflow,
and glottic resistance.

Swallowing:
○ 600 times/day
○ 42 muscles involved
○ Stages:
○ Oral preparatory stage (voluntary)
○ Oral propulsive stage (voluntary)
○ Pharyngeal stage (involuntary)
○ Oesophageal stage (involuntary)