Download - neurootologi
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• Indra Setiawan, dr Sp THT-KL
ANATOMI & FISIOLOGIANATOMI & FISIOLOGITELINGATELINGA
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“yang membaca akan dikalahkan oleh yang menghafal
yang menghafal akan dikalahkan oleh yang mengerti
yang mengerti akan kalah dan dikalahkan oleh yang mampu memanfaatkan pengertiannya dan…..
yang mampu memanfaatkan tadi masih akan dikalahkan oleh yang mampu dan ikhlas berbagi pengertiannya demi kebaikan bersama “ ---nitra---
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• Suara/bunyi adalah bentuk energi yang merambat dalam bentuk gelombang
• Frekwensi bunyi yang dapat didengar manusia antara 20 sampai 20,000 Hz
PENDAHULUAN
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Telinga indera sangat pentingPada telinga 2 sistem:
• Pendengaran (auditif) perifer : N.Akustikus sentral : Korteks serebri• Keseimbangan (vestibuler) perifer : Utrik,sakul N.Auditivus sentral : N.Auditivus Kort serebri
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GANGGUAN KOMUNIKASI
GANGGUAN DI PEKERJAAN, PENDIDIKAN, HUBUNGAN SOSIAL & KELUARGA
DEPRESI
GANGGUAN PENDENGARAN
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BAYI TULI
GANGGUAN PERKEMBANGAN BICARA dan BAHASA
“BISU”
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GANGGUAN VESTIBULER(VERTIGO, NISTAGMUS, REAKSI SARAF OTONOM)
GANGGUAN KESEIMBANGAN TUBUH
TIDAK MAMPU MELAKSANAKAN KEGIATAN
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ANATOMI & FISIOLOGI PENDENGARAN
Telinga dibagi 3 bagian Telinga luar (auris eksterna)
• Aurikulum• Meatus akustikus eksternus• Membran timpani
Telinga tengah (auris media)• Kavum timpani• Tuba Eustachius• Antrum & sel-sel mastoid
Telinga dalam (auris interna = labirin)• Koklea (organ auditivus)• Labirin vestibuler (organ vestibuler
/status)
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Helix
Crus Helix
Anti Helix
MAE
Concha
Tragus
Lobulus
Fossa Triangular
AURIKEL
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AURIS EKSTERNA
Aurikulum = pina = daun telinga Bentuk pipih, berlekuk Kerangka tulang rawan (kartilago atau
kondrium), kecuali lobulus Diliputi kulit lekat pada perikondrium
Pada proses mendengar:Aurikulum menangkap dan mengumpulkan gelombang bunyi dan menentukan arah sumber bunyi (pada binatang aurikulum dapat digerakkan)
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Fungsi lain???
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Fungsi lain???
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Meatus Akustikus Eksternus (MAE) = liang telinga luar
Tabung bengkok, penampang ± 0,5 cm, panjang ± 2,5 – 3 cm
1/3 luar rangka tulang rawan (pars kartilago), kulit berambut, kel serumen
2/3 dalam rangka tulang (pars oseus)
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Alasan Energi suara harus ditingkatkan
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Pada proses mendengar: melanjutkan gelombang bunyi meresonansi meningkat 15-20 dB
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Membran timpani (gendang telinga) Selaput putih mutiara Bentuk oval – kerucut Terdiri dari
• Pars flaksida (2 lapis)• Pars tensa (3 lapis)
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MEMBRAN TIMPANI
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MEMBRAN TIMPANI
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AURIS MEDIA1. Kavum TimpaniTerdiri dari 3 bagian:• Epitimpanum
• Mesotimpanum• Hipotimpanum
Merupakan kotak 6 dinding yang dibentuk oleh:•Lateral dind lat epitimpani,membran timpani•Medial promontorium labirin, for. Ovale,
for. Rotundum(membr sec), can semisirc hor/lat, can n.VII hors
•Superior tegmen timpani fosa kranii media (lobus temporalis)
• Inferior bulbus vena jugularis•Anterior muara tuba Eustachius,
arteri karotis interna posterior,origo m. tensor timpani
•Posterior aditus ad antrum, antrum,sel-sel mastoid, can n.VII pars vert.
