翻译：林靖飞 高健，校对：刘欣，王帆
Bradley L. Njaa, DVM, MVSca, *, Lynette K. Cole, DVM, MSb , Natalie Tabacca, DVM, MSc
THE MIDDLE EAR 中耳
The middle ear is an air-filled alcove fortified on nearly every fringe by bone; laterally by the tympanic portion of the temporal bone and medial surface of the tympanic membrane; ventrally by the tympanic bulla; medially by the petrous portion of the temporal bone; and dorsally by petrous portion and the tympanic portion of the temporal bone (Fig. 9).1–3 Rostrally, this chamber is open to the nasopharynx by the narrow musculotubular canal, through which penetrates the cartilage conduit of the auditory tube and the tensor veli palatine muscle.4 Finally, three auditory ossicles (malleus, incus, and stapes) form a chain of bones dorsally in the middle ear and provide a direct bony connection between the aerated external environment and the fluid environment of the perilymph of the internal ear.1,4
中耳是一个充满空气的壁龛，几乎每个边缘都有骨头加固;外侧通过颞骨的鼓膜部分和鼓膜的内表面包围;腹侧是鼓泡;内侧是颞骨的岩部;背侧是颞骨的岩部和鼓膜部。（图9）[1-3]吻侧，这个腔室通过狭窄的肌管道与鼻咽相通，肌管道穿过咽鼓管的软骨导管和腭帆张肌。[4]最后，三个听小骨(锤骨、砧骨和镫骨)在中耳的背侧形成一串，提供了通风的外部环境和内耳周围液体环境之间的直接骨连接。[1，4]
The mean middle ear cavity volume of mesaticephalic dogs as measured by computed tomography technique is 1.5 mL, and the middle ear cavity volume increases in a nonlinear fashion by body weight45 suggesting that on average when flushing the middle ear cavity during a deep ear flush or when instilling medications into the tympanic bulla that 1.5 mL should be a sufficient volume in an average-size dog.
中头型犬的平均中耳腔体积1.5 mL,以计算机断层扫描技术计算，中耳腔体积随着体重45以非线性的方式增加，表明通常以深部耳冲洗方式冲洗中耳腔或灌输药物进入鼓泡时，平均体型的犬上1.5mL应该足够。
The tympanic cavity is divided into the epitympanic recess, the tympanic cavity proper, and the ventral cavity.
The epitympanic recess is the smallest of the three areas and is occupied almost entirely by the head of the malleus and incus (see Fig. 9).1,12
The tympanic cavity proper is adjacent to the tympanic membrane.
On the medial wall of the tympanic cavity proper, there is a bony eminence, the promontory of the petrous portion of the temporal bone, which houses the cochlea.
The promontory is located opposite to the mid-dorsal aspect of the tympanic membrane.
The cochlear (round) window is located in the caudolateral portion of the promontory6,12 and is covered by a thin membrane.6
The vestibular (oval) window is located on the dorsolateral surface of the promontory, medial to the pars flaccida.1,12
Normally, the stapes is firmly lodged in the vestibular window with its baseplate held in place by the annular ligament of the vestibular window.
The largest of the three cavities is the ventral cavity, occupying the ventromedial portion of the tympanic bulla (see Fig. 9).1,2
鼓室分为；鼓室上隐窝、鼓室腔本体和腹侧腔。
鼓室上隐窝是三个区域中最小的，几乎全部被锤骨头和砧骨所占据(见图9)。[1,12]
鼓室腔本体与鼓膜相邻。
在鼓室腔本体的内侧壁，有一骨隆起，是颞骨岩部的隆突，它覆盖着耳蜗。
隆突位于鼓膜中背侧的对面。
耳蜗(圆形)窗位于隆突的尾侧 [6,12] ，被一层薄膜覆盖。[6]
前庭窗(椭圆形)位于隆突背外侧表面，松弛部内侧。[1,12]
正常情况下，镫骨固定在前庭窗内，其小板由前庭窗环状韧带固定。
三个腔中最大的是腹侧腔，腹侧腔占据鼓室的腹内侧部分(见图9)。[1,2]
Fig. 9. Right ear, rostral view, dog. The middle ear has 3 main compartments. The epitympanic recess (arrow) is the smallest, most dorsal compartment occupied by the articulated malleus and incus (I). The next largest is the tympanic cavity proper (Tp) demarcated laterally by the tympanic membrane (torn in this image) and medially by the promontory of the petrous portion of the temporal bone (P). The largest is the ventral compartment (V) surrounded by the bone of the tympanic bulla (asterisk). Ventral bony ridge of the external acoustic meatus (double asterisk); stapes (arrowhead). (Courtesy of Dr B.L. Njaa, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK.)
