Auditory and Vestibular Pathways

The auditory and vestibular pathways are anatomically related but discrete pathways that permit conscious perception of and reaction to sound and spatial orientation. Stimulation of specialized hair cells in the cochlea and vestibular apparatus excite and send signals through partitions of the vestibulocochlear nerve (CN VIII) to the brainstem, where they synapse on various targets, send and receive other projections, and ultimately contribute to spatial orientation and perception of sound.

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Auditory Pathway

The auditory pathway of the brain begins with the external auditory canal and includes the middle/inner ear and eventually the brainstem nuclei before sending final signals to the primary auditory cortex in the temporal lobe.

Components

  • Peripheral components:
    • Outer ear:
      • Auditory canal and tympanic membrane
      • Transfers sound waves 
    • Middle ear:
      • Airspace with 3 ossicles (malleus, incus, stapes)
      • Conducts and amplifies sound
    • Inner ear:
      • Fluid-filled cochlea
      • Tonotopy of basilar membrane: low frequency heard at apex and high frequency heard at base
      • Vibration transduced via hair cells → auditory nerve signaling (CN VIII) → brainstem
  • Central components:
    • Consist of the organ of Corti and brainstem auditory nuclei
    • Afferent fibers convey information from the organ of Corti → auditory nuclei in the brainstem:
      • Cochlear nuclei: located at the dorsolateral side of the brainstem at the pontomedullary junction
      • Superior olivary nuclei: located in the pons
      • Lateral lemniscal nuclei: tract of axons in the brainstem carrying auditory information to the inferior colliculus of the midbrain
      • Inferior colliculus: located in the midbrain
      • Medial geniculate body of the thalamus: part of thalamic relay system
      • Auditory cortex: located in the anterior and posterior transverse temporal areas
Nuclei involved in auditory sensation

This image illustrates the nuclei involved in auditory sensation. Each of the parts plays an important role in the conduction of auditory information from CN VIII up to the cortex.

Image by Lecturio.

Circuitry of pathway

Outer ear → inner ear → depolarization of cochlear hair cells in the cochlea → both the ipsilateral and contralateral superior olivary nucleus → lateral lemniscus → inferior colliculus → medial geniculate bodies of the thalamus → auditory cortex of temporal lobe

Pathway of sound

Image depicting the pathway of sound from the cochlea to the level of the auditory cortex with multilevel axial slices through the brainstem

Image: “Auditory Pathway” by Jonathan E. Peelle. License: CC BY 4.0

Vestibular Pathway

The vestibular pathway of the brain begins with the utricle and saccule, with additional input from the semicircular canals. Information eventually reaches the brainstem nuclei before sending final signals to the thalamus and cerebellum.

  • Monitors the orientation of the body with respect to gravity and stimulates the vestibulospinal tracts to elicit compensatory movements
  • Head position relative to gravity is sensed by the 2 otolith organs, the utricle and saccule:
    • Utricle: oriented horizontally
    • Saccule: oriented vertically
  • Angular acceleration of the head is sensed by the 3 semicircular canals.
  • Hair cells in the utricle, saccule, and semicircular canals are displaced based on their position relative to gravity, leading to depolarization and stimulation of the vestibular portion of CN VIII.
  • Afferent fibers of the vestibular apparatus convey information to 4 pairs of vestibular nuclei (superior, lateral, inferior, and medial) in the medulla and pons.
    • Vestibular nuclei inputs:
      • 1st-order afferents in vestibular ganglion
      • Cerebellum: flocculonodular lobe
    • Vestibular nuclei outputs:
      • Oculomotor, trochlear, and abducens nuclei via medial longitudinal fasciculus (MLF)
      • Thalamus
      • Cerebellum: flocculonodular lobe via inferior cerebellar peduncle
      • Descending motor tract of lateral vestibulospinal tract
      • Descending motor tract of medial vestibulospinal tract
Intricate pathways of the vestibular system

This image demonstrates the intricate pathways of the vestibular system.
Note the flow of information. Depolarization of hair cells in the inner ear sends auditory information to the vestibular ganglia, which transmits this information to the vestibular nuclei (also receives input from the cerebellum).
From here, the vestibular nuclei send information to CN III, IV, and VI to dictate eye movement. The vestibular nuclei also send information to the thalamus, cerebellum, and medial and lateral vestibulospinal tracts, allowing for perception, integration, and adjustments of body position within space.

