Vestibulocochlear Nerve

It appears in the groove b/w pons medulla oblongata

behind the facial nerve and in front of inferior
cerebellar peduncle. It contains two sets of fibers
,although differing in their principal central
connexions ,are both concerned in the transmission of
afferent impulses from the internal ear to brain
VESTIBULAR NERVE nerve of equilibration
COCHLEAR NERVE nerve of hearing

COCHLEAR NERVE
It is connected with brainstem by afferent and efferent
nerves.
 AFFERENT fibers ; sensory information to brain
 cell bodies in spiral
ganglion
 terminal dendrites make
contact with hair cells

 30,000 mylinated n, fibers

 95% enter the type1 cells in
spiral ganglion these cells
are bipolar, large cells.
TERMINAL dendrites
reach 3500 inner hair cells.
Each inner hair cells have
10 dendrites synapsing
around lower part of cell
bodies
  5% intertype 2 cells in
spiral ganglion and supply
Outer hair cells 12000 .These fibers leave spiral
ganglion run first across the floor of tunnel of corti and
descend up to 1mm within an outer spiral bundle of
nerve fibers
before being distributed to 10 or more OUTER HAIR
CELLS in various rows.

EFFERENT FIBRES ; Pass directly through the spiral

ganglion as, their cell bodies are located in the brain
stem (few in number )
Terminate mainly on several outer hair cells and supply
few inner hair cells. Dense innervation at BASE of
cochlea and decreases towards the APEX

The COCHLEAR NERVE FIBRES enter in the

internal auditory meatus and merge with vestibular
nerve, the two divisions’ now one bundle can be
identified more medially by shallow groove running
longitudinally along the bundle
CLINICAL IMPORTANCE; Vestibular neurectomy
Some outer fibres of
cochlear division are sacrificed; High frequency’; not
clinically significant

The Facial nerve and Cochlear nerves rotate about 90

degree in passing thru I.A.M. And C.P. angle so that by
the time it reaches brainstem the facial nerve is
ROSTRAL to 8TH nerve
Both nerves are separated at brainstem by
ANTERIOR INFERIOR CEREBELLAR ARTERY.

CLINICAL IMPORTANCE; Supplies inferior and

lateral part of cerebellum and has a branch
LABRYNTHINE ARTERY so it should be preserved
during surgery in this region

COCHLEAR NERVE enters the anterior surface

of brainstem at lower border of pons on lateral side of
the Facial nerve and separated from it by vestibular
nerve .On entering the pons COCHLEAR nerve divides
in to two branches, which enter the cochlear nuclei
situated on either side of INFERIOR CEREBELLAR
PEDUNCLE

VENTRAL COCHLEAR NUCLEUS;

functions as a simple relay for afferent information.
DORSAL COCHLEAR NUCLEUS:
it has complex response properties and contributes to
complex signal analysis; their output axons by pass next
nucleus and end in the nuclei of lateral lemniscus and
inferior colliculus.
From cochlear nuclei the fibres project to SUPERIOR
OLIVARY COMPLEX .
It receives input from both sides
Ipsilateral input is predominantly excitatory
Contralateral input is inhibitory
INTER AURAL INTENSITY DISPARITIES and hence
code the direction of sound in space
INTER AURAL TIMING ;and hence codes direction of
sound in space on basis of timing difference

The axons now ascend thru posterior part

of pons and midbrain and form a tract LATERAL
LEMINISCUS; each lateral leminiscus therefore
consists of 3rd order neurons from both sides, some of
them relay in nucleus of lateral leminiscus
On reaching MIDBRAIN the fibres enter
INFERIOR COLLICULUS
It receives afferent from both sides of cochlear nuclei
and SOC .Commissural fibers link the two auditory
pathways at level of inferior colliculus and auditory
reflexes are mediated thru the
colliculus,tectospinal,tectobulbar tract and medial
longitudinal fascicules.
From inferior colliculus fibres enter
MEDIAL GENICULATE BODY ,
It is the thalamic auditory relay station. Here the final
neurons of hearing form acoustic radiation, which
passes below lentiform nucleus to AUDITORY
CORTEX Area 41, 42 situated in superior temporal
gyros, immediately below lateral sulcus .
HEARING is relayed equally from each ear to acoustic
cortex of both sides, so for deafness in either ear to arise
from central causes the acoustic paths from both ears
must be damaged.
CENTRIFUGAL PATHWAYS
 Olivocochlear bundle arises from superior olivary
regions of both sides of brainstem ,it decreases the
auditory input when subject is attending to stimuli in
another modality.
It is responsible for auditory discrimination in
presence of noise.

