NEUROTRANSMITTERS are the brain chemicals that communicate information throughout our brain and body.

They relay signals between nerve cells, called neurons. The brain uses neurotransmitters to tell your heart to beat, your lungs to breathe, and your stomach to digest. They can also affect mood, sleep, concentration, weight, and can cause adverse symptoms when they are out of balance. Neurotransmitter levels can be depleted many ways. As a matter of fact, it is estimated that 86% of Americans have suboptimal neurotransmitter levels. Stress, poor diet, neurotoxins, genetic predisposition, drug (prescription and recreational), alcohol and caffeine usage can cause these levels to be out of optimal range. There are two kinds of neurotransmitters INHIBITORY and EXCITATORY. Excitatory neurotransmitters are not necessarily exciting they are what stimulate the brain. Those that calm the brain and help create balance are called inhibitory. Inhibitory neurotransmitters balance mood and are easily depleted when the excitatory neurotransmitters are overactive.

Inhibitory Neurotransmitters
SEROTONIN is an inhibitory neurotransmitter which means that it does not stimulate the brain. Adequate amounts of serotonin are necessary for a stable mood and to balance any excessive excitatory (stimulating) neurotransmitter firing in the brain. If you use stimulant medications or caffeine in your daily regimen it can cause a depletion of serotonin over time. Serotonin also regulates many other processes such as carbohydrate cravings, sleep cycle, pain control and appropriate digestion. Low serotonin levels are also associated with decreased immune system function. GABA is an inhibitory neurotransmitter that is often referred to as natures VALIUM-like substance. When GABA is out of range (high or low excretion values), it is likely that an excitatory neurotransmitter is firing too often in the brain. GABA will be sent out to attempt to balance this stimulating over-firing. DOPAMINE is a special neurotransmitter because it is considered to be both excitatory and inhibitory. Dopamine helps with depression as well as focus, which you will read about in the excitatory section.

Excitatory Neurotransmitters
DOPAMINE is our main focus neurotransmitter. When dopamine is either elevated or low we can have focus issues such as not remembering where we put our keys, forgetting what a paragraph said when we just finished reading it or simply daydreaming and not being able to stay on task. Dopamine is also responsible for our drive or desire to get things done or motivation. Stimulants such as medications for ADD/ADHD and caffeine cause dopamine to be pushed into the synapse so that focus is improved. Unfortunately, stimulating dopamine consistently can cause a depletion of dopamine over time. NOREPINEPHRINE is an excitatory neurotransmitter that is responsible for stimulatory processes in the body. Norepinephrine helps to make epinephrine as well. This neurotransmitter can cause ANXIETY at elevated excretion levels as well as some MOOD DAMPENING effects. Low levels of norepinephrine are associated with LOW ENERGY, DECREASED FOCUS ability and sleep cycle problems.

EPINEPHRINE is an excitatory neurotransmitter that is reflective of stress. This neurotransmitter will often be elevated when ADHD like symptoms are present. Long term STRESS or INSOMNIA can cause epinephrine levels to be depleted (low). Epinephrine also regulates HEART RATE and BLOOD PRESSURE.

Q.1) This collects acoustic sounds and funnels it to the eardrum...

A.inner ear B.middle ear C.outer ear

Q.2) What is the most severe type of hearing loss you can get from cerumen impaction?
A.severe sensorineural B.moderate conductive C.severe conductive D.profound conductive

Q.3) What are the 3 functions of the external ear?

A.Impedance matching, Localization, Protection B.Protection, Amplification, Localization C.Protection, Amplification, Pressure Equalization

Q.4) A small air filled cavity lined with a mucous membrane....

( 2 words )

Q.5) Where are the ME and IE housed?

( 6 words )

Q.6)

What is a concave, disk-like structure with invaginated portion pointed in toward the middle ear space?

A.mastoid B.stapes C.tympanic membrane D.scala vestibuli

Q.7) What is the order of the TM layers, outer to inner?

( 3 words )

Q.8) Largest bone in the ME Q.9) What is the ring-shaped ligament that holds the footplate of the stapes in the oval window?

A.Axial ligament B.Tensor tympani C.Annular ligament D.Stapedius

Q.10) What do the axial ligaments do?

A.hold the footplate of the stapes B.pulls malleus medially and anteriorly, tensing the TM C.suspends the ossicles in the tympanic cavity

D.pulls stapes in a posterior direction

Q.11) The passageway leading from the nasopharynx to the anterior wall of the ME is
( 2 words )

Q.12) The Eustachian tube is usually Q.13) What are the functions of the middle ear?
A.Amplification, Protection, Impedance matching B.Protection, Impedance matching, Pressure Equalization C.Protection, Localization, Impedance matching

Q.14) How many decibels does the ME compensate for? Q.15) The area difference btwn the TM and footplate of the stapes is...
A.17:1 B.13:1 C.20:1 D.30:1

Q.16) The ratio of the lever action of the ossicular chain is Q.17) Higher mass equals
A.higher frequency B.lower frequency

Q.18) Higher stiffness equals

A.higher frequency B.lower frequency

Q.19) If the TM retracts due to negative pressure in the ME,what happens?