Image by Lecturio.

Vestibular pathway outputs

Table: Vestibular pathway outputs
Anatomical structureFunction
Cranial nerve nucleiControl over eye movements
ThalamusConscious perception of movement and gravity through connections to cortex
Cerebellum (flocculonodular lobe)Coordination of postural adjustments
Lateral vestibulospinal tractWalking upright
Medial vestibulospinal tractAssisting in integration of head and eye movements

Clinical Relevance

  • Acoustic neuroma: an acoustic neuroma is a benign tumor of Schwann cells that involves the cranial nerves within the cranium. Acoustic neuromas most frequently affect CV VIII but can also impact CN VII due to the location in the cerebellopontine angle. Acoustic neuromas often present with hearing loss and tinnitus. Treatment is with surgical removal.
  • Hearing loss: hearing impairments are classified into conductive hearing loss and sensorineural hearing loss. Conductive hearing loss comes about when there is a problem transferring sound waves anywhere along the pathway from the outer ear, the tympanic membrane, or middle ear. In cases of sensorineural hearing loss, there is an error in the transmission of auditory stimuli from the cochlea to the auditory nuclei.
  • Vertigo: the sensation of movement between oneself and the surroundings when no movement is actually occurring. Vertigo is not limited to a feeling of rotation (spinning); other forms include upward lifting, swaying, rocking, and unsystematic movement. Vertigo most often occurs due to problems within the semicircular canals.

References

  1. Park, JK, & Vernick, DM. (2020). Vestibular schwannoma (Acoustic neuroma). UpToDate. Retrieved May 26, 2021, from https://www.uptodate.com/contents/vestibular-schwannoma-acoustic-neuroma
  2. Kutz, JW. (2020). Acoustic neuroma. Medscape. Retrieved May 26, 2021, from https://emedicine.medscape.com/article/882876-overview
  3. Stanton, M, & Freeman, AM. (2021). Vertigo. StatPearls. Treasure Island (FL): StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK482356/
  4. Barrett, KE, Barman, SM, Boitano, S, & Reckelhoff, JF. (2017). Hearing & equilibrium. In Ganong’s Medical Physiology Examination; Board Review. McGraw-Hill Education. http://accessmedicine.mhmedical.com/content.aspx?aid=1142554680 
  5. Wipperman, J. (2021). Dizziness and vertigo. In Conn’s Current Therapy 2021, pp. 9–14. Elsevier. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323790062000045 
  6. Walker, MF, & Daroff RB. (2018). Dizziness and vertigo. In Jameson, J, et al. (Eds.), Harrison’s Principles of Internal Medicine, 20e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?sectionid=192011330&bookid=2129&Resultclick=2 
  7. Kerber, K. (2021). Dizziness. DeckerMed Medicine. Retrieved September 15, 2021, from https://doi.org/10.2310/PSYCH.6089
  8. Isaacson, B. (2010). Hearing loss. Medical Clinics of North America. 94(5), 973–988. https://doi.org/http://dx.doi.org/10.1016/j.mcna.2010.05.003 
  9. Shapiro, SB, et al. (2021). Hearing loss and tinnitus. Medical Clinics of North America. 105(5), 799–811. https://doi.org/http://dx.doi.org/10.1016/j.mcna.2021.05.003 
  10. Molina, FJ. (2012). Chapter 18: Hearing loss. In Henderson, MC, Tierney, LM, & Smetana, GW. (Eds.), The Patient History: An Evidence-Based Approach to Differential Diagnosis, 2e. The McGraw-Hill Companies. http://accessmedicine.mhmedical.com/content.aspx?aid=56852049 
  11. Berkowitz, AL. (2016). The auditory and vestibular pathways and approach to hearing loss and dizziness/vertigo: Cranial nerve 8. In Clinical Neurology and Neuroanatomy: A Localization-Based Approach. McGraw-Hill Education. http://accessmedicine.mhmedical.com/content.aspx?aid=1160204039 
  12. Krogmann, RJ, & Al Khalili, Y. (2021) Cochlear Implants. StatPearls. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544280/

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