Special Senses

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Learning Outcomes
35.1 Describe the anatomy of the nose and the function of each part. 35.2 Describe how smell sensations are created and interpreted. 35.3 Describe the anatomy of the tongue and the function of each part. 35.4 Describe how taste sensations are created and interpreted.
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Learning Outcomes (cont.)

35.5 Name the four primary taste sensations and the acknowledged fifth taste sensation. 35.6 Describe the anatomy of the eye and the function of each part, including the accessory structures and their functions. 35.7 Trace the visual pathway of through the eye and to the brain for interpretation.

35.8 Identify ways that patients can practice preventive eye care.
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Learning Outcomes (cont.)

35.9 State ways that vision changes with age.
35.10 List the medical professionals involved in diagnosis and treatment of visual disorders, including the roles that each play in patient care. 35.11 List treatments for eye visual disorders. 35.12 Describe the causes, signs and symptoms, and treatments of various diseases and conditions of the eye.
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Learning Outcomes (cont.)

35.13 Describe the anatomy of the ear and the function of each part. 35.14 Explain the role of the ear in maintaining equilibrium.

35.15 Explain how sounds travel through the ear and are interpreted in the brain.
35.16 State ways that hearing changes with age.

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Learning Outcomes (cont.)

35.17 List the types of hearing loss and how they differ. 35.18 Describe treatments for ear and hearing disorders. 35.19 Explain how patients can be educated about preventive ear care. 35.20 Describe the causes, signs and symptoms, and treatments of various disorders of the ear and hearing.

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Introduction

Special senses

Sensory receptors located in head

Nose smell Tongue taste Eyes vision Ears hearing and equilibrium Touch is a generalized sense

Stimulus nervous system brain response

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Nose and Sense of Smell

Olfactory receptors

Chemoreceptors respond to changes in chemical concentrations Chemicals must be dissolved in mucus

Located in the olfactory organ

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Nose and Sense of Smell (cont)

Smell sensation
Activation of smell receptors information sent to olfactory nerves that send the information along olfactory bulbs and tracts to different areas of the cerebrum; cerebrum interprets the information as a particular type of smell
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Nose and Sense of Smell (cont.)

Sensory Adaptation

Chemical can stimulate receptors for limited time Receptors fatigue and stop responding to chemical No longer smell order

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Apply Your Knowledge

You notice an odor coming from a patient when you enter the exam room. Why would the patient not be able to smell it?
ANSWER: After a few minutes, smell receptors undergo sensory adaptation and no longer respond to the chemical, and the patient can no longer smell the odor.

Very Good!
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Tongue and Sense of Taste

Gustatory receptors located on taste buds Taste buds

Location

Papillae of the tongue Roof of mouth } fewer than on tongue Walls of throat
Tongue

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Tongue and Sense of Taste (cont.)

Taste cells and supporting structures

On taste buds Supporting structures fill in space Taste cells

Chemoreceptors Chemicals in food and drink must be dissolved in saliva to activate

Tongue

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Tongue and Sense of Taste (cont.)

Taste sensation

Unami

4 primary

Sweet tip Sour sides Salty tip and sides Bitter back

5th basic taste Glutamic acid

Spicy foods

Activate pain receptors Interpreted by brain as spicy Tongue

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Back
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Tongue and Sense of Taste (cont.)

Taste sensation
Activation of taste cells Cranial nerves

Gustatory cortex of cerebrum interprets information

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Apply Your Knowledge

What are the four primary taste sensations and where are their corresponding taste cells located?
ANSWER: The four primary taste sensations are:

Sweet concentrated on the tip of the tongue

Sour concentrated on the sides of the tongue Salty concentrated on the tip and sides of the tongue Bitter concentrated on the back of the tongue

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Eye and Sense of Sight

Vision system
Eyes Optic nerves Vision centers in the brain Accessory structures

Eye
Processes light to produce images Three layers Two chambers Specialized parts

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Eye and Sense of Sight (cont.)

Outer sclera

White of the eye Protects the eye Sense receptors Cornea

Front of eye Window that allows light into eye Bends light as it enters

Eye

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Eye and Sense of Sight (cont.)

Middle choroid

Contains blood vessels Iris

Ciliary body

Colored part of eye Muscle that contracts and relaxes to open or close pupil Regulates the amount of light that enters the eye

Muscles Controls the shape of the lens Posterior to iris Focuses light on retina

Lens

Accommodation
Eye

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Eye and Sense of Sight (cont.)

