This document discusses hearing and assistive devices, from hearing aids to electronic ears. It begins by explaining the auditory system as an energy transformation system, where acoustic energy is transformed into mechanical, hydraulic, and bioelectric energy as it travels through the outer, middle, and inner ear. It then provides detailed descriptions of the anatomy and functions of the outer, middle, and inner ear. It also discusses various physical properties of sound including frequency, wavelength, amplitude, interference, resonance, and more. The document is an in-depth overview of the human auditory system and how assistive devices can help with hearing impairments.
Physiology of Hearing by Dr. Sudin Kayastha Sudin Kayastha
Contains: fundamentals of sound, role of external ear in hearing, role of middle ear in hearing, role of inner ear in hearing, central auditory pathway
Physiology of Hearing by Dr. Sudin Kayastha Sudin Kayastha
Contains: fundamentals of sound, role of external ear in hearing, role of middle ear in hearing, role of inner ear in hearing, central auditory pathway
ANATOMY AND PHYSIOLOGY OF EAR, NOSE, THROAT and NEWER INVESTIGATION MODALITI...Dr.AKSHAY B K
A conceptual and picture oriented presentation of basics of ent, anat, physio and some techniques of their functional assessment. Much usefull for undergraduate understanding.
The Ear, Anatomy, Physiology, Clinical diseases, and pathology, hearing testsHamzehKYacoub
Ear is composed of three parts: External ear, middle ear, and the Inner ear.
Hearing tests (Rinne's and Weber's tests).
Most important hearing and ear diseases are included.
Hearing, or auditory perception, is the ability to perceive sounds by detecting vibrations, changes in the pressure of the surrounding medium through time, through an organ such as the ear. The academic field concerned with hearing is auditory science. Sound may be heard through solid, liquid, or gaseous matter.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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台科大 助聽器到電子耳 03042012 2
1. 聽能障礙與輔具的應用—
從助聽器到電子耳
王智弘 醫師
三軍總醫院 耳鼻喉頭頸外科部
Chih-Hung Wang, MD, PhD
Department of Otolaryngology-Head and Neck Surgery
Tri-Service General Hospital, National Defense Medical Center
Taipei, TAIWAN, ROC
2. Auditory System = Energy Transformation System
acoustic energy---mechanical energy---hydraulic energy---bio-electric energy
→ Outer ear ←→ Middle ear ←→ Inner ear ←
6. Anatomy of the Outer Ear
The Outer Ear:
Auricle (pinna):
is composed of a sheet of cartilage, and this is
continous with the cartilage which forms the
framework of the outer 1/3 of the EAC.
Function:
☆ It protects the ear canal and eardrum by repelling any
objects that strike it
☆ collect and capture the acoustic energy and direct it to
the tympanic membrane
☆ the surface of the auricle can modify the
spectral composition of the incoming
sound
☆ localize the source of sound, using intensity and phase
differences of signal at two ears
☆ beautiful to look at
7. Anatomy of the Ext. Ear Canal
External auditory canal:
A narrow, slightly tortuous passage (from concha to the tympanic membrane,
approximately 2.5~3 cm in the adult).
The membrane is set obliquely in the depth of the canal, in such a way that the front
(anterior) wall is longer than the back (posterior) wall. (inferior wall of EAC is longer
than superior one)
.
sup.
pos. ant.
inf. 5 mm
ant.
sup inf.
pos
8. The ear canal reinforces sound
Sound is directed towards the eardrum in two ways:
► Intensity of sound at eardrum is increased by 20 dB because of resonances from the external
ear (concha, meatus, canal and eardrum)
► This increase in sound intensity is for high frequency sounds. In adults the peak freqeuncies
are found around 2500 Hz. For children the peak intensities are at higher frequencies
10. 耳道的共振效應
波長: 4 x L (管長) 基礎共振頻率 first harmonic
4 x L x 1/3 第三共振頻率 third harmonic
4 x L x 1/5 第五共振頻率 third harmonic
11. Function of Ext. Ear Canal
In the adult, the outer cartilaginous portion
of the canal runs slightly upwards and
backwards, the inner bony portion
running slightly downwards and
forwards.
