Histology of Otorhinolaryngo,

Head and Neck

dr. Ira Cinta Lestari, M.Sc
Histology Dept.
Medical Faculty
Universitas Islam Sumatera Utara
EARS: THE VESTIBULOAUDITORY SYSTEM
External Ear

stratified squamous epithelium

small hair follicles (F)
sebaceous glands (SG)
ceruminous glands (CG)  modified apocrine sweat glands
cerumen (C)  secretions from SG and CG
Tympanic membrane (eardrum)
• External side  epidermis
• Inner surface  simple cuboidal epithelium
• Between the two epithelial  fibrous
connective tissue layer  collagen, elastic
fibers and fibroblasts.
• Vibrations of the tympanic membrane
produced by sound waves transmit sound
wave energy to the middle and inner ear
Middle Ear

• Tympanic cavity  simple cuboidal

epithelium
• Auditory tube  ciliated pseudostratified
columnar epithelium
• The tympanic membrane is connected to
the oval window by auditory ossicles
(malleus, incus, stapes)
• 2 small skeletal muscles (tensor timpani,
stapedius)
Eustachian Tube – Auditory Tube

1. Eustachian tube
2. Bone
3. Stapes, hyaline tube cartilage (ossicle)
4. Basal plate (closes the oval window),
lamina membranacea
5. Pressure compensation tube with parietal
multilayered ciliated epithelium, which
contains goblet cells
6. Lamina propria with lymphocytes
Inner Ear
SACCULE AND UTRICLE
Hair cells and hair bundles
Ampullae and cristae of the semicircular ducts
Mechanotransduction in hair cells
Cochlea and spiral organ
Cochlea and spiral organ

basilar membrane (BM)

tectorial membrane (TM)
spiral limbus (SL)
inner hair cells (IHC)
outer hair cells (OHC)
inner phalangeal cells (IP)
outer phalangeal cells (OP)
inner pillar cells (IPC)
outer pillar cells (OPC)
inner tunnel (IT)
other supporting cells (SC)
outer tunnel (OT)
cochlear nerve (CN)
Cochlear duct and spiral ganglion

spiral organ (SO)

cochlear duct (CD)
stria vascularis (STV)
periosteum of the bone (B)
scala vestibuli (SV)
scala tympani (ST)
spiral ganglion (SG)
Sound waves and movements in the ear
Nasal Cavity
• External vestibule  the epithelium loses its keratinized
• Internal nasal cavities (nasal fossae)
• Nasal septum
• Conchae
The middle and inferior conchae respiratory epithelium
the superior conchae olfactory epithelium
lamina propria of the conchae  large venous plexuses (swell bodies)
Nasal Cavity
• The nasal cavity is divided into right and left halves by the cartilaginous and bony
nasal septum.
• Each half of the nasal cavity is bounded laterally by a bony wall and a cartilaginous
ala (wing) of the nose
• It communicates with the outside, anteriorly, via the naris (nostril) and with the
nasopharynx by way of the choana.
• Projecting from the bony lateral wall are three thin scroll-like bony shelves,
situated one above the other: the superior, middle, and inferior nasal conchae.
Anterior Portion of the Nasal Cavity
• The anterior portion of the nasal cavity, in the vicinity of the nares, is dilated and
is known as the vestibule.
• This region is lined with thin skin and has vibrissae-short, stiff hairs that prevent
larger dust particles from entering the nasal cavity.
• The dermis of the vestibule houses numerous sebaceous and sweat glands.
• The dermis is anchored by numerous collagen bundles to the perichondria of the
hyaline cartilage segments that form the supporting skeleton of the ala.
Posterior Aspect of the Nasal Cavity
• Except for the vestibule and the olfactory region, the nasal cavity is lined by
pseudostratified ciliated columnar epithelium, frequently called the respiratory
epithelium, which is well endowed with goblet cells in the more posterior regions
of the nasal cavity.
• The subepithelial connective tissue (lamina propria) is richly vascularized,
especially in the region of the conchae and the anterior aspect of the nasal
septum, housing large arterial plexuses and venous sinuses.
• The lamina propria has many seromucous glands and abundant lymphoid
elements, including occasional lymphoid nodules, mast cells, and plasma cells.
• Antibodies produced by plasma cells (immunoglobulins IgA, IgE, and IgG) protect
the nasal mucosa against inhaled antigens as well as against microbial invasion.
Clinical Correlations
• Nasal bleeding usually occurs from Kiesselbach's area, the anteroinferior region of
the nasal septum, which is the site of anastomosis of the arterial supply of the
nasal mucosa.
• The bleeding may be arrested by applying pressure on the region or by packing
the nasal cavity with cotton.
Olfactory Region of the Nasal Cavity
The olfactory region comprises the olfactory epithelium and the underlying lamina propria
that houses Bowman's glands and a rich vascular plexus.
Olfactory epithelium and olfactory receptors
The olfactory epithelium is located on the inferior surface of the cribriform plate and superior nasal conchae.
Olfactory Epithelium

