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Samenvatting anatomie
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InhoudInleiding.................................................................................................................................................................................................4
Indeling van het oor..............................................................................................................................................................................4
anatomie van het Uitwendig oor (binnenoor)......................................................................................................................................5
Oorschelp..........................................................................................................................................................................................5
Uitwendige gehoorgang (+- 3 cm lang).............................................................................................................................................6
anatomie van het Middenoor...............................................................................................................................................................6
trommelholte (Cavum tympani).......................................................................................................................................................6
Trommelvlies.....................................................................................................................................................................................7
Oriëntatiepunten...............................................................................................................................................................................7
kwadranten.......................................................................................................................................................................................8
Gehoorbeenketen.............................................................................................................................................................................8
Middenoorspiertjes en peesjes (bevestiging aan de gehoorbeentjesketen)...................................................................................9
Buis van Eustachius (tuba auditiva,) +- 2,5 cm lang..........................................................................................................................9
Mastoïd = processus mastoideus van het os temporale................................................................................................................10
Nervus facialis, chorda tympani..................................................................................................................................................10
Fysiologie van het middenoor.............................................................................................................................................................10
1. Transformatorfunctie..................................................................................................................................................................10
2. Beluchting....................................................................................................................................................................................10
3. Drainage en afweer.....................................................................................................................................................................10
anatomie van het Binnenoor (cochlea)...............................................................................................................................................10
Fysiologie van het binnenoor..............................................................................................................................................................11
Cochlea als transducent..................................................................................................................................................................11
De functie van de buitenste haarcellen..........................................................................................................................................12
Cochleaire pathofysiologie..............................................................................................................................................................12
Centraal auditief systeem...................................................................................................................................................................12
Vestibulair systeem.........................................................................................................................................................................13
Het visuele systeem........................................................................................................................................................................13
Proprioceptieve systeem.................................................................................................................................................................13
Andere zintuigsystemen..................................................................................................................................................................13
Anatomie en fysiologie vestibulair systeem...................................................................................................................................13
Haarcellen.......................................................................................................................................................................................14
Statolietorganen = otolietorganen......................................................................................................................................................14
Anatomie: utriculus en sacculus.....................................................................................................................................................14
Werking...........................................................................................................................................................................................14
Richtinggevoeligheid.......................................................................................................................................................................14
Halfcirkelvormige kanalen...................................................................................................................................................................15
Anatomie.........................................................................................................................................................................................15
, Werking...........................................................................................................................................................................................15
Richtinggevoeligheid.......................................................................................................................................................................15
Beperkingen van het evenwichtsorgaan.........................................................................................................................................15
Nervus vestibularis..........................................................................................................................................................................15
Vestibulo- of archicerebellum.........................................................................................................................................................15
Vestibulaire cortex..........................................................................................................................................................................15
Functies van het vestibulaire systeem................................................................................................................................................16
1. Ruimtelijke oriëntatie..................................................................................................................................................................16
2. Beeldstabilisatie..........................................................................................................................................................................16
3. Houdingsregulatie.......................................................................................................................................................................16
Centrale verwerking: het centrale vestibulaire systeem................................................................................................................16
Invloed op het autonome zenuwstelsel..........................................................................................................................................16
Beperkingen van het evenwichtssysteem.......................................................................................................................................16
Centrale compensatie van een perifeer vestibulaire laesie............................................................................................................17
Elektrische otoscoop, voorhoofdslamp en oormicroscoop................................................................................................................18
Onderzoek van oorschelp, gehoorgang en trommelvlies...................................................................................................................18
Beoordeling van het trommelvlies..................................................................................................................................................19
Bacteriologisch onderzoek van het oorsecreet..............................................................................................................................19
Beeldvormend onderzoek van het oor en vestibulair systeem......................................................................................................19
Onderzoek van de buis van Eustachius (tuba auditiva)..................................................................................................................19
Grondbegrippen uit de geluidsleer en de audiologie........................................................................................................................19
Onderzoek van het gehoor.................................................................................................................................................................20