The skin covering the cartilaginous portion
of the canal contains short hairs,
ceruminous and sebaceous glands.
Two constrictions in the canal: one at the
junction of the cartilaginous and bony
portions; the other, the isthmus, 5 mm
from the tympanic membrane, in the
bony portion.
Function: cartilage bone
☆Cleaning: cilia Outer 1/3 Inner 2/3
☆Protection: cerumen, moisture
☆Resonance & sound amplification: Hair Yes NO
Natural frequency in EAC: Sebaceous gland Yes NO
343m/(4x0.03) = 2834 HZ Ceruminous gland Yes NO
2500~4000 Hz, 2x~4x intensity Sweat gland Yes NO
☆Sound localization:
13. The Middle ear as an Impedence Transformer
☆ The middle ear acts as an
impedence-matching device.
☆ Amplify sound pressure:
@ Lever action: d1p1=d2p2
malleal arm: incudal arm = 1.3: 1
@ Areal ratio of the tympanic membrane
to the oval window
a1p1=a2p2
tympanic memb.: oval window = 14: 1
→ x 18.2 → 25.25 db SPL
Exp.: Resonance in EAC: 2.5K~4k Hz: 2x ~ 4x
14. The Middle Ear Cleft:
The tympanic cavity is an air-containing cavity in the
air-
petrous part of the
temporal bone and is lined with mucous membrane.
It contains the auditory ossicles, and communicates in
ossicles,
front through the E-
E-
tube with the nasopharynx and behind with the mastoid
antrum.
antrum.
Roof:
A thin plate of bone, the tegmen tympani, which is part of
the petrous
temporal bone
It seprates the tympanic cavity from the meninges and
temporal lobe of the
brain in the middle cranial fossa.
fossa.
Floor:
A thin plate of bone, which may be deficient and partly
replaced by fibrous tissue.
It separates the tympanic cavity from the superior bulb of
the internal jugular vein.
17. Anatomical two parts:
1). Bony labyrinth: comprising a series of cavities within the bone
labyrinth
2). Membranous labyrinth: comprising a series of membranous
sacs and ducts contained within the bony labyrinth.
18. Anatomy of the Labyrinth
Bony Labyrinth:
Vestibule:
The central part of the bony labyrinth, lies posterior to
the cochlea and ant. to the semicircular canals.
Within the vestibule are the saccule and utricle of the
membranous labyrinth.
Semicircular canals:
Within the canals are the semicircular ducts. Each
canal has a swelling at one end called ampulla.
ampulla.
Cochlea:
Two and a half turns in the human, these coils(holly
bony tube) turning around a central ‘pillar’, the
pillar’
modiolus
19.
20.
21.
22.
23. Membranous Labyrinth:
Utricle: indirectly connected to the saccule by utricular duct.
Saccule: globular in shape, saccular duct
Semicircular ducts:
Cochlear duct: triangular in cross section, connected to the saccule by the ductus
reunions.
24. Perilymph:
• Primarily formed by filtration from blood vessels in the inner e ar
• Communicates with the cerebrospinal fluid (CSF) through the coch lear
aqueduct, a narrow channel 3- 4 mm long, with its inner ear opening at
the base of the scala tympani.
• Resembles the extracellular fluids:
( high Na+ :140 mEq/liter; low K+:10 mEq/liter; Protein: 200-400 mg%,
CSF: Na+ :152 mEq/liter; K+:4 mEq/liter; Protein: 20-50 mg% )
Endolymph:
• Produced by the secretory cells in the stria vascularis of the cochlea and the
dark cells of the vestibular labyrinth.
• Re-absorption of endolymph take place in the endolymphatic sac.
• Resenble the intracellular fluids:
( low Na+ :5 mEq/liter; high K+:144 mEq/liter; Protein: 126 mg%)
26. Blood supply of the inner ear
Basilar artery—ant. inf. cerebellar artery—labyrinthine artery
↗ common cochlear a. --↗main cochlear a ----------------------------- ↓
↘vestibulo-cochlear a ↗cochlear ramus ↑
→post. vestibular a.↓
↘ ant. vestibular a. ----------------------------------------------------------↑
27. Blood supply of the inner ear
Basilar artery—ant. inf. cerebellar artery—labyrinthine artery
↗ common cochlear a. --↗main cochlear a ----------------------------- ↓
↘vestibulo-cochlear a ↗cochlear ramus ↑
→post. vestibular a.↓
↘ ant. vestibular a. ----------------------------------------------------------↑
34. Innervation and central connections
Two types: Afferent fibres: carrying sensory
fibres:
information to the brain.
