山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (5): 6-10.doi: 10.6040/j.issn.1673-3770.1.2019.038

• 专家笔谈 • 上一篇    下一篇

中耳肌肉生理及病理

韩朝1,2,3(),丁娟1,2,3   

  1. 1. 复旦大学附属眼耳鼻咽喉医院耳鼻喉科
    2. 上海听觉医学中心
    3. 国家卫生健康委员会听觉医学重点实验室（复旦大学），上海 200031
  • 收稿日期:2019-06-06 修回日期:2019-08-06 出版日期:2019-09-20 发布日期:2019-10-15
  • 通讯作者: 韩朝 E-mail:sfhanzao@163.com
  • 作者简介:韩朝，复旦大学附属眼耳鼻喉科医院副主任医师，硕士生导师。主要学术任职：中国中西医结合学会第七届耳鼻咽喉科专业委员会委员兼秘书、耳鸣专家学组副主任兼委员，上海中西医结合学会第六届耳鼻咽喉科专业委员会委员兼秘书，上海市听觉与前庭专科委员会委员兼秘书，《中国中西医结合耳鼻喉咽喉科杂志》常务编委。全国第一个耳鸣公益网站——耳鸣之光www.tinnitus-light.org创始人之一。以第一作者及通讯作者发表SCI收录论文12篇（总分29.414），以第一作者及通讯作者发表中文论文30篇，负责国家自然科学基金面上项目1项，上海市科委自然科学基金项目2项。擅长耳鸣、眩晕、耳聋的诊断和治疗。
  • 基金资助:
    国家自然科学基金面上项目(81371093);上海市自然科学基金项目(18ZR1406100)

Physiology and pathology review of the middle ear muscles

Zhao HAN1,2,3(),Juan DING1,2,3   

  1. 1. Department of Otorhinolaryngology, Eye and Nasopharyngeal Hospital, Fudan University
    2. Shanghai Hearing Medicine Center
    3. Key Laboratory of Auditory Medicine, National Health and Wellness Committee (Fudan University), Shanghai 200031, China
  • Received:2019-06-06 Revised:2019-08-06 Online:2019-09-20 Published:2019-10-15
  • Contact: Zhao HAN E-mail:sfhanzao@163.com

RichHTML

1229

PDF (PC)

1120

摘要：

中耳肌肉是耳部“降噪系统”中最为关键的部分，其在持续监测声学输入和动态调节听觉灵敏度方面发挥着重要的保护作用。当中耳肌肉收缩时, 它们将镫骨推入卵圆窗, 并增加内耳膜迷路内液体的压力。如果中耳肌肉失去调节内耳压力的能力, 如强直、痉挛或肌张力障碍, 产生的异常压力将对内耳压力产生影响, 并导致许多问题, 如耳鸣、梅尼埃病和感音神经性听力损失等。综述中耳肌肉的生理构造及各自所起的作用，讨论中耳肌肉功能紊乱与耳部疾病的联系。

关键词: 中耳肌肉, 鼓膜张肌, 镫骨肌, 梅尼埃病, 听觉过敏

Abstract:

With the complex anatomy of the human ear, we need to better understand the physiological and pathological characteristics of the “noise reduction system” of the ear, the most critical part being the middle ear muscle (MEM). MEMs play an important protective role by constantly monitoring acoustic input and dynamically adjusting hearing sensitivity, to enhance external sounds and to reduce transmission of loud sound through the middle ear. If the MEMs lose the ability to regulate cramps, spasms, or dystonia in the ear, the resulting abnormal pressure can have a significant impact on internal cellular pressure, which can cause some otologic disorders including tinnitus, Meniere’s disease, and sensorineural hearing loss. This literature review aims to explain the physiological structure and function of MEMs and discuss several otological disorders associated with MEM dysfunction.