onderzoek bij de duizelige patiënt......................................................................................................................................................22
anamnese bij de duizelige patiËnt......................................................................................................................................................22
Lichamelijk onderzoek met betrekking tot het evenwicht.................................................................................................................24
Onderzoek van stabiliteit van de ogen...........................................................................................................................................24
Onderzoek van de oogstand:..........................................................................................................................................................27
Onderzoek van de gladde oogvolgbewegingen..............................................................................................................................28
Onderzoek van de saccades............................................................................................................................................................28
Onderzoek van de optokinetiek......................................................................................................................................................28
Onderzoek van de fixatie – suppressie...........................................................................................................................................28
Hyperventilatie – provocatietest....................................................................................................................................................29
De head impulse test (HIT)..............................................................................................................................................................29
De Dix – Hallpike en supine roll test...............................................................................................................................................30
Testen van het gaan en staan van coördinatie...............................................................................................................................31
Het acute probleem: HINTS+..........................................................................................................................................................32
Aanvullend onderzoek voor kwantificering van de evenwichtsfunctie..............................................................................................32
Video – oculografie (VOG) en elektro – oculografie (EOG).............................................................................................................33
Het calorisch onderzoek..................................................................................................................................................................33
, Draaistoeltesten..............................................................................................................................................................................34
De video head impulse test (VHIT)..................................................................................................................................................35
Vestibular evoked lyogenic potentials (VEMPs).............................................................................................................................35
De waarde van het kwantificerend evenwichtsonderzoek.............................................................................................................36
Functies neus.......................................................................................................................................................................................37
Uitwendige neus.................................................................................................................................................................................37
Inwendige neus...................................................................................................................................................................................38
Fysiologise van de neus.......................................................................................................................................................................39
Ademhaling.....................................................................................................................................................................................39
Neusbijholten..................................................................................................................................................................................40
Anamnese............................................................................................................................................................................................41
Uitwendig onderzoek......................................................................................................................................................................41
inwendig onderzoek........................................................................................................................................................................41
Rinoscopie...................................................................................................................................................................................42
Neusendoscopie en nasofarynscopie.........................................................................................................................................42
Aanvullend diagnostisch onderzoek...................................................................................................................................................42
Allergietests vermoeden op atopie:...............................................................................................................................................43
Neusdoorgankelijkheidsonderzoek.....................................................................................................................................................43
Onderzoek van het mucociliair systeem.........................................................................................................................................43
Reukonderzoek...............................................................................................................................................................................44
Radiologisch onderzoek..................................................................................................................................................................44
Bovenste deel van de tractus digestivus.............................................................................................................................................46
Mondholte lippen tot de overgang naar de orofarynx (orofaryngeale isthmus) ..........................................................................46
Farynx van schedelbasis tot onderrand van het cartilago cricoidea..............................................................................................49
Slokdarm.............................................................................................................................................................................................51
Fysiologie van de slikactie...............................................................................................................................................................51
Larynx..............................................................................................................................................................................................52
Trachea............................................................................................................................................................................................55
Hals......................................................................................................................................................................................................56
Fasciae.............................................................................................................................................................................................56
Grote vaten en zenuwen in de hals................................................................................................................................................56
Speekselklieren...................................................................................................................................................................................57
Glandula parotidea (grootste).........................................................................................................................................................57
Glandula submandibularis..............................................................................................................................................................58
Fysiologie.........................................................................................................................................................................................58
Productie van speeksel................................................................................................................................................................58
Samenstelling van speeksel.........................................................................................................................................................59
Functie van het speeksel.............................................................................................................................................................59
Schildklier en bijschildklieren..............................................................................................................................................................59
, H1: ANATOMIE EN FYSIOLOGIE VAN
HET OOR EN VESTIBULAIR SYSTEEM
INLEIDING
Oor en evenwichtsorgaan:
- Eén anatomisch geheel
- Sterke fysiologische overeenkomsten
Vestibulair functie verlies is relatief complex
- Klachten daarvan niet altijd duidelijk (niet persé vertigo)
- In tegen stelling tot bijvoorbeeld oorproblemen gehoorverlies
- Klachten van evenwichtsproblemen zijn niet altijd duidelijk.
INDELING VAN HET OOR
Uitwendig oor: oorschelp, uitwendige gehoorgang
Middenoor: trommelvlies, trommelholte, gehoorbeentjes, middenoorspiertjes
Binnenoor: onderdeel van labyrint
Nervus cochlearis: onderdeel van de nervus vestibulocochlearis
Centraal auditief systeem
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