FISIOLOGI PENDENGARAN DAN

KESEIMBANGAN

SONNY PAMUJI LAKSONO

BAGIAN ILMU FAAL FKUY
 Audition

• Our senses have evolved to allow us to detect

and interpret biologically useful information from
our environment .
• However, we do not detect all sensory
information in the world.
• Some sensory information lies beyond our ability
to detect it.
• We also tend to focus on information that is
important or relevant.
 Audition

• Audition refers to our sense of hearing.

• Audition depends upon our ability to detect
sound waves.
• Sound waves are periodic compressions of
air, water or other media.
• Sound waves are “transduced” into action
potentials sent to the brain.
 Audition

• The amplitude refers to the height and

subsequent intensity of the sound wave.
• Loudness refers to the perception of the
sound wave.
– Amplitude is one factor.
• Frequency refers to the number of
compressions per second and is measured in
hertz.
– Related to the pitch (high to low) of a
sound.
Fig. 7-1, p. 196
 Audition

• Anatomist distinguish between:

– The outer ear
– The middle ear
– The inner ear
 Audition

• The outer ear includes the pinna and is

responsible for:
– Altering the reflection of sound waves into
the middle ear from the outer ear.
– Helping to locate the source of a sound.
 Audition

• The middle ear contains the tympanic

membrane which vibrates at the same rate
when struck by sound waves.
• Three tiny bones (malleus, incus, & stapes)
transmit information to the oval window or a
membrane in the middle ear.
Fig. 7-2, p. 197
 Audition

• The inner ear contains a snail shaped

structure called the cochlea which contains
three fluid-filled tunnels (scala vestibuli, scala
media, and the scala tympani).
• Hair cells are auditory receptors that excite
the cells of the auditory nerve when displaced
by vibrations in the fluid of the cochlea.
– Lie between the basilar membrane and the
tectorial membrane in the cochlea.
Fig. 7-3, p. 198
 Audition

• Pitch perception can be explained by the

following theories:
• Frequency theory - the basilar membrane
vibrates in synchrony with the sound and
causes auditory nerve axons to produce
action potentials at the same frequency.
• Place theory - each area along the basilar
membrane is tuned to a specific frequency of
sound wave.
Fig. 7-4, p. 199
 Audition

• The current pitch theory combines modified

versions of both the place theory and
frequency theory:
– Low frequency sounds best explained by
the frequency theory.
– High frequency sounds best explained by
place theory.
 Audition

• Volley principle states that the auditory nerve

can have volleys of impulses (up to 4000 per
second) even though no individual axon
approaches that frequency by itself.
– provides justification for the place theory
and
 Audition

• The primary auditory cortex is the ultimate

destination of information from the auditory
system.
– Located in the superior temporal cortex.
• Each hemisphere receives most of its
information from the opposite ear.
 Audition

• The superior temporal cortex contains area

MT which allows for the detection of the
location of sound.
• Area A1 of the brain is important for auditory
imagery.
• The auditory cortex requires experience to
develop properly.
– Auditory axons develop less in those who
are deaf from birth.
Fig. 7-5, p. 200
 Audition

• The cortex is necessary for the advanced

processing of hearing.
– Damage to A1 does not necessarily cause
deafness unless damage extends to the
subcortical areas.
• The auditory cortex provides a tonotopic map
in which cells in the primary auditory cortex
are more responsive to preferred tones.
– Some cells respond better to complex
sounds than pure tones.
Fig. 7-6, p. 201
 Audition

• Areas around the primary auditory cortex

exist in which cells respond more to changes
in sound.
• Cells outside A1 respond to auditory “objects”
(animal cries, machinery noise, music, etc.).
– Because initial response is slow, most
likely responsible for interpreting the
meaning of sounds.
 Audition

• About 99% of hearing impaired people have

at least some response to loud noises.
• Two categories of hearing impairment
include:
1. Conductive or middle ear deafness.
2. Nerve deafness.
 Audition

• Conductive or middle ear deafness occurs if

bones of the middle ear fail to transmit sound
waves properly to the cochlea.
• Caused by disease, infections, or tumerous
bone growth near the middle ear.
• Can be corrected by surgery or hearing aids
that amplify the stimulus.
• Normal cochlea and normal auditory nerve
allows people to hear their own voice clearly.
 Audition

• Nerve or inner-ear deafness results from

damage to the cochlea, the hair cells or the
auditory nerve.
• Can be confined to one part of the cochlea.
– people can hear only certain frequencies.
• Can be inherited or caused by prenatal
problems or early childhood disorders
(rubella, syphilis, inadequate oxygen to the
brain during birth, repeated exposure to loud
noises, etc).
 Audition

• Tinnitus is a frequent or constant ringing in

the ears.
– experienced by many people with nerve
deafness.
• Sometimes occurs after damage to the
cochlea.
– axons representing other part of the body
invade parts of the brain previously
responsive to sound.
– Similar to the mechanisms of phantom
limb.
 Audition