Key words: Middle ear muscle, Tensor tympani muscle, Stapedius muscle, Meniere’s disease, Hyperacusis

中图分类号: 

  • R764

图1

中耳内部结构"

图2

中耳肌肉。A图显示附加在锤骨上的鼓膜张肌(红色)和附着于镫骨的镫骨肌(灰色)。当鼓膜张肌收缩时，听骨链被向前拉，迫使镫骨进入耳蜗，并提高内耳膜迷路内液体的压力。B图来自组织病理学的三维重建，中耳肌呈红色，听骨链呈黄色，鼓膜呈绿色。箭头表示由鼓膜张肌收缩引起的运动。图片由R.Pennings和M.Bance，Dalhosie大学提供[20]。"

1 Mukerji S , Windsor AM , Lee DJ . Auditory brainstem circuits that mediate the middle ear muscle reflex[J]. Trends Amplif, 2010, 14(3): 170-191. doi:10.1177/1084713810381771 .
doi: 10.1177/1084713810381771
2 Bance M , Makki FM , Garland P. ,et al . Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle [J].The Laryngoscope,2013, 123:1021-1027. doi:10.1002/lary.23711 .
doi: 10.1002/lary.23711
3 Simmons FB . LXI perceptual theories of middle ear muscle function [J]. Trans Am Otol Soc,1964,73(3):724-739. doi: 10.1177/000348946407300312 .
doi: 10.1177/000348946407300312
4 Magen HS , Kang M , Tiede MK , et al . Posterior Pharyngeal Wall Position in the Production of Speech[J]. J Speech Lang Hear Res. 2003 Feb;46(1):241-251. doi: 10.1044/1092-43882003/019 .
doi: 10.1044/1092-43882003/019
5 Mukerji S , Windsor AM , Lee DJ . Auditory brainstem circuits that mediate the middle ear muscle reflex[J]. Trends Amplif, 2010, 14(3): 170-191. doi:10.1177/1084713810381771 .
doi: 10.1177/1084713810381771
6 Feeney MP , Keefe DH , Hunter LL ,et al . Normative Wideband Reflectance, Equivalent Admittance at the Tympanic Membrane, and Acoustic Stapedius Reflex Threshold in Adults[J]. Ear Hear. 2017 May/Jun;38(3):e142-e160. doi: 10.1097/AUD.0000000000000399 .
doi: 10.1097/AUD.0000000000000399
7 Moller A . Hearing: Anatomy, Physiology, and Disorders of the Auditory System[M].(2nd ed.. San Diego USA: Elsevier, 2006: 8-9.
8 Dammeijer PF , van Dijk P , Manni JJ , et al . Stapedius muscle fiber characterization during postnatal development in the rat[J]. Hear Res, 2006, 219(1/2): 48-55. doi:10.1016/j.heares.2006.05.003 .
doi: 10.1016/j.heares.2006.05.003
9 Anniko M , Wroblewski R . Ultrastructure and elemental composition of the stapedius muscle in guinea pig[J]. Arch Otorhinolaryngol, 1981, 230(2): 109-112.doi:10.1007/bf00456139 .
doi: 10.1007/bf00456139
10 Lyon MJ , Malmgren LT . A histochemical characterization of muscle fiber types in the middle ear muscles of the cat. 1. The stapedius muscle[J]. Acta Otolaryngol, 1982, 94(1/2): 99-109. doi:10.3109/00016488209128
doi: 10.3109/00016488209128
11 Shankland W . The trigeminal nerve. part IV: the mandibular division[J]. J of craniomandibular practice, 2001,19(3):153-161.doi: 10.1080/08869634.2001.117
doi: 10.1080/08869634.2001.117
46164.
doi: 10.1080/08869634.2001.117
12 Neergaard EB , Andersen HC , Hansen CC , et al . Experimental studies on sound transmission in the human ear. iii. influence of the stapedius and tensor sympani muscles[J]. Acta Otolaryngol Suppl, 1964, 188: SUPPL 188:280+.doi:10.3109/00016486409134577 .
doi: 10.3109/00016486409134577
13 Lyon MJ , Malmgren LT . Muscle fiber types in the cat middle ear muscles. II. Tensor tympani[J]. Arch Otolaryngol Head Neck Surg, 1988, 114(4): 404-409.doi:10.1001/archotol.1988.01860160048019 .
doi: 10.1001/archotol.1988.01860160048019
14 Girardet R . Contribution to the study of the innervation of the tensor tympani [J]. Arch Anat Histol Embryol, 1960, 43(2): 121-164.[非正式结果,仅供参考]