图 9. 犬右耳，吻侧观。中耳有三个主要的隔室。鼓室上隐窝(箭头所指)是最小的、最背侧的腔室，被锤骨和砧骨所占据(I)。第二大的是鼓室本体(Tp)，外侧面由鼓膜(图中已被撕裂的)划分，内侧由颞骨岩部的岬(P)划分。最大的是腹侧腔(V)，周围是鼓泡骨(星号)。外耳道腹侧骨平台(双星号);镫骨(箭头)。
Bs, brainstem; 脑干C, cochlea; 耳蜗Cr, cerebellar cortex; 小脑皮质E, external ear canal; 外耳道F, facial nerve in its facial canal; 面神经管中的面神经S, incomplete septum bulla. 不完全的鼓泡隔
Within the middle ear of the dog and cat is a bony septum referred to as the septum bulla (Fig. 10).1–4 In the dog, the bulla septum is a small, incomplete ridge that only makes contact with the petrous portion of the temporal bone rostrally and often has tiny, elongate bony spicules with bulbous ends.1,8 In the cat, the septum bulla abuts the petrous portion of the temporal bone and separates the tympanic cavity into two compartments: the dorsolateral epitympanic cavity (pars tympanica) and the ventromedial tympanic cavity (pars endotympanica).1,4,8
This separation is almost complete, allowing communication between the 2 compartments only through two small openings: one is between the septum bulla and petrous portion of the temporal bone and the other is located caudally, just lateral to the round window.
The difference in the size of this septum between the dog and the cat is of clinical significance in the treatment and management of middle ear disease.
Because the bulla septum is very small in the dog, resulting in a large opening between the tympanic cavity proper and the ventral bulla, this allows one to be able to flush the entire tympanic bulla.
In the cat, it is only possible to flush the dorsolateral compartment of the tympanic bulla because it is divided into two compartments.
Therefore,in most cases of middle ear disease in the cat, surgical management of the ear disease is necessary.
In addition, one needs to avoid the use of ointment-based medications or otic packing material instilled into the ear of the cat with a ruptured tympanic membrane, because the medication may leak into the large ventromedial compartment and become trapped.
在犬猫的中耳内有一个骨隔，称为鼓泡隔 (图10)。[1-4]犬的鼓泡隔是一个小而不完整的脊，只与颞骨岩部相连，通常有微小的，细长的骨性针状体和球根状末端。[1,8] 猫的鼓泡隔紧靠颞骨岩部，将鼓室分成两个腔室:背外侧鼓室(鼓泡部)和腹内侧鼓室(内鼓泡部)。[1,4,8]
这种分隔几乎封闭的，两个隔室之间只能通过两个小口相通:一个位于鼓泡隔和颞骨岩部之间另一个位于后侧，紧邻圆窗的外侧。
犬猫这个鼓泡隔的大小差异在中耳疾病的治疗和管理中具有重要的临床意义。
因为犬鼓室隔很小，导致鼓室本体和腹侧腔之间有一个很大的开口，这样就可以冲洗整个鼓室。
在猫，只能冲洗鼓泡的背外侧鼓室，因为鼓泡被分成两个隔室。
因此，在猫中耳疾病的大多数情况下，手术治疗耳部疾病是必要的。
此外，鼓膜撕裂时，还应避免使用药膏或耳朵填充材料灌入，因为这些药物可能会渗漏到大的腹内侧隔室而无法洗出。
Fig. 10. Septum bullae. (A) Right ear, caudoventral view, dog. The septum bulla (S) is incomplete separating the tympanic cavity proper from the ventral tympanic cavity (V). Dorsorostrally, the auditory tube is visible (arrow). (B) Left ear, ventral view, cat. The septum bulla (S) is complete and abuts (double asterisk) the petrous portion of the temporal bone (P). Caudally, there is an open communication (arrow) between the two cavities formed by the septum bulla. (Courtesy of Dr B.L. Njaa, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK.)