• Sound localization depends upon comparing

the responses of the two ears.
• Humans localize low frequency sound by
phase difference and high frequency sound
by loudness difference.
 Audition

• Three mechanisms:
1. High-frequency sounds (2000 to 3000Hz)
create a “sound shadow”, making the
sound louder for the closer ear.
2. The difference in the time of arrival at the
two ears is most useful for localizing
sounds with sudden onset.
3. Phase difference between the ears
provides cues to sound location for
localizing sounds with frequencies up to
1500 Hz.
Fig. 7-7, p. 202
Fig. 7-8, p. 203
Fig. 7-9, p. 203
 The Mechanical Senses

• The mechanical senses include:

– The vestibular sensation
– Touch
– Pain
– Other body sensations
• The mechanical senses respond to pressure,
bending, or other distortions of a receptor.
 The Mechanical Senses

• The vestibular sense refers to the system that

detects the position and the movement of the
head.
– Directs compensatory movements of the
eye and helps to maintain balance.
• The vestibular organ is in the ear and is
adjacent to the cochlea.
 The Mechanical Senses

• The vestibular organ consists of two otolith

organs (the saccule and untricle) and three
semicircular canals.
• The otolith organs have calcium carbonate
particles (otoliths) that activate hair cells
when the head tilts.
• The 3 semicircular canals are oriented in
three different planes and filled with a jellylike
substance that activates hair cells when the
head moves.
Fig. 7-10, p. 206
 The Mechanical Senses

• The vestibular sense is integrated with other

sensations by the angular gyrus.
– Angular gyrus is an area at the border
between the parietal and temporal cortex.
SISTEM KESEIMBANGAN

Fig. 9-2. Schematic drawing of the vestibular epithelium
showing the two cell types and the nerve connections made
on each. (Brodal A: Neurological Anatomy in Relation to
Clinical Medicine, 2nd ed. New York, Oxford Univ. Press,
1969)
Fig. 9-3. The effects of different positions of the head upon the otolith
organs. A. Upside down, C. right-side up, and B. in between. The
arrows indicate the direction of gravitational force. (Eyzguirre C,
Fidone SJ: Physiology of the Nervous System. Chicago, Year Book
Medical Publishers, 1975)
 Vestibular physiology
Fig. 9-4. The position of the crista ampullaris and cupula within a
cross section of the ampulla of one semicircular canal. Also shown
is the movement of the cupula and its embedded cilia during
rotation first in one direction and then in the opposite direction.
(Eyzguirre C, Fidone SJ: Physiology of the Nervous System.
Chicago, Year Book Medical Publishers, 1975)
Fig. 9-5. Shearing force in vestibular organs. Upper
diagram shows arrangement of cilia on a hair cell
as seen from above; position of kinocilium
indicated by larger dot. Dashed line indicates
direction of effective shearing forces; forces at
right angles are ineffective. Lower diagram shows
section through hair cell along dashed line (upper
diagram) with cilia at rest (center) and tilted right
and left. Tilt toward kinocilium excites, tilt away
deceases excitation. (Klinke R: Physiology of
hearing. In Schmidt RF [ed]: Fundamentals of
Sensory Physiology. New York, Springer-Verlag,
1978)
 Vestibular physiology
Fig. 9-6. Schematic of the horizontal semicircular canals complete
with hair cells sporting stereo- and kinocilia. Direction of a leftward
head rotation is indicate as are the relative fluid movements in the
canals. The effect of the fluid movement on the two hair cells is
indicated by the bold upward and downward arrows.
Fig. 9-7. Schematic of the two superior and two
posterior semicircular canals. Curved arrows are
meant to give a 3-d representation of the relative fluid
movement within each canal that excites that canal. Of
course, the head movement that produces the indicated
fluid movement would be in the direction opposite that
indicated by the arrow.
Electrophysiology of the vestibular nerve

Fig. 9-8. Response of semicircular canals to angular

rotation. A. The velocity of an angular rotation of the
head (ordinate) plotted against time (abscissa). B. The
change in frequency of discharge of a receptor
innervating one of the semicircular canals during
periods of constant acceleration, of constant velocity,
and of constant deceleration of the head.
Vestibulo-ocular reflex