Inner retina

Visual receptors

Cones

Rods

Sensitive to light Will function in dim light limited night vision Do not provide sharp image or detect color

Function in bright light Sensitive to color and provide sharp images

Optic disc optic nerve enters retina

Eye

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Eye and Sense of Sight (cont.)

Chambers of the eye

Anterior chamber

Front of lens Filled with aqueous humor nourishes and bathes anterior eye

Posterior chamber

Behind lens Contains vitreous humor maintains shape of eyeball and holds retina in place

Eye

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Back
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Eye and Sense of Sight:

Visual Accessory Organs

Eye orbits

Eyelids

Eye sockets Form a protective shell around the eyes Eyebrows protect eyes

Skin, muscle, and connective tissue Blinking

Prevents surface from drying out Keeps foreign material out of eye

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Eye and Sense of Sight:

Visual Accessory Organs (cont.)

Conjunctivas

Lacrimal apparatus

Mucus membranes Line inner surfaces of eyelids

Lacrimal glands

Lateral edge of eyeballs Produce tears

Nasolacrimal ducts

Medial aspect of eyeballs Drain tears into nose

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Eye and Sense of Sight:

Visual Accessory Organs (cont.)

Extrinsic eye muscles

Six per eye move the eyeball

Superiorly Inferiorly Laterally Medially

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Eye and Sense of Sight:

Visual Pathways

Eye works like a camera

Light enters the eye through the lens Refraction cornea, lens, and fluids bend light to focus it on the retina
Image turned right-side up

Image upside down on retina

Retina converts light to nerve impulse

Optic nerve

Optic chiasm

Occipital lobe of cerebrum

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Eye Safety and Protection

90% of eye injuries are preventable

Eye safety practices

Adequate lighting / handrails Pad or cushion sharp edges on furniture Toys should be age-appropriate Do not mix chemicals

Proper protective wear

Goggles Sports eye guards

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Apply Your Knowledge

Matching: ANSWER: ___ G Middle layer of eye H Eye sockets ___ ___ F Control shape of lens ___ D Outer layer of eye ___ B Anterior chamber A Tears ___ ___ I Bending of light ___ E Posterior chamber C Inner layer of eye ___
A. B. C. D. E. F. G. H. I. Lacrimal glands Aqueous humor Retina Sclera Vitreous humor Ciliary body Choroid Orbits Refraction

Out of Sight!

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The Aging Eye

Eyelids may droop Quality and quantity of tears decrease Conjunctiva thins and eyes may become dryer Cornea yellows, fat deposits around it Brown spots on sclera Pupils become smaller

Lens denser and more rigid Lens yellows Retinal changes vision fuzzy Changes in ability of eye to adapt to light Impaired night vision Decreased peripheral vision; depth perception Floaters or flashes of light

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Preventing Falls in the Elderly

Falls can result in fractures of major bones Complications of falls can lead to death Prone to falling

Vision problems Poor health Slower reflexes

Safety checklist Precautions

Equilibrium problems Medication

Patient education

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Apply Your Knowledge

What vision changes can occur in the elderly patient?
ANSWER: An elder patient may have difficulty seeing because of drooping eyelids. Focusing may be more difficult because less light enters the eye. He may have difficulty distinguishing colors due to yellowing of the lens. Vision may be fuzzy because of changes in the retina. Night vision can become impaired. The patient may see floaters or sparks.

Nice job!
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Vision Testing

Professionals include

Ophthalmologist medical doctor who is an eye specialist Optometrist provides vision screening and diagnostic testing Opticians fills vision prescriptions for glasses and contacts
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Vision Testing: Screening Tests

Myopia impairment of distance vision

Hyperopia impairment of near vision

Eyeball is too long Light focuses anterior to retina Snellen chart Normal vision

20/20

Eyeball is shorter Light focused posterior to retina Test using a handheld chart with various sizes of print Presbyopia

Impairment due to aging Loss of lens elasticity

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Vision Testing: Screening Tests (cont.)