( 3 words )

Q.20) If fluid builds up in the ear, what happens?

( 3 words )

Q.21) How does the ME protect?

( 2 words )

Q.22) The acoustic reflex can reduce how many decibels of loud sounds?
A.70-80 B.50-60 C.10-30 D.20-40

Q.23) What is the structure comprising of the sensory organs for hearing and balance?
A.Tympanic membrane B.middle ear C.inner ear

Q.24) What is the auditory portion of the inner ear? Q.25) The base of the cochlea deals with...
A.high frequencies B.low frequencies

Q.26)

What is the membrane covered opening in the labyrinthine wall of the ME space, leading in the scala tympani?

A.oval window B.round window C.scala media

Q.27)

The opening in the labyrinthine wall of the ME space, leading into the scala vestibuli of the cochlea, into which the footplate of the stapes fits is

( 2 words )

Q.28) Which is filled with endolymph?

A.scala vestibuli B.scala tympani C.scala media

Q.29) Perilymph is not only similar to CSF, but also...

A.high in potassium B.high in sodium

Q.30) The base of the basilar membrane is for

A.high frequencies B.low frequencies

Q.31) How many rows of outer hair cells are there? Totally in what?
A.5 or 6, totaling in 12,000 B.3 or 4, totaling in 13,000 C.3 or 4, totaling in 12,000 D.5 or 6, totaling in 3,500 E.3 or 4, totaling in 3,500

1. Synonyms of middle ear include

A. B. C. D.

? ? ? ?

Tympanum Protympanum Eustachean tube Epitympanum

2. Lateral wall of tympanum is formed by

A. B. C.

? ? ?

Eustachean tube Tympanic membrane Promontry

D.

Cochlea

3. Lateral wall of epitympanum is formed by

A. B. C. D.

? ? ? ?

Pars tensa of ear drum Pars flaccida of ear drum Promontory Cochlea

4. Scutum is also known as the

A. B. C. D.

? ? ? ?

Eustachean tube bony portion COG Tensor tympani projection Outer attic wall

5. The difference between pars tensa and pars flaccida is

A. B. C. D.

? ? ? ?

The lack of external squamous layer in pars tensa The lack of inner mucousal layer in pars tensa Lack of middle fibrous layer in pars flaccida Lack of middle fibrous layer in pars tensa

6. Posterior canaliculus for corda tympani nerve is seen

A. B. C.

? ? ?

At the junction between lateral and posterior walls of tympanic cavity At the junction between anterior and medial walls of tympanic cavity At the junction of posterior and medial walls of tympanic cavity

D.

At the medial wall of tympanic cavity

7. Glaserian fissure is also known as

A. B. C. D.

? ? ? ?

Squamotympanic fissure Petromastoid fissure Petrotympanic fissure Squamomastoid fissure

8. Important content of Glasserian fissure is

A. B. C. D.

? ? ? ?

Facial nerve Chordatympani nerve Eustachean tube Anterior malleolar ligament

9. Glaserian fissure transmits

A. B. C. D.

? ? ? ?

Chorda tympni nerve Facial nerve Labyrinthine artery Anterior tympanic branch of maxillary artery

10. Canal of Hugier contains

A. B. C.

? ? ?

Facial nerve Anterior tympanic artery Chordatympani nerve

D.

Anterior malleolar ligament

11. Canal of Hugier lies

A. B. C. D.

? ? ? ?

Medial to glasserian fissure Lateral to glasserian fissure Lateral to petrotympanic fissure Superior to Glasserian fissure

12. Roof of the middle ear cavity is formed by

A. B. C. D.

? ? ? ?

Mastoid process Tegment tympani Promontory Cog

13. Petrosquamous suture line is seen in

A. B. C. D.

? ? ? ?

The roof of the middle ear cavity Medial wall of middle ear cavity Close to the ear drum Labyrinth

14. Anterior wall of middle ear is formed by

A. B. C.

? ? ?

Convergence of medial and lateral walls Promontory Aditus

D.

Short process of incus

15. Lower portion of the middle ear anterior wall is related to

A. B. C. D.

? ? ? ?

Mastoid antrum Aditus Internal carotid artery Maxillary artery

16. Carotico tympanic nerves enter middle ear cavity via

A. B. C. D.

? ? ? ?

Medial wall Posterior wall Roof Anterior wall

17. Number of caroticotympanic nerves which enter the middle ear cavity are

A. B. C. D.

? ? ? ?

one in number Three in number Two in number Four in number

18. Upper portion of the anterior wall of middle ear cavity is related to

A. B. C.

? ? ?

Internal carotid artery Carotico tympanic nerves Eustachean tube

D.