Efferent fibres: Pass from the brain-stem to
fibres: brain-
the cochlea, perhaps 1000 in number
As many as 95% of all afferent fibres make
contact with the inner hair-cells, 5% with
hair-
outer hair cells, and each inner hair-cell has
hair-
terminals from about 10~20 afferent fibres.
fibres.
The vast majority of the fibres of the cochlear
nerve (about 30,000 of them) are afferent
and their cell bodies are in the spiral
ganglion in the modiolus.
modiolus.
The modiouls contains many small canal, the
most central of them carrying fibres from the
apex of the cochlea, while the outermost
canal carry fibres from the basal part of the
cochlea.
38. Response to a 150 Hz tone Response to a pulse sequence
Response to a 1.5 kHz tone
Low frequency traveling wave in 3-D
Response to a 15 kHz tone
High frequency traveling wave in 3-D
40. PHYSICAL PROPERTIES OF
SOUND
Chih-Hung Wang, MD, PhD
Tri-Service General Hospital, National Defense Medical Center
王智弘
三軍總醫院耳鼻喉部 國防醫學院耳鼻喉學系
41. Nature of sound
• The sensation of sound is determined by the
interaction of sound waves with the hearing system.
• The normal human ear has an auditory sensitivity
which ranges from 20-20,000 Hz.
Humans: 20- 20,000 Hz
Whales: 20- 100,000 Hz
Bats: 1500- 100,000 Hz
Frogs: 600- 3000 Hz
Fish: 20- 3000 Hz
Crickets: 500- 5000 Hz
42. Production of sound
► Sound is a form of energy
► The vibration of an elastic body (tuning fork, piano string, vocal cords) gives rise to
the propagation of pressure waves [ a sequence of increases (compressions)
and decreases (rarefactions) in pressure].
►When the vibrating object is a sound source, these pressure waves are known as
sound waves.
►Sound wave:
Energy transmission by media
Longitudinal wave = pressure wave
縱波: 波傳遞時,介質振動的方向與波行進方向平行
橫波:波傳遞時,介質振動的方向與傳遞方向互相垂直
44. Characters of sound
1). Frequency: one double vibration is called a cycle. The
frequency of sound is determined by the number of complete
cycles per second and is expressed in hertz (Hz).
► Pitch: Psychoacoustics terms
► Octave: at twice the frequency:
► Fundamental frequency: the basic underlying sine wave
► Harmonics: the higher frequencies based on multiples of a
fundamental frequency.
45.
46. •The lowest component of the waveform is known as the FUNDAMENTAL
•The second harmonic is twice the fundamental frequency, the third harmonic is
three times the fundamental frequency, and so forth.
47. 2). Period: the time for one double vibration= second/ per cycle
3). Wave length: the distance for one cycle = m/sec
4). Phase: the phase of a sine wave corresponds to its
distance form zero at the moment in which the
vibration begins (onset) and is usually defined in
terms of time (period) or angular measure.
48. interference
If you strike a tuning fork and rotate it next to your ear, you will note that the
sound alternates between loud and soft as you rotate through the angles where
the interference is constructive and destructive.
49. The arrow indicates one cycle of the sound. The time it takes to complete a
cycle is the period. Frequency is the inverse of this, the number of cycles in a
second. The distance sound travels during one period is the wavelength.
P = 1/f λ = S/f
The upside down y is λ (lambda): wavelength
P = period,
f = frequency
S = the speed of sound
20℃、海平面上,聲音的速率: 343 m/s 溫度的變化:『v = (331 + 0.6T) m/s 』
在水中,20℃時聲音的速率: 1,482 m/s
鋼鐵材質中則大約5,960 m/s。
50. Sine wave
• The waveform produced by simple harmonic
motion is the SINE WAVE
• the simplest type of sound wave is one which
has only one frequency and is constant in
amplitude
51. Beats
When two waves with the same amplitude but different
frequency are added together a phenomenon called "beating"
occurs.