Contrast sensitivity

Color vision

Distinguish shades of gray Testing

Color-blindness

May be inherited More common in males Ishihara color system Richmond pseudoisochromatic color test

PelliRobson contrast sensitivity chart

Vistech Consultants vision contrast system

Tests

Detect cataracts or retinal problems before sharpness is impaired

Difficulties may indicate retinal or optic nerve disease

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Apply Your Knowledge

What is the difference between myopia and hyperopia and what is presbyopia? What effect does each have on vision?
ANSWER: If the patient has myopia, the eyeball is elongated and light focuses in front of the retina. She will have difficulty seeing far away. If she has hyperopia, the eyeball is shorter than normal and light focuses behind the retina. With presbyopia, the lens loses elasticity due to aging, resulting in the inability to see things close up.

Reyeght!
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Treating Eye Problems

Delicate organ caution and sterile technique necessary Patient education on preventive care Administration Eye irrigation of medications Sterile solution

Only ophthalmic medications Avoid touching dropper or ointment tube to the eye

Purpose

Remove foreign material Relieve discomfort

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Common Diseases and Disorders

Disorder / Disease Description Amblyopia Lazy eye; one eye is not used regularly; poor depth perception; often concurrent with strabismus Cornea or lens has abnormal shape; blurred images Opaque structures in lens prevent light from passing through; vision fuzzy Pink eye; highly contagious bacterial infection
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Astigmatism Cataracts Conjunctivitis

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Common Diseases and Disorders

(cont.)
Disorder / Disease Description
Dry eye syndrome Common problem; decreased production of oil in tears Entropion Glaucoma Inversion of lower eyelid Increase in intraocular pressure due to a buildup of aqueous humor in anterior chamber

Hyperopia

Farsightedness

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Common Diseases and Disorders

(cont.)
Disorder / Disease Description
Macular degeneration Myopia Nystagmus Progressive disease; inadequate blood supply to retina; most common cause of vision loss; affects people over 50 years Nearsightedness Rapid, involuntary eye movements

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Common Diseases and Disorders

(cont.)

Disorder / Disease Description

Prespyopia Retinal detachment Strabismus Convergent Divergent Loss of lens elasticity; develops with age Layers of retina separate; medical emergency Misalignment of eyes Crossed eyes; one or both eyes turn inward Wall eye; one or both eyes turn outward
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Apply Your Knowledge

It is okay to use any solution or medication in the eye?
ANSWER: Only medications or solutions specifically designated for ophthalmic use may be used in the eyes. Medications not designated for the eye may be too concentrated or contain substances that can injure the eye. Solutions should be sterile and care must be taken not to contaminate the tip of the dropper or bottle.

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The Ear and the Senses of Hearing and Equilibrium: Structures

External ear

Auricle (pinna)

Collects sound waves Guides sound wave to tympanic membrane

External auditory canal

Tympanic membrane

Separates external canal and middle ear Vibrates when sound hits it

Ear

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The Ear and the Senses of Hearing and Equilibrium: Structures (cont.)

Middle ear

Ear ossicles

Eustachian tube

Malleus Incus Stapes

Ossicles vibrate in response to vibration of tympanic membrane

Connects middle ear to throat Equalizes pressure on eardrum Separates middle ear from inner ear

Oval window

Ear

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The Ear and the Senses of Hearing and Equilibrium: Structures (cont.)

Inner ear labyrinth of communicating chambers

Semicircular canals detect balance of the body Vestibule equilibrium Cochlea

Hearing receptors

Organ of Corti organ of hearing

Ear

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The Ear and the Senses of Hearing and Equilibrium: Structures (cont.)

Equilibrium

Head movement causes fluid in semicircular canals and vestibule to move Equilibrium receptors transmit information along vestibular nerves to cerebrum Cerebrum determines if body needs to make adjustments
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The Ear and the Senses of Hearing and Equilibrium: Hearing Process

Sound waves collected Waves cause tympanic membrane to vibrate Ossicles amplify vibrations, which enter inner ear Movement of hairs lining cochlea trigger nerve impulses Impulses are transmitted by auditory nerve to the brain for interpretation
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The Ear and the Senses of Hearing and Equilibrium: Hearing Process (cont.)