Fig. 9-11. Brainstem pathways for control of eye movements by the

left horizontal semicircular canal. (Gruesser O-J, Gruesser-
Cornehls V: Physiology of vision. In Schmidt RF [ed]:
Fundamentals of Sensory Physiology. New York, Springer-Verlag,
1978)
 Vertigo
Vertigo adalah salah satu bentuk gangguan keseimbangan
dalam telinga bagian dalam sehingga menyebabkan
penderita merasa pusing atau ruang di sekelilingnya
menjadi serasa 'berputar' ataupun melayang.
Vertigo menunjukkan ketidakseimbangan dalam tonus
vestibular. Hal ini dapat terjadi akibat hilangnya masukan
perifer yang disebabkan oleh kerusakan pada labirin dan
saraf vestibular atau juga dapat disebabkan oleh
kerusakan unilateral dari sel inti vestibular atau aktivitas
vestibulocerebellar
 Penyebab dan Diagnosa
• Vertigo patologis bisa bermacam-macam jenis. Ada yang
sementara atau persisten, fungsional atau struktural
penurunan nilai vestibular atau nilai visual, atau sistem
proprioseptif sistem atau dari pusat integratif mealui suatu
mekanisme juga menyebabkan "ketidakcocokan".
• Evaluasi vertigo memiliki dua tujuan mendasar yakni:
menentukan lokalisasi sumber asalnya dan menentukan
etiologinya/penyebabnya.[2]
• Sebelum memulai pengobatan, harus ditentukan sifat dan
penyebab dari vertigo. Gerakan mata yang abnormal
menunjukkan adanya kelainan fungsi di telinga bagian
dalam atau saraf yang menghubungkannya dengan otak
• Vertigo vestibuler
Memiliki karakteristik: lesi di bagian perifer dari apparatus vestibuler seperti: organ vestibuler
atau saraf vestibulokoklear. Pasien merasa lingkungan sekitarnya berputar (oscillopsia),rasanya
naik turun seperti berada di atas kapal. Vertigo vestibuler seringkali diikuti dengan gejala otonom
seperti nausea dan muntah serta nistagmus. Lesi vestibuler juga ada yang di bagian sentral
contohnya lesi pada nukleus vestibuler di batang otak. Lesi sentral vestibuler juga bisa
menyebabkan vertigo direk, akan tetapi secara umum lebih ringan dibandingkan lesi perifer.
Gejala otonom juga cenderung lebih minim atau bahkan tidak ada.[3]
• Vertigo jinak(benign paroksismal positional vertigo)
BPV sejauh ini merupakan penyebab paling umum dari vertigo. Merupakan hasil dari kristal
kalsium karbonat yang mengambang bebas yang secara tidak sengaja memasuki lengan panjang
kanalis semisirkularis posterior. Normalnya kristal ini melekat pada makula utricular. Dengan
adanya perubahan posisi, kristal bergerak dalam endolymph dan menggantikan cupula sehingga
menyebabkan vertigo.[1]
• vestibulopathy perifer akut (neuritis vestibular)
Merupakan jenis pemnyakit epidem dan dapat mempengaruhi beberapa anggota keluarga yang
sama sekaligus. Penyakit ini lebih sering ditemukan pada musim semi atau awal musim panas.
Faktor-faktor resiko ini menunjukkan bahwa penyakit ini merupakan infeksi virus dan studi
patologis menunjukkan atrofi dari satu atau lebih dari batang saraf vestibular, yang paling sesuai
dengan proses infeksi atau pascainfeksi.[1]
• Sindrom Meniere
Berdasarkan Temuan patologis, prinsip dari penyakit ini adalah peningkatan volume endolimfe
yang berhubungan dengan distensi seluruh sistem endolimfatik (hidrops endolymphatic).
Pecahnya membran labirin mungkin dapat menjelaskan karakteristik mendadak dari episode-
episode pada sindrom ini
• Vertigo nonvestibuler
Vertigo nonvestibuler seringkali sulit dideskripsikan secara jelas oleh pasien. Pasien biasanya
mengeluhkan rasa pusing, kekosongan di kepala, dan gelap pada mata. Kondisi oscillopsia dan
gejala otonom tidak pernah ditemukan. Lesi pada bagian saraf pusat dapat menyebabkan
nistagmus patologis Vertigo nonvestibuler bisa disebabkan lesi pada bagian nonvestibuler dari
sistem regulator keseimbangan atau bisa juga disebabkan kesalahan proses informasi di sistem
saraf pusat(misal karena lesi cerebelar). Hipotensi ortostatik dan stenosis aorta dapat menjadi
penyebab vertigo nonvestibuler.[3]
• Migrain
Vertigo yang disebabkan karena migrain dikarenakan Vasospasme atau cacat metabolik yang
diturunkan.[1]
• Insufisiensi Vertebrobasilar
Biasanya disebabkan oleh aterosklerosis pada arteri subklavia, tulang belakang, dan basilar.
Vertigo juga umum dihubungkan dengan infark batang otak lateral atau otak kecil.[1]
• Tumor sudut cerebellar-pontine
Tumor ini tumbuh lambat, memungkinkan sistem vestibular untuk mengakomodasi perubahan
yang terjadi. Sehingga manifestasi klinis yang dihasilkan biasanya berupa sensasi samar
ketidakseimbangan bukan vertigo akut.