15 2nd Shankland WE . The trigeminal nerve. Part IV: the mandibular division[J]. Cranio, 2001, 19(3): 153-161.
16 Drake R , Vogl AW and Mitchell AWM . Gray’s anatomy for students [M] (3rd edition). Philadelphia: Elsevier/Churchill Livingstone,2005:902-942.
17 Gulya AJ , Minor LB and Poe DS . Surgery of the ear[M] (6th Edition). Connecticut USA: People’s medical publishing house, 2010: 38-40.
18 Raghavan P and Gandhi D . Tinnitus: Imaging, Endovascular and Surgical Approaches, An issue of Neuroimaging Clinics of North America. Philadelphia USA: Elsevier, 2016:201-205.
19 Suga N , Shimozawa T . Neural attenuation of lateral lemniscal responses to self-vocalized sounds in echolocating bats[J]. J Acoust Soc Am, 1974, 55(2): 479. doi:10.1121/1.3438008 .
doi: 10.1121/1.3438008
20 Bell A . How do middle ear muscles protect the cochlea? Reconsideration of the intralabyrinthine pressure theory[J]. J Hear Sci, 2011,1(2):9-23.
21 Klockhoff I . Middle ear muscle reflexes in man. A clinical and experimental study with special reference to diagnostic problems in hearing impairment[J]. Acta Otolaryngol Suppl, 1961, 164: 1-92.
22 Klockhoff IH , Anderson H . Recording of the stapedius reflex elicited by cutaneous stimulation; preliminary report[J]. Acta Otolaryngol, 1959, 50: 451-454. doi:10.3109/00016485909129218 .
doi: 10.3109/00016485909129218
23 Terkildsen K . Acoustic reflexes of the human musculus tensor tympani[J]. Acta Otolaryngol Suppl, 1960, 158: 230-238.
24 Kaffenberger TM , Mandal R , Schaitkin BM , et al . Palatal botulinum toxin as a novel therapy for objective tinnitus in forced eyelid closure syndrome[J]. Laryngoscope, 2017, 127(5): 1199-1201. doi:10.1002/lary. 26191 .
doi: 10.1002/lary. 26191
25 Wersall R . The tympanic muscles and their reflexes; physiology and pharmacology with special regard to noise generation by the muscles[J]. Acta Otolaryngol Suppl, 1958, 139: 1-112.
26 Simmons FB . LXI perceptual theories of middle ear muscle function [J]. Trans Am Otol Soc,1964,73(3):724-739. doi: 10.1177/000348946407300312 .
doi: 10.1177/000348946407300312
27 Schwartze H . Zur tenotomie des tensor tympani[J]. Archiv F Ohrenheilkunde, 1876, 11(2): 124-126. doi:10.1007/bf02209374 .
doi: 10.1007/bf02209374
28 Vassiliou A , Vlastarakos P , Maragoudakis P , et al . Menieres disease:still a mystery disease with difficult differential diagnosis [J]. Ann Indian Acad Neurol, 2011, 14(1): 12-18.
29 Bance M , Makki FM , Garland P , et al . Effects of tensor tympani muscle contraction on the middle ear and markers of a contracted muscle[J]. Laryngoscope, 2013, 123(4): 1021-1027. doi:10.1002/lary.23711 .
doi: 10.1002/lary.23711
30 Kirikae I . An experimental study on the fundamental mechanism of bone conduction[J]. Acta Otolaryngol Suppl, 1959, 145: 1-111.
31 Simmons FB . Variable nature of the middle ear muscle reflex[J]. Int Audiol, 1964, 3(2): 136-146. doi:10.3109/05384916409074078 .
doi: 10.3109/05384916409074078
32 Shearer WM . Speech: behavior of middle ear muscle during stuttering[J]. Science, 1966, 152(3726): 1280. doi:10.1126/science.152.3726.1280 .
doi: 10.1126/science.152.3726.1280
33 Klockhoff I , Anderson H . Reflex activity in the tensor tympani muscle recorded in man; preliminary report[J]. Acta Otolaryngol, 1960, 51: 184-188. doi:10.3109/00016486009124480 .