52. Refraction 折射
▶In the first, the beam crosses the boundry between warm and cool at a right angle. All that
happens is the wavelength changes. It gets shorter, since the speed of sound is lower in
the cool air.
▶ Look at the beam that strikes the boundry at an angle.The wavefront that has just crossed
actually has two wavelengths; long for the part still in the warm air, short for the part in
the cold.This makes it skewed. All later waves just propagate off this crooked wavefront,
in a new direction.
54. 5). Amplitude: The difference between normal (atmospheric)
pressure and the pressure in the presence of a sound wave. It varies
with time between positive and negative values and is expressed in
pascals (newtons/m2).
The lower limit to the hearing threshold at 1k Hz:
2 x 10-5 newton/m2= 20 µPa
► The measurement of amplitude of the sound wave:
Pressure: Newton/m2 or dyne/cm2
Intensity: power : watt/m2 or watt/cm2
Exp: 1k Hz: (power) 1 x10-16 watt/cm2 =(pressure) 0.0002 dyne/cm2
or 2 x 10-4 dyne/cm2
Intensity being proportional to the square of the amplitude of sound pressure
(I ∞ P2)
56. Amplitude and waveform
•Amplitude of sounds as loudness.
•The shape of a sound is its waveform
•The shape of the curve is very important in establishing the
timbre of the sound..
57. Tuninig curve of single nerve fiber
100
dB 80
60
40
20
1 10 40
kHz
Normal Loss of OHC Loss of IHC & OHC
59. Measurement of Sound
MKS CGS
Length m cm
Mass Kg g
Time second second
sound wave
pressure Newton/m2 dyne/cm2
intensity watt/m2 watt/cm2
F=ma Newton: 1N = 105 dyne
60. Bel system
Bel system=Intensity (power) system, named
after the scientist
Alexander Graham Bell
BelIL = log I/I0
0 bel =1 x 10-12 watt/m2 (I0: a tone which is only just audible= a threshold sound)
1 bel =10 x 10-12 watt/m2
3 bel =10 x 10 x 10 x 10-12 watt/m2 (a whisper is 1000 times more powerful than
a threshold sound = raised to the power of three)
61. Decibel system
Decibel system: for clinical purposes, the bel has been broken down into
ten smaller units known as decibels (dB)
dBeL = 10 log I/I0 I: the intensity to be measured
I0: threshold sound = 1 x 10-12 watt/m2 = 1 x 10-16 watt/cm2
Exp: when noise is 1 x 10-14 watt/cm2
dBeL= 10 log 1 x 10-14 watt/cm2 / 1 x 10-16 watt/cm2 =20 dB
Similarly, a whisper (3 bels) = 30 dB = 103 x threshold sound
A conversational voice (6 bels) = 60 dB = 106 x threshold sound
A loud shout (9 bels) = 90 dB = 109 x threshold sound
Loudness: Psychoacoustics terms
62. (I (power)∞ p2 )
Intensity being proportional to the square of the amplitude of sound pressure
dBSPL = 20 log P/P0
P=power
Exp.:
A: 0.002 dyne/cm2: dBSPL=20 log 0.002/0.0002= 20
B: 0.02 dyne/cm2: = 40
C: 0.004 dyne/cm2: = 26
BelIL = dBelIL/10 = dBSPL/20
63. Auditory threshold
• 1). dB SPL (sound pressure level): a value in decibels which express
the pressure of sound in relation to a reference pressure which for
conventional purposes is the minimum pressure required for the perception
of a 1000-4000 Hz sine wave in the average adult.
• 2). dB HL (hearing level): the minimum intensity at which a person can
hear at a specific frequency (e.g. 1000 Hz ) in relation to a basic value (0 dB
HL) which represents minimum hearing in normal hearing subjects.
•
3). dB SL (sensation level): the level of hearing in dB HL above
threshold for the subject being tested.