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SKEMA KAVUM TIMPANI (1)
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SKEMA KAVUM TIMPANI (2)
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SKEMA KAVUM TIMPANI (3)
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Diagram Of Coronal View Of The Middle EarDiagram Of Coronal View Of The Middle Ear
Lateral MallealLigament
Superior MallealLigament
PosteriorLigament
Mastoid Process
Facial nerve
Oval window
Cochlear promontory
Round window
Eustachian TubeBony Annulus
Fibrous Annulus
Tympanic MembranePars Flaccida
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Isi kavum timpani• Osikula : maleus, inkus, stapes• Muskulus : tensor timpani, stapedius• Lain-lain : ligamen, saraf (korda timpani)
Pada proses mendengar membran timpani & osikulae memperkuat
gelombang bunyi 22 kali m tensor timpani & mstapedius
mengurangi gelombang bunyi yang terlalu keras
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2. Tuba Eustachius
•Menghubungkan kavum timpani dengan nasofaring
Untuk: • drainase• ventilasi (pertahankan
tekanan udara dan oksigenasi)
•Bag tulang: 1/3 lateral, arah bawah, medial dan anterior, selalu terbuka
•Bag kartilago: 2/3 medial, terbuka jika menelan, mengunyah,menguap
•Epitel bersilia sama dg mukosa nasofaring dan kav timpani
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Lanjutan tuba...
• Pada bayi: lebih pendek, lebar dan horisontal
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3. Antrum & sel-sel Mastoid Berhubungan dengan kavum timpani
lewat aditus ad antrum Pneumatisasi (2 pengertian) :
• Proses pembentukan sel-sel mastoid
• Jenis tergantung jumlah sel mastoid: normal, hiper, hipopneumatik dan sklerotik
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• Luas membran timpani 90mm2• Luas membran timpani yang
berfungsi 2/3 • Luas basis stapes 3.2mm2• Rasio luas MT dan basis stapes
14:1• Energi suara meningkat
GERAKAN HIDROLIK MEMBRAN TIMPANI
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Peningkatan oleh tulang• lengan malleus 1.3 kali lebih
panjang dari prosesus incus • Akibatnya terjadi mekanisme
seperti pengungkit yang merubah tekanan kecil menjadi besar
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dari Membran timpani
• Tuba Eustachius menyeimbangkan tekanan atmosphere telinga tengah agar tetap normal
• Gerakan mengerucut dari MT akan meningkatkan transfer energi
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Total rasio peningkatan transfer energi =14x1.3x4=73:1
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AURIS INTERNA
1. Organ auditus koklea
Rumah siput 2½ lingkaran, panjang ±3.5 cmTiga ruangan :
-skala vestibuli
-skala timpani
-skala media
Berisi cairan perilimf
Berisi cairan endolimfdan organ Corti
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2. Organ status (vestibuler)
Pada proses mendengar :• Organ Corti merupakan reseptor pendengaran,
merubah rangsang bunyi (mekanis) menjadi listrik (cochlear microphonic)
• Utrikulus –makula utrikuli• Sakulus—makula sakuli• Can semi sirkularis: superior(anterior),
inferior(posterior), lateralis(horisontalis)• Krista ampularis• N vestibularis• Endolimf
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BAGAN PROSES MENDENGAR
Konduksi
Aurikulum
M.A.E
M.Timpani
Maleus
Inkus
Stapes
Sensorineural
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BAGAN PROSES MENDENGAR
Sensorineural
Konduksi
Koklear
Perilimf(skala vestibuli skala timpani)
Endolimf(skala media)
Organ Corti
Retrokoklear
• M.Reisner dan M.Basilaris bergetar
• M.Tektoria bergetar Gesekan dengan
sel rambut
• Cochlear microphonic
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BAGAN PROSES MENDENGAR (lanjutan)
Sensori
Koklear
Retrokoklear
N.Koklearis
N.Akustikus
Nuklei di Batang otak
Pusat PendengranKorteks Serebri
Lobus Temporalis(Wernicke)
• Meneruskan Impuls listrik
• Mendengar dengan sadar
neural
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FISIOLOGI PENDENGARAN
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• gelombang yang dihasilkan oleh suara berfrekuensi tinggi hanya sedikit sampai dalam koklea sebelum ter-redam, dan bunyi berfrekuensi rendah dapat mencapai apeks koklea
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• Nada / frekwensi tinggi resonansinya terjadi di dekat basis koklea dan nada / frekwensi rendah merangsang apeks koklea.
•
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Membranbasal
Rambut sel luar
Rambut sel dalam
Serabut saraf
Membran Reissner
Membran sektorialOrgan Corti
Duktus Koklea
Ligamenspiral
Dari tingkaplonjong
Ganglion
Ke tingkapbulat
ORGAN CORTI
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ANATOMI & FISIOLOGI KESEIMBANGAN
ORGAN STATUS : LABIRIN VESTIBULERTerdiri dari Utrikulus Makula Utrikularis Sakulus Makula Sakularis 3 Kanalis Semisirkularis :
• Horisontal, • Vertikalis ant, • Vertikalis Post.
Reseptor: Makula Utrikulus/Sakulus gerak lurus/linier Krista Ampularis gerak
berputar/sentrifugal
Krista Ampularis
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SKEMA LABIRIN (1)