图 10. 鼓泡隔(A)右耳，后腹侧观，犬。鼓泡隔(S)不完全分开鼓室本体与腹侧鼓室腔（V）。背前侧可见咽鼓管(箭头)。(B)左耳，腹侧观，猫。鼓泡隔(S)完整，与颞骨岩部(P)相邻(双星号)。在尾部，有一个开口(箭头)在两腔之间形成的鼓泡隔。
Tympanic bulla (asterisk). 鼓泡（星号）M, manubrium of the malleus; 锤骨柄P, petrous portion of the temporal bone; 颞骨岩部Tm, tympanic membrane. 鼓膜
Tympanic bulla (asterisk). 鼓泡（星号）R, round window; 圆窗V, ventral tympanic cavity. 腹侧鼓泡腔
AUDITORY OSSICLES 听小骨
The auditory ossicular chain formed by articulations between the malleus and incus, or the incudomallearis joint, and the incus and the stapes, or the incudostapedius joint, functions as a lever system.
In concert with the marked difference in surface area between the tympanic membrane and the footplate of the stapes, the net result is amplification of the initial air pressure wave to account for the increase impedance of the fluid in the membranous labyrinthine compartment of the cochlear of the internal ear.44
听骨链由锤骨和砧骨(或砧锤关节)、砧骨和镫骨(或砧镫关节)之间的关节组成，起杠杆系统的作用。
对比鼓膜表面积和镫骨小板表面积明显不同，最终的结果是将最初的空气压力放大，以应对内耳耳蜗中膜迷路内液体阻抗的增加。[44]
The malleus, the largest of the auditory ossicles, has a long process, the manubrium, embedded in the tympanic membrane（TM）. Projecting rostrally from the neck of the malleus is the muscular process, the attachment site for the tensor tympani muscle. [url=]Dorsally, the head of the malleus and body of the incus articulate to form the incudomallearis joint, anchored in the epitympanic recess by ligaments.[/url]
A small branch of the facial nerve, the chorda tympani, exits the facial canal, passes beneath the base of the muscular process of the malleus medial to but in close proximity to the pars flaccida before exiting the middle ear (see Fig. 8).1,2,4
Once beyond the ear, the chorda tympani merges with the lingual branch of the mandibular nerve (cranial nerve V) once exiting through a canal in the rostrodorsal wall of the tympanic bulla to innervate the rostral third of the tongue.1 Otitis media and traumatic or surgical rupture dorsal in the tympanic membrane can potentially result in impairment of taste.
