Auditory and Vestibular Systems April 19, 2010 1.

Understand the differences between auditory pathways and the general sensory pathways in their organizations a. Auditory pathway: has 4 neurons in its system i. Has a series of accessory/regulatory nuclei (e.g. superior olivary nucleus, trapezoid body) that influence the pathway b. General sensory pathways: have only 3 neurons 2. Know where the auditory pathways start, what some of the relay stations are, before information is transmitted to the cortex

Superior Olivary Nucleus (SON): sends bilateral axons to the inferior colliculus makes auditory pathway bilateral!

a. b. Because of the bilateral innervations arising from the SON as well as the inferior colliculus (crossing in the commissure of the inferior colliculus), the information that reaches the primary auditory cortex comes from BOTH EARS i. However, info comes predominantly from CONTRALATERAL EAR ii. This is why unilateral lesions in the brain stem only cause a slight hearing loss, with a little more in the contralateral ear c. Superior Olivary Nucleus i. Olivocochlear bundle: efferents from SON

1. Reach outer hair cells in the cochlea dampen inner hair response to loud noise (PROTECTIVE) 3. Know where the primary and secondary (association) cortices are located a. Primary auditory cortex: transverse gyrus (of Heschle) b. Auditory association cortex: superior temporal gyrus 4. Know the concept of tonotropic localization a. Auditory pathways exhibit a tonotropic localization of auditory stimuli b. Different frequencies of sound are received by hair cells in select areas of the spiral organ, which is retained throughout the pathways and the auditory cortex i. Basilar membrane: allows us to discriminate the pitch of sound we hear 1. Apex: lower frequency 2. Base (near the round/oval windows): higher frequency 5. Identify several levels along the transmission of auditory information where pathology can lead to a loss/diminution of hearing
Location External/middle ear Type of hearing loss Conduction deafness Pathologies/causes Wax in the external ear; ruptured tympanic membrane; fluid in middle ear; otosclerosis Aging; ototoxicity (e.g. aminoglycosides), loud sounds; vestibular schwannoma

Spiral organ/CN VIII

Sensorineural deafness

6. Know the basic anatomy of the vestibular nuclei and their connections a. Located in the lateral angle of the 4th ventricle b. Afferents: input from vestibular sensory organs via vestibular part of CN VIII c. Efferents: project to i. Abducens nuclei, MLF, CN III and CN IV nuclei vestibulo-ocular reflex (VOR)

ii. LMN via vestibulospinal tracts bilateral control of neck muscles to stabilize our head when it changes position iii. Ipsilateral vestibulocerebellum coordination of eye movments and head movements 7. Know the basics of the mechanisms of caloric, rotary, and optokinetic nystagmus a. Optokinetic nystagmus: in response to focusing on a fast moving object; activated by vision i. E.g. train is passing on the right eyes follow slowly to the right rapid eye movement to the left (left nystagmus) b. Rotary nystagmus: in response to rotating objects i. E.g. spinning in a chair to the right eyes gaze slowly in opposite direction rapid eye movement back to direction of rotation (right nystagmus) c. Caloric nystagmus: in response to cold/warm water i. Cold: nystagmus to the side opposite where water was poured ii. Warm: nystagmus to the same side as which water was poured 8. Explain what dolls eyes are and its significance in a comatose patient a. Dolls eyes: vestibulo-ocular reflex b. Normal: eyes will stay looking straight c. Coma: when head rotates, eyes move with the head (no nystagmus)