Oreille

Anatomie :

A - L'OREILLE EXTERNE :

1) LE PAVILLON :

Relief cartilagineux.

2) LE CONDUIT AUDITIF EXTERNE :

Il mesure environ 3 cm

Tissu fibro-cartilagineux

Tissu osseux

Garni de poils
B - L'OREILLE MOYENNE :

C'est un milieu aérien

Située entre l'oreille externe et l'oreille interne

Elle comprend:

. Le tympan

. Le marteau

. L'enclume

. L'étrier

. La fenêtre ovale

 

C - L'OREILLE INTERNE :

Milieu liquide

Appareil cochléo-vestibulaire

1) LA COCHLÉE :

Organe de l'audition

Elle ressemble à un escargot; on l'appelle aussi le limaçon

Elle est divisée en 3 canaux longitudinaux:

. La rampe vestibulaire

. La rampe tympanique

. Le canal cochléaire

Le liquide que contient le canal cochléaire s'appelle l'endolymphe.

Celle-ci est très riche en potassium; très différente des autres milieux de l'organisme

Le canal cochléaire contient 2 types de cellules ciliées:

. Les cellules ciliées internes qui captent les sons (phénomène passif)

. Les cellules ciliées externes qui amplifient les sons (phénomène actif)

2) L'APPAREIL VESTIBULAIRE :

Organe de l'équilibre

Il est constitué de :

. L'utricule

. Le saccule

. Les canaux semi-circulaires

Les canaux semi-circulaires sont au nombre de trois

Ils sont perpendiculaires les uns par rapport aux autres

Ils délimitent les trois plans de l'espace

Physiologie :

A - PHYSIOLOGIE DE L'AUDITION :

1) BUT :

Transformer une onde sonore en un signal biologique

L'oreille transmet l'onde aérienne et l'amplifie

Elle la transforme en onde liquidienne puis en impulsion électrique

2) TRANSMISSION ET AMPLIFICATION :

C'est le rôle de l'oreille externe et de l'oreille moyenne

Rapport d'amplification:

. Rapport de surfaces entre le tympan et la fenêtre ovale: 25 fois

. Amplification du mouvement par les osselets: 7 fois

Rôle de protection et de filtrage:

. L'étrier possède un muscle qui s'appelle le muscle stapédien

. Celui-ci assure le filtrage des sons en bloquant les mouvements trop violents

Passage du milieu aérien au milieu liquidien

Aération de la caisse par la trompe d'Eustache

3) TRANSDUCTION ET PERCEPTION :

Transformation de l'onde sonore en signal électrique

La platine de l'étrier transforme le mouvement du tympan, amplifié par les osselets, en onde liquidienne

Ces ondes sont différentes en intensité et en fréquence en fonction des sons

Les cellules ciliées internes sont sensorielles (rôle passif)

Les cellules ciliées externes amplifient (rôle actif)

Chaque cellule ciliée interne le long du limaçon capte une seule fréquence

C'est la tonotopie

Plus on avance le long du limaçon, plus le son perçu est grave (basses fréquences)

Un système d'amortissement des ondes est assuré par la fenêtre ronde

B - PHYSIOLOGIE DE L'ÉQUILIBRE :

1) BUT :

Transformer les accélérations de la tête et l'effet de gravité en signaux biologiques

2) ORGANES :

Ils sont au nombre de 5:

. Les 2 macules situées l'une dans l'utricule et l'autre dans le saccule

. Les 3 crêtes ampulaires situées dans les ampoules à l'extrémité des canaux semi-circulaires

a) Les macules :

Elles réagissent aux accélérations linéaires

Elles sont perpendiculaires les unes par rapport aux autres

Ce sont des membranes sensorielles composées de cellules ciliées

Celles-ci sont surmontées de charges lourdes: les otolithes

b) Les crêtes ampulaires :

Chaque canal semi-circulaire est terminé par une ampoule qui contient une crête ampulaire

Ces crêtes réagissent aux variations angulaires

Les méthodes d'exploitation cochléo-vestibulaire :

A - EXAMENS :

1) COCHLÉAIRES :

a) Otoscopie :

Examen du conduit auditif externe

b) Acoumètrie :

Pratiquée avec un diapason

Épreuve de Weber:

Application du diapason ou milieu du front

. Si le son est entendu au milieu, l'audition est normale

. S'il est latéralisé, il y a un problème

Épreuve de Rinne:

On compare:

. La conduction aérienne (diapason en l'air devant l'oreille)

. La conduction osseuse (diapason sur l'os derrière l'oreille)

Il court-circuite l'oreille externe et moyenne

2) VESTIBULAIRES :

a) Déviation des index :

Vérification de l'équilibre

b) Nystagmus :

Saccades oculaires liées à des vertiges

c) Épreuve de Romberg :

On demande au patient de marcher d'avant en arrière

Il se déplace en étoile

d) Manoeuvres positionnelles :

B - AUDIOMETRIE :

Voix chuchotée: 20 décibels

Voix normale: 40 dB

Un avion à réaction: 80 dB

On parcourt la bande sonore de 125 à 8000 Hertz et on voit à quel niveau sonore le patient l'entend

. En conduction aérienne (casque)

. En conduction osseuse (en appui sur l'os derrière l'oreille)

On trace deux courbes

La perception aérienne est toujours plus faible que la conduction osseuse

Dans le meilleur des cas:

. La conduction aérienne est égale à la conduction osseuse

. La courbe oscille en dessous de 20 dB

C - DEUX TYPES DE SURDITÉ :

1) RINNE :

a) Surdité de transmission :

Rinne ouvert

Il y a un écart entre conduction aérienne et conduction osseuse

Trouble de l'oreille externe ou moyenne

b) Surdité de perception ou de transduction :

Rinne fermé: pas d'écart entre la conduction aérienne et la conduction osseuse

Courbe basse: il faut plus de décibels pour que le son soit perçu

Trouble de l'oreille interne

2) WEBER :

a) Surdité de transmission :

Le weber est latéralisé du côté atteint

En effet: l'oreille interne, du côté touché, est habituée à mal entendre

Elle a tendance à amplifier les sons

b) Surdité de perception :

Le Weber est latéralisé du côté sain

1 vote. Moyenne 5.00 sur 5.

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