Bone conduction

Alternative pathway Bypasses external and middle ear directly to inner Useful in determining cause of hearing problem
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Apply Your Knowledge

Matching: ___ E Pinna ___ C Malleus, incus, and stapes ___ F Hearing receptors ___ G Inner ear ___ A Organ of hearing ___ B Earwax ___ D Eardrum ___ H Detect balance of body

ANSWER:
A. Organ of Corti B. Cerumen C. Ear ossicles D. Tympanic membrane E. Auricle F. Cochlea G. Labyrinth H. Semicircular canals
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How to Recognize Hearing Problems in Children

Guidelines

Infants to 4 months

Startled by loud noises Recognize mothers voice Regularly follow sounds Babble at people Respond to the sound their name Respond to no
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4 to 8 months

8 to 12 months

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The Aging Ear

External ear larger / earlobe longer Cerumen dryer and prone to impaction Ear canal narrower Eardrum shrinks and appears dull and gray Ossicles do not move as freely Semicircular canals less sensitive to changes in position affects balance
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Apply Your Knowledge

What problem with the aging ear makes the elderly more prone to falls?
ANSWER: The semicircular canals become less sensitive to change in position, which affects balance. This problem with equilibrium results in increased chance of falls in the elderly. Great Answer!

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Hearing Loss

Symptom of a disease, not a normal part of aging Conductive hearing loss Sensorineural hearing loss

Interruption in transmission to inner ear Causes Obstruction of ear canal Infection of middle ear Reduced movement of stirrup

Sound waves not perceived by brain as sound Causes Hereditary Repeated exposure to loud noises / viral infections Side effect of medication

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Hearing Loss (cont.)

Noise pollution causes damage to sensitive cells in cochlea Working with the hearing-impaired patient

Speak at a reasonable volume, in clear, low-pitched volumes Face the person; use hand gestures, if appropriate Do not overemphasize lip movements Have patient repeat message to verify understanding Treat hearing-impaired patients with patience and respect
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Hearing and Diagnostic Tests

Hearing tests

Tuning forks differentiate between types of loss Audiometer measures hearing acuity Tympanometry

Diagnostic testing

Measures the ability of the eardrums to move Detects diseases and abnormalities of the middle ear
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Apply Your Knowledge

Identify the types of hearing loss based on the description below. What can be used to differentiate between the two?
Answer:
A tuning fork is a simple test to distinguish between types of hearing loss.

Conductive hearing loss

Sensorineural hearing loss

Interruption in transmission to inner ear Causes Obstruction of ear canal Infection of middle ear Reduced movement of stirrup

Bravo!

Sound waves not perceived by brain as sound Causes Hereditary Repeated exposure to loud noises / viral infections Side effect of medication

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Treating Ear and Hearing Problems

Patient education

Preventative ear care Administer ear medications

Medications and Irrigation

Relieve inflammation or irritation of canal Loosen and remove impacted cerumen or foreign body
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Treating Ear and Hearing Problems (cont.)

Hearing aids

Other devices / strategies

Obtaining a hearing aid

Otologist medical doctor specializing in health of ear Audiologist evaluates and corrects hearing problems

Amplifiers Closed-captioning Appliances that light up as well as ring

Care and use

Batteries Routine cleaning Keep dry and avoid hair sprays

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Common Diseases and Disorders

Disorder / Disease
Cerumen impaction Hearing loss

Description
Build up of wax within external auditory canal Deafness

Menieres disease Disturbance in equilibrium characterized by vertigo and tinnitus

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Common Diseases and Disorders

Disorder / Disease
Otitis Otitis externa Otitis media Otitis interna Osteosclerosis Presbycusis

Description
Inflammation of the ear Swimmers ear Middle ear infection; common infection Labyrinthitis; inner ear infection Immobilization of the stapes; common cause of conductive hearing loss Hearing loss due to aging process
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Apply Your Knowledge

True or False:

ANSWER:
otologist

___ F An audiologist is a physician that specializes in ear health. ___ F Otitis media is also called swimmers ear. externa

___ T Presbycusis is hearing loss due to the aging process. ___ F Vertigo is ringing in the ears. Tinnitus ___ T Otitis interna is an inflammation of the labyrinth. ___ T Menieres disease is characterized by disturbances in equilibrium. ___ T Otosclerosis is the immobilization of the stapes. ___ F tinnitus is dizziness. Vertigo
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In Summary

Special senses detect changes in the environment

Each works with the nervous system to enable the body to cope with environmental changes

Medical assistants knowledge of senses

Provide eye and ear care to patient Patient education Meet needs of children, elderly, and patients with impairments

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