CLINICAL APPLICATION OF CENTRAL

AUDITORY PATHWAY

ELECTRIC RESPONSE AUDIOMETRY

AIM; is to record the potentials that arise in the
auditory system as a result of sound stimulation.
They are of value in
1) Estimation of hearing.
2)D/D
3) Identification of site of lesion.
4) Clinical monitoring; pharmacological
Effects, coma.
TYPES OF E.R .A
1)Electrocochleography
2)Brain stem evoked response audiometry
3)Cortical electric response audiometry
 Comparison of techniques of E.R.A

Electrodes Effect of Portion of Reliability

anaesthesia auditory
system
tested
ECocG Promontory none peripheral Excellent
BSERA Surface none Brainstem good
CERA Surface marked Entire fair

ELECTROCOCHLEOGRAPHY
It is the measurement of the electrical output of
cochlea and 8th nerve in response to auditory stimuli.
1) Cochlear Micro phonics
2) Summating Potentials
3) Action Potentials

COCHLEAR MICROPHONICS

Helps in differentiation of cochlear and retro cochlear

lesion.
If present means HAIR CELLS are intact
When impaired means LOSS OF HAIR CELLS in
spiral organ
When present in pt with total hearing loss implies that
lesion is central to cochlea
SUMMATING POTENTIALS
 It is the direct current shift of the base line of recording
and is always negative for all frequencies and intensities
in man.
SOURCE is hair cells Important in meniers
disease,markedly negative S.P.

ACTION POTENTIALS
It is the average response of the discharge pattern of
many auditory neurons.
In pt with normal hearing A.P can be elecited within 5
to 10db of pt,s behavioral threshold, at the high
intensities the potential is large consistent ,easily
recordable and reproducible

CLINICAL APPLICATION;
1)Threshold testing
2)Meniers disease
3)Acoustic neuroma
 BSERA

CLINICAL APPLICATION

1)In peadiatrics ,threshold of hearing,

screening the high risk group of neonates

2)Detecting lesion involving middle ear ,

cochlea ,8th nerve,brainstem

A series of seven waves are recorded during the first

10m.s following sound stimulation

The latency of wave 5 is the measure used most

often in BSERA. WAVE 5 is dependent on stimulus
intensity. As the I of stimulus increases ,there is
shortening of the latency

Interaural latency difference of wave 5 is ,< 0.2m.s.

In acoustic neuroma IT5 is > 0.2m.s

Interval between wave 3 and wave5 is 1.9+- 0.1m.s

In acoustic neuroma larger than 3c.m T(5-3) is2.1-

2.8m.s

Intra axial pontine masses which impinge on

auditory tract produce loss of BSER.The level of mass
can be predicted on presence or absence of succeeding
Brain stem responses.
Absence of BSR is an early indication of multiple
sclerosis.
CORTICAL ELECTRIC RESPONSEAUDIOMETRY

It involves the measurement of the potentials that arise

in the auditory system above the brainstem.An
advantage of CERA is that ,in measuring the most
central responses , the entire auditory mechanism is
tested.Responses can thus be best equated with clinical
hearing. Major disadvantage of CERA is that the
potentials are markedly affected by
anaesthesia,sleep,and sedation.So it is more difficult to
perform in clinical setting.

ACOUSTIC REFLEX MEASUREMENT

Loud sounds directed into either ear causes bilateral

contraction of stapedius muscle in each ear.

Afferent limb of the arc is formed by middle

ear,cochlea and auditory division of 8th cranial nerve.

Efferent limb is formed by 7th cranial nerve,stapedius

muscle and stapes.

Minimum sound intensity required to produce

this response is70—95db above threshold.Frequency
Of 500—4000hz are best used clinically
In middle ear disorder tympanogram+ acoustic reflex
threshold are abnormal.

In cochlear disorder tympanogram+acoustic reflex

threshold are usually normal. Only in patients with
severe cochlear hearing loss>80db,ARmay not be
observed because the reflex eliciting sound can never be
made sufficiently intense.

In neural deafness abnormally fast decay of reflex or

absence of reflex is noted.