Promontory

19. Medial wall of middle ear cavity is formed by

A. B. C. D.

? ? ? ?

Mastoid air cells Antrum Promontory Eustachean tube

20. Promontory is formed by

A. B. C. D.

? ? ? ?

Lateral semicircular canal Utricle Saccule Basal turn of cochlea

21. Grooves on the promontory contain

A. B. C. D.

? ? ? ?

Lymphatics air cells Tympanic plexus Branches of internal auditory artery

22. Above and slightly behind the promontory lies

A. B. C.

? ? ?

Oval window Round window Stapedial tendon

D.

Pyramid

23. Inferior border of oval window is

A. B. C. D.

? ? ? ?

Convex Concave Straight linear

24. Above the oval window lies

A. B. C. D.

? ? ? ?

Promontory Horizontal portion of facial nerve Vertical portion of facial nerve Facial recess

25. Tunnel for tensor tympani muscle lies

A. B. C. D.

? ? ? ?

In the medial wall of middle ear In the anterior wall of middle ear In the lateral wall of middle ear In the posterior wall of middle ear

26. Round window membraneis made up of

A. B. C.

? ? ?

One layer Two layers Three layers

D.

Four layers

27. Secondary tympanic membrane provides a reliable landmark for

A. B. C. D.

? ? ? ?

Cochlear nerve Singular nerve Facial nerve Chorda tympani nerve

28. The closest vestibular structure to the secondary tympanic membrane is

A. B. C. D.

? ? ? ?

Lateral canal Superior canal Ampulla of posterior canal Utricle

29. The oval and round windows are separated by

A. B. C. D.

? ? ? ?

Ponticulous Chorda tympani nerve Subiculum Eustachean tube

30. Round window niche is __________ in shape

A. B. C.

? ? ?

Circular Oval Triangular

D.

Ovoid

31. Sinus tympani lies under

A. B. C. D.

? ? ? ?

Pyramid Cog Eustachean tube Malleus

32. Posterior wall of middle ear cavity is

A. B. C. D.

? ? ? ?

Of the same size along the entire length of the middle ear Is wider above than below Is wider below than above The communication of middle ear to the eustachean tube

33. Overall length of the malleus is

A. B. C. D.

? ? ? ?

2-4 mm 1-2 mm 15 mm 7.5 - 9 mm

34. Tendon of tensor tympani inserts into

A. B. C.

? ? ?

Anterior process of handle of malleus Medial surface of the handle of malleus Head of the malleus

D.

Close to the articular facet of the malleus

35. Commonest portion of ossicle which easily undergoes necrosis is

A. B. C. D.

? ? ? ?

Head of malleus Handle of malleus Crura of stapes Long process of incus

36. Stapedial muscle is supplied by

A. B. C. D.

? ? ? ?

Mandibular nerve Chorda tympani nerve Facial nerve Trigeminal nerve

37. Taste fibres travelling via chorda tympani nerve supplies

A. B. C. D.

? ? ? ?

The entire tongue Posterior 1/3 of tongue Lateral surface of tongue Anterior third of tongue

38. Tympanic plexus is seen over

A. B. C.

? ? ?

Lateral surface of ear drum Medial surface of ear drum Promontory

D.

Attic region

39. Mucosal lining of attic region is

A. B. C. D.

? ? ? ?

Ciliated columnar Cuboidal Squamous Pavement

40. Type of mucosa lining hypotympanum is

A. B. C. D.

? ? ? ?

Pavement epithelium Ciliated columnar epithelium Squamous epithelium Cuboidal epithelium

1. Lately I have seen many young adults with a pierced tragus. It

also has the tendency to be hairy. The English translation of tragus is what? Goat Hair Shave Mammal

2. A portion of the mandible which protrudes into the ear canal is

called what? condyle mandibular portion isthmus wisdom tooth

3. A pathology in the outer and/or middle ear causes which type of

hearing loss? sensorineural mixed wax blockage conductive

4. Two cranial nerves course parallel in the internal auditory

meatus. Which are they? Auditory and Trigeminal Facial and Optic Facial and Auditory Optic and Auditory

5. A perforation in the tympanic membrane will cause which type

of hearing loss? cochlear conductive conductive sensorineural

mixed

6. What are the correct anatomical names for the bones in the
middle ear? vice, anvil, cochlea malleus, incus, stapes tympani,eustachian, stapes cochlea, vestibule, incus

7. The anatomical feature of the ear responsible for pressure

equalization is known as what? tympanic membrane eustachian tube nasopharynx cochlear tube

8. The end organ of hearing is known as what?

organ of Corti scala media cochlea inner hair cells

9. The vestibular portion of the inner ear controls balance. What

are the main antatomical features of the vestibular apparatus? semicircular canals; saccule and utricle

vestibule, cochlear canals, utricle cochlea, semicircular canals, vestibule semicircular canals, eustachian tube, vestibule

10. Which bone houses and protects the cochlea?

temporal occipital frontal parietal