 Supporting cells and Olfactory

glands are innervated by
branches of the facial (VII) nerve
The olfactory epithelium consists of olfactory receptors, supporting cells, and basal cells.
Olfactory Epithelium

olfactory cilia (Ci), basal cell (BC), olfactory cell (OC), lamina propria (LP)
OLFACTORY CELLS
• Olfactory cells are bipolar neurons whose apical aspect, the distal terminus of its
slender dendrite, is modified to form a bulb, the olfactory vesicle, which projects
above the surface of the sustentacular cells.
• The nucleus of the cell is spherical and is closer to the basal lamina than to the
olfactory vesicle.
• Six to eight long, nonmotile olfactory cilia extend from the olfactory vesicle and lie
on the free surface of the epithelium.
• The basal region of the olfactory cell is its axon, which penetrates the basal lamina
and joins similar axons to form bundles of nerve fibers.
• The nerve fibers pass through the cribriform plate in the roof of the nasal cavity to
synapse with secondary neurons in the olfactory bulb
Sustentacular cells/ Supporting cells
• Are columnar cells, 50 to 60 μm tall, whose apical aspects have a striated border
composed of microvilli.
• Their oval nuclei are in the apical third of the cell, somewhat superficial to the
location of the olfactory cell nuclei.
• The apical cytoplasm of these cells has secretory granules housing a yellow
pigment whose color is characteristic of the olfactory mucosa.
• These cells are believed to provide physical support, nourishment, and electrical
insulation for the olfactory cells.
Basal cells
• Two types, horizontal and globose.
 Horizontal cells are flat and lie against the basement membrane
 Globose cells are short, basophilic, pyramid-shaped cells whose apical aspects do not
reach the epithelial surface. Their nuclei are centrally located, but because these are
short cells, the nuclei occupy the basal third of the epithelium.
• The globose type of basal cells have considerable proliferative capacity and can
replace both sustentacular and olfactory cells.
• In a healthy person, the olfactory cells live for less than three months and
sustentacular cells have a life span of less than a year.
• The horizontal basal cells replicate to replace the globose basal cells.
Lamina propria
• The lamina propria of the olfactory mucosa is composed of a richly vascularized,
loose to dense, irregular collagenous connective tissue that is firmly attached to
the underlying periosteum.
• It houses numerous lymphoid elements as well as the collection of axons of the
olfactory cells, which form fascicles of unmyelinated nerve fibers.
• Bowman's glands (olfactory glands), which produce a serous secretory product,
are also present and are indicative of the olfactory mucosa.
• These glands release IgA, lactoferrin, lysozyme, and odorant-binding protein, a
molecule that prevents the odorant from leaving the region of the olfactory
epithelium, thus enhancing a person's ability to detect odors.
Clinical Correlations
• The nasal mucosa is protected from dehydration by alternating blood flow to the
venous sinuses of the lamina propria overlying the conchae of the right and left
nasal cavities.
• The erectile tissue-like region (swell bodies) of one side expands when its venous
sinuses become engorged with blood, reducing the flow of air through that side.
See page of plasma from the sinuses and seromucous secretions from the glands
thus rehydrate the mucosa approximately every half hour
• Chemical irritants and particulate matter are removed from the nasal cavity by the
sneeze reflex. The sudden explosive expulsion of air usually clears the nasal
passage of the irritant
Sinuses & Nasopharynx
• Paranasal sinuses :
• thinner respiratory epithelium with fewer goblet cells
• the lamina propria contains only a few small glands

• Sinusitis???
• obstruction of drainage orifices
• immotile cilia syndrome  defective ciliary action

• Nasopharynx
• the first part of the pharynx
• it is lined with respiratory epithelium
• contains the medial pharyngeal tonsil
• contains bilateral openings of the auditory tubes to each middle ear
Larynx Short passageway for air between the pharynx and trachea.
Its wall contains skeletal muscles and pieces of cartilage  for sound production.

Laryngeal vestibule (LV)

Seromucous glands (G)
Vestibular folds (VF)
lymphoid nodules (L)
Ventricle (V)
Vocal folds or cords (VC)
Striated vocalis muscle (VM)
Larynx
Larynx
• The wall of the larynx is reinforced by
• Hyaline cartilages  thyroid and cricoid cartilages, the inferior aspect of the arytenoids
• Elastic cartilages  epiglottis, corniculate and cuneiform cartilages, the superior aspect
of the arytenoids
• These cartilages are connected to one another by ligaments, and their movements
with respect to one another are controlled by intrinsic and extrinsic skeletal
muscles.
Larynx
• The lumen of the larynx is characterized by two pairs of shelf-like folds :
• the superiorly positioned vestibular folds  immovable.
• the inferiorly placed vocal folds  reinforced by dense, regular elastic connective
tissue, the vocal ligament.
• Their lamina propria, composed of loose connective tissue, seromucous glands,
adipose cells, and lymphoid
• The vocalis muscle  attached to the vocal ligament, assists the other intrinsic
muscles of the larynx in altering the tension on the vocal folds.
• These muscles also regulate the width of the space between the vocal folds (the
rima glottidis), thus permitting precisely regulated vibrations of their free edges
by the exhaled air.
Larynx
• The larynx is lined by pseudostratified ciliated columnar epithelium, except on
the superior surfaces of the epiglottis and vocal folds, which are covered by
stratified squamous nonkeratinized epithelium.
• The cilia of the larynx beat toward the pharynx, transporting mucus and trapped
particulate matter toward the mouth to be expectorated or swallowed.
Clinical Correlations
• Laryngitis (inflammation of the laryngeal tissues, including the vocal folds)
prevents the vocal folds from vibrating freely. Persons suffering from laryngitis
sound hoarse or can only whisper.
• The presence of chemical irritants or particulate matter in the upper air passages,
including the trachea or bronchi, elicits the cough reflex, producing an explosive
rush of air in an effort to remove the irritant.
Resume
References