doi: 10.3109/00016486009124480
34 Bell A . How do middle ear muscles protect the cochlea? Reconsideration of the intralabyrinthine pressure theory[J]. J Hear Sci, 2011，1(2):9-23.
35 Rowan D , Kapadia S , Lutman ME . Does static ear canal pressure influence pure tone pitch perception?[J]. Acta Otolaryngol, 2004, 124(3): 286-289. doi:10. 1080/00016480310000511 .
doi: 10. 1080/00016480310000511
36 Mattox DE . Unsolved mysteries of Meniere’s disease[M]. In: Harris JP, editor. Meniere’s Disease. The Hague: Kugler, 1999: 409-418.
37 Klockhoff I . Impedance fluctuation and a “tensor tympani syndrome”. Fourth International Symposium on Acoustic Impedance Measurements; Lisbon: Universidade Nova de Lisboa. 1981.
38 Westcott M , Sanchez TG , Diges I , et al . Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: a multi-clinic prevalence study[J]. Noise Health, 2013, 15(63): 117-128. doi:10.4103/1463-1741.110295 .
doi: 10.4103/1463-1741.110295
39 Tensor Tympani Syndrome . Website:
40 Mascarello F , Carpenè E , Veggetti A , et al . The tensor tympani muscle of cat and dog contains IIM and slow-tonic fibres: an unusual combination of fibre types[J]. J Muscle Res Cell Motil, 1982, 3(3): 363-374.doi:10.1007/BF00713043 .
doi: 10.1007/BF00713043
41 Han Y , Wang J , Fischman DA , et al . Slow tonic muscle fibers in the thyroarytenoid muscles of human vocal folds; a possible specialization for speech[J]. Anat Rec, 1999, 256(2): 146-157. doi:10.1002/ (SICI) 1097-0185(1999 1001)256:2<146:AID-AR5>3.0.CO;2-842.
doi: 10.1002/
42 Ramirez Aristeguieta LM , Ballesteros Acuña LE, Sandoval Ortiz GP . Tensor veli palatini and tensor tympani muscles: Anatomical, functional and symptomatic links[J]. Acta Otorrinolaringologica Engl Ed, 2010, 61(1): 26-33. doi:10.1016/s2173-5735(10)70005-3 .
doi: 10.1016/s2173-5735(10)70005-3
43 Kierner AC , Zelenka I , Lukas JR , et al . Observations on the number, distribution and morphological peculiarities of muscle spindles in the tensor tympani and stapedius muscle of man[J]. Hear Res, 1999, 135(1/2): 71-77.doi:10.1016/s0378-5955(99)00092-1 .
doi: 10.1016/s0378-5955(99)00092-1
[1] 王登元,陈智斌,王杪琳. 伴发梅尼埃病的良性阵发性位置性眩晕的临床特点[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 61-65.
[2] 侯小兵,任同力,张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 37-40.
[3] 廖礼兵,刘绮明,宗凌,翟锦明,张建国. 42例耳鸣伴听觉过敏患者特征分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 31-36.
[4] 刘旭晖,黄魏宁,孟曦曦,刘芳,陈敏,傅元,张晨,张媛媛. 梅尼埃病患者内耳内淋巴间隙的比值与正常受试者的比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 39-42.
[5] 张运波,习国平,靳红芳,王彩君. 非手术序列化治疗单侧梅尼埃病48例[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 73-76.
[6] 苏怡, 张革化, 曾祥丽. 早期梅尼埃病患者前庭诱发肌源性电位的特征[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 26-29.
[7] 菅慧蓉，于刚，陈刚，林乃芬，王海波. 绝经后梅尼埃病女性雌激素水平与听-前庭功能关系的研究[J]. 山东大学耳鼻喉眼学报, 2012, 26(2): 39-41.
[8] 于海洋， 孙丰林， 张增，王卫国. 鼻内镜下经咽鼓管鼓室内置管注药治疗梅尼埃病[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 64-.
[9] 吴佳欐1，陈文文1，罗禹2，童军1，邓亚新1，单良1，方旭华1. 突发聋和梅尼埃病鼓室灌注疗效与内耳MRI显影相关性[J]. 山东大学耳鼻喉眼学报, 2011, 25(4): 38-40.
[10] 赵晓燕,王建明,黄 安 . 前庭诱发肌源性电位对眩晕患者的诊断价值[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 43-45 .
[11] 谭杰,张榕 . 内淋巴囊的神经分布[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 493-496 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发