AUDITORY AND

VESTIBULAR PATHWAYS
Alexandria R. Bayaoa, M.D.
Department of Anatomy
UERMMMC, Inc.

Objectives:
Function of the cochlear system
Receptors for hearing
Tracing the pathway of sound
from the environment to the
sense organ for hearing

Objectives:
Describing the origin, course,
and termination of the cochlear
nerve
Tracing the central auditory
pathway from the organ of
Corti until the nerve impulse
reaches the auditory cortex

Objectives:
Role of the olivocochlear bundle
of Rasmussen in sound
perception
Pathways of auditory reflexes
Differentiating between
conductive and sensory
deafness

Objectives:
Explaining tinnitus, Rinnes &
Webers test
Function of the vestibular system
Parts of Static labyrinth vs
kinetic labyrinth
Location of the receptors for
vestibular control

Objectives:
Origin, course, and termination
of the vestibular nerve
Describing the role of: MLF,
medial vestibulospinal tract,
lateral vestibulospinal tract in
the maintenance of equilibrium

Objectives:
Connections of the vestibular
apparatus with the cerebellum
Define: vertigo and nystagmus
Tests for vestibular function
Clinical manifestations of
disturbances in vestibular
apparatus

EAR

Functions of the Cochlear System

Cochlea:

Auditory Pathway:

COCHLEAR NERVE NUCLEI

Snell, Richard; Clin.

Neuroanatomy, 7th ed, 2010

Auditory Pathway:

Descending Pathway

Auditory pathway lesion

Unilateral lesions of the receptors, cochlear
nerve/nuclei result to TOTAL DEAFNESS OF
THE AFFECTED EAR
Central unilateral lesions (cortex, medial
geniculate body, lateral lemniscus) result in
IMPAIRED HEARING IN BOTH EARS BUT
MORE MARKED ON THE OPPOSITE SIDE

Auditory Reflexes:
Audiomotor reflexescontractions of the tensor
tympani and stapedius ms.
General acoustic muscle reflexgeneralized jerking of the body
in response to a loud, sudden
sound

Auditory Reflexes:
Auditory-palpebral reflex- blink
of the eyelids to a loud noise
Auditory-oculogyric reflexdeviation of the eyes in the
direction of a sound
Cochleopupillary reflexdilation of the pupils to loud
noise

Dolls eye/vestibulo-ocular reflex

test of brainstem function
Head is moved from one side to the
other
The eyes will normally lag behind
then assume a midline position
Failure to lag/assume a midline=
lesion on the ipsilateral side

CHL vs SNHL

During the Weber test , the stem of a

vibrating tuning fork is placed on the
head in the midline.
If the tone is perceived in the affected
ear, this indicates a unilateral
conductive hearing loss.
In the case of unilateral sensorineural
hearing loss, the tone is heard in the
unaffected ear instead.

Rinne Test

The stem of the tuning fork is placed on the mastoid

and the subject is asked to indicate when she or he
stops hearing the sound.
The fork is then held 2.5 cm from the pinna, and the
patient is asked if she or he still hears the sound.
If the sound is still audible, air conduction is greater
than bone conduction (AC > BC in normal ear); if
not, BC > AC.

Proper recording of the Rinne test should be

"AC > BC" or "BC > AC" for each ear;
For the Weber test, "Weber R" or
"Weber L" or "Weber not referred.

Static vs Kinetic Labyrinth

Dynamic/Kinetic

Dynamic vs Static
Semicircular canals: detect
motion of the head in space
(angular acceleration)
Utricle: detect position of the
head (and body) in space
(linear acceleration)

Vestibular Pathway

Vestibular Pathway

Vestibulospinal tract

Vestibuloocular pathway

Calorics
Lying down, head tilted 30 deg
Seated, head tilted backward 60
deg
Irrigation with cold/warm water
Convection current in the endolymph
Nystagmus
COWS

Vestibular lesions
Result in impaired postural adjustments :if unilateral
the eyes, head and body will turn to the affected side
There will be vertigo and a tendency to fall to the side of the
lesion
Spontaneous nystagmus is present
Nystagmus is characterized by slow movement of the eyes
in one direction ff by rapid return to opposite side
Vestibular nerve and/or receptors : horizontal and rotatory
with fast component opposite the diseased ear
Vestibular nuclie and their central connections : usually
vertical

References:
1. Snell, R. Clinical Neuroanatomy, 7th ed. 2010
2. Gilman, S. Newman SW. Manter and Gantzs
Essentials of Clinical Neuroanatomy and
Neurophysiology, 10th ed. 2003
3. Carague-Lansang,EN, et al. 4th ed. Lansang
notes: Modules in Neuroanatomy. 2006