锤骨是最大的听小骨，有一个长柄，附着于鼓膜（TM）的内面。锤骨颈有条肌肉向吻侧延伸，是鼓膜张肌附着点。在背侧，锤骨头和砧骨体关节窝形成了砧锤关节，通过韧带固定在鼓室上隐窝。
鼓索，面神经的一个小分支， 从锤骨内侧肌肉基部下方通过，在出中耳前，靠近鼓膜松弛部。（见图8）[1,2,4]
一旦穿过耳部，鼓索神经则与下颌神经（第五脑神经）的舌神经支汇合，一旦从鼓泡前背侧骨壁通道穿出，即可支配舌部前三分之一区域的运动。中耳炎和鼓膜背侧创伤性或手术性破损，可导致味觉功能受损。
The incus is much smaller that the malleus with two bony extensions or crura (Fig. 11). Although the short crus is largely anchored in the epitympanic recess along with the incudomallearis joint, the long crus extends medially and caudally from the malleus to articulate with the stapes (see Fig. 8).1,2,8 At the distal, medial end of the long crus is a small flat bone, the lenticular process, that articulates with the head of the stapes to form the incudostapedius joint (shown in Figs. 1 and 3 in the article by Garosi elsewhere in this issue).1,2,4,8
砧骨比锤骨小得多，有两个延伸骨或腿（图11）。虽然短腿与砧锤关节一起主要固定在鼓室上隐窝，但是长腿从锤骨向中间和尾部延伸至镫骨，以关节相连。
The smallest of the auditory ossicles, the stapes, is a triangular bone that is anchored in the oval or vestibular window by its annular ligament (see Figs. 8 and 11). It functions as a piston that transduces tympanic membrane vibrations to fluid waves in the perilymph of the internal ear membranous labyrinthine compartments. [1,2,8]
听小骨中最小的镫骨是三角形骨，通过其环形韧带固定在椭圆窗或前庭窗内(见图8和图11)。它起活塞的作用，将鼓膜振动转换为内耳膜迷路的外淋巴液流动波.1,2,8
The facial nerve enters the internal acoustic meatus and travels through the facial canal of the petrous portion of the temporal bone, exiting the skull through the stylomastoid foramen immediately caudal to the external acoustic meatus.1–3,8
The facial canal is a bony tunnel that courses through the petrous portion of the temporal bone. In a small region caudal and dorsal to the caudal crus of the stapes, this bony canal is incomplete and exposed to the middle ear compartment. The opening corresponds to the region where the tendon of the stapedius muscle emerges and inserts near the head of the stapes (Fig. 12; also shown in Fig. 1 in the article by Garosi elsewhere in this issue).
This opening also corresponds to the location where otitis media can infiltrate through connective tissue and result in facial neuritis. Otitis media resulting in facial nerve paralysis causes facial drooping or spasms and ocular signs. If the patient develops a head tilt, this is a clinical indication of vestibulocochlear nerve involvement caused by an ascending otitis interna (see the article by Garosi elsewhere in this issue).
面神经进入内耳道并穿过颞骨岩部的面神经管，通过茎乳突孔离开颅骨，直接到达外耳道尾侧。[1-3,8]
面神经管是穿过颞骨岩部的骨隧道。位于镫骨尾侧腿的尾侧和背侧一小块区域内，该骨通道不完整，并暴露于中耳内。开口对应于镫骨肌肌腱出现并插入镫骨头部附近的区域（图12）
该开口还对应于中耳炎可通过结缔组织浸润并导致面神经炎的位置。导致面神经麻痹的中耳炎引起面部下垂或痉挛和眼部症状。如果患者出现头部倾斜，这是由内耳炎上行波及前庭神经的临床指征。
Fig. 11 Auditory ossicles, right ear, dog.
图 11. 听小骨，犬右耳。
The stapes is the smallest bone with a narrow head (Sh), a broader foot plate (Fp), and an attachment site close to the head for the tendon of the stapedius muscle. The malleus and incus are articulated to form the incudomallearis joint (Im). The malleus has a long manubrium (M) That is embedded in the tympanic membrane, a neck (Mn), and head (Mh). The incus has a body (Ib), short crus (Sc), and long crus (Lc). At the end of the long crus is the lenticular process (Lp) that articulates with the head of the stapes to form the incudostapedius joint. Insertion site for tendon of stapedius muscle (St). (Courtesy of Dr B.L. Njaa, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK.)
镫骨是最小的骨，具有较窄的头部(Sh)，较宽的小板(Fp)，和靠近头部的镫骨肌腱附着点。锤骨和砧骨连接形成砧锤关节（Im）。锤骨有一个长柄（M），嵌在鼓膜、锤骨颈（Mn）和锤骨头（Mh）。砧骨有砧骨体（Ib）、砧骨长腿（Sc）和砧骨短腿（Lc）。砧骨长脚的末端是饼状突（Lp），与镫骨头部连接形成砧镫关节。镫骨肌肌腱连接点（St）。
Fig. 12. Right middle ear, dog.
图 12. 犬右侧中耳。
In this ventral view, the facial nerve (double asterisk) is exposed caudal to the stapes (S) with an incomplete bony ridge of the facial canal (arrowhead) visible dorsally. The tendon of the stapedius muscle (arrow) emerges from the same opening in the facial canal. C, chorda tympani; E, epitympanic recess; I, incus; M, muscular process of the malleus; P, promontory; R, round window; T, tensor tympani muscle. (Courtesy of Dr B.L. Njaa, DVM, MVSc, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK.)
犬右侧中耳，腹侧图观，犬面神经（双星号）暴露于镫骨尾部，背侧可见面神经通道的一段没有骨骼的边界（箭头）。镫骨肌的肌腱（箭头）从面神经管的相同开口出现。
C、 鼓索；E，鼓室上隐窝；I，砧骨；M，锤骨肌；P， 隆突；R，椭圆窗；T，鼓膜张肌。
THE AUDITORY TUBE 咽鼓管
The auditory tube is a short canal that extends from the nasopharynx to the rostral portion of the tympanic cavity proper (Fig. 13). It functions to equalize pressure on both sides of the tympanic membrane.46 The auditory tube is divided into three portions: (1) cartilaginous (proximal and opens into the nasopharyx); (2) junctional (part of tube at which the cartilaginous and osseous portions connect); and (3) the osseous potion (distal and opens into the rostral middle ear). The osseous portion of the auditory tube is patent at all times, whereas the cartilaginous portion is closed at rest and opens during swallowing.47
咽鼓管是一条短通道，从鼻咽延伸到鼓室的吻侧部分（图13）。它的作用是平衡鼓膜两侧的压力。[46]咽鼓管分为三部分：（1）软骨部分（近端和开口进入鼻咽）；（2）结合部（软骨和骨质部分相连接的管的一部分）；（3）骨质部分（远端和开口进入中耳吻侧）。咽鼓管的骨质部分始终是打开的，而软骨部分在休息时关闭并在吞咽期间打开.[47]
Contraction of the levator muscle and tensor palatini muscle function in concert to open the auditory tube. The entrance to the auditory tube is obscured behind the soft palate, midway between the caudal aspect of the nares and the caudal border of the soft palate.12 Based on contrast-enhanced computed tomographic imaging, the auditory tube originates from the rostral, dorsomedial aspect of the bulla and enters the dorsolateral aspect of the nasopharynx just caudal to the hamulus process of the pterygoid bone.48
腭提肌和腭张肌的收缩协同作用可以打开咽鼓管。咽鼓管的入口隐藏在软腭后面，在鼻后侧和软腭后侧边缘的中间位置。[12]基于增强计算机断层扫描成像，咽鼓管起源于鼓泡吻侧背内侧，进入鼻咽部背外侧，正好在翼状骨钩状突的后部。[48]
Fig. 13. Auditory tubes, dog.
图 13. 犬咽鼓管。
Both tympanic bullae (asterisks) are exposed after removal of the mandible and associated muscles. Bilaterally opening into the nasopharynx (N) are the auditory tubes (arrows). Sutures were placed and used to hold the auditory tubes open. However, they are typically closed. (Courtesy of Dr B.L. Njaa, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK.)
双侧鼓泡(星号)在切除下颌骨及相关肌肉后均暴露。双侧开口进入鼻咽（N）的即咽鼓管(箭头)。放置了缝线来保持咽鼓管打开。然而，它们通常是关闭的。
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发表于 2021-2-12 17:01:08
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