MCAT · Perception, Cognition, Emotion

Auditory System Structure and Processing (6A)

How the ear transforms pressure waves into neural signals that the brain interprets as sound.

MCAT emblem with a laboratory flask, DNA, and a brain.
Inside this lesson 10 sections 5 questions 7 figures

SECTION 1

Historical Context & Motivation

The scientific study of hearing spans centuries and integrates contributions from physics, anatomy, and neuroscience. Early anatomists dissected the temporal bone and marveled at the intricate chain of ossicles, yet the mechanism by which vibrations became perception remained enigmatic. Understanding the auditory system required breakthroughs in both mechanics and electrophysiology — from Helmholtz's resonance theory to Békésy's Nobel-winning work on cochlear traveling waves. For the MCAT, this topic bridges sensory physiology with cognitive perception, testing your ability to trace a stimulus from its physical origin through transduction to cortical processing.

1561 • Fallopius Describes the Cochlea

Gabriele Fallopius, the Italian anatomist, provided the first detailed anatomical description of the cochlea, establishing the snail-shaped structure as a critical component of the inner ear.

1863 • Helmholtz's Resonance Theory

Hermann von Helmholtz proposed that different locations along the basilar membrane resonate at different frequencies, analogous to piano strings, laying the groundwork for tonotopic theory.

1928 • Békésy's Traveling Wave

Georg von Békésy demonstrated that sound creates a traveling wave along the basilar membrane, with the peak amplitude location varying by frequency. He received the Nobel Prize in 1961 for this work.

1978 • Discovery of Otoacoustic Emissions

David Kemp detected sounds emitted by the cochlea itself, providing evidence for active amplification by outer hair cells — a paradigm shift in cochlear physiology.

2000s • Molecular Basis of Mechanotransduction

Identification of tip-link proteins (e.g., cadherin-23 and protocadherin-15) and the mechanotransduction channel candidates revealed the molecular machinery that converts stereocilia deflection into ionic currents.

The central question driving auditory research has always been: how does a pressure wave traveling through air become a specific, consciously experienced pitch, timbre, and spatial location? Answering this demands an understanding of how mechanical energy is funneled through the outer and middle ear, transduced by hair cells in the cochlea, encoded as action potentials in the auditory nerve, and processed through successive relay stations up to the auditory cortex. This lesson traces that entire pathway.

SECTION 2

Core Principles of Auditory Processing

Auditory processing can be decomposed into several foundational principles, each of which the MCAT can test directly. Sound begins as a longitudinal pressure wave — alternating compressions and rarefactions of air molecules — characterized by frequency (perceived as pitch, measured in Hz), amplitude (perceived as loudness, measured in dB), and waveform complexity (perceived as timbre). The ear captures these physical parameters and faithfully encodes them as neural signals through a multi-stage process involving mechanical amplification, fluid dynamics, and electrochemical transduction.

1

Impedance Matching

Sound passes from air (low impedance) to cochlear fluid (high impedance). Without the middle ear's ossicular chain and tympanic membrane area-ratio advantage, ~99.9% of energy would be reflected. The ossicles provide ~22 dB of gain to overcome this impedance mismatch.
2

Tonotopic Organization

The basilar membrane is frequency-tuned along its length: the base (narrow, stiff) resonates to high frequencies, while the apex (wide, flexible) responds to low frequencies. This mapping is preserved throughout the central auditory pathway.
3

Mechanotransduction

Deflection of inner hair cell stereocilia opens mechanically gated ion channels via tip links. K⁺ influx from endolymph depolarizes the cell, triggering neurotransmitter release onto afferent auditory nerve fibers.
4

Temporal & Place Coding

Place theory explains high-frequency discrimination (>4 kHz) through basilar membrane location. Temporal (volley) theory explains low-frequency coding (<4 kHz) through phase-locked firing patterns.
5

Binaural Processing

Sound localization relies on interaural time differences (ITDs, for low frequencies) and interaural level differences (ILDs, for high frequencies), processed in the superior olivary complex of the brainstem.
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KEY TAKEAWAY

Think of the auditory system as a sophisticated analog-to-digital converter. The outer ear acts as a satellite dish, funneling signals. The middle ear is a mechanical amplifier that matches impedance — like a transformer stepping up voltage for long-distance power transmission. The cochlea performs a real-time Fourier decomposition, separating a complex waveform into frequency components along the basilar membrane. Inner hair cells then digitize this information into discrete neural spikes, analogous to sampling a continuous signal.

SECTION 3

Anatomy of the Auditory Pathway

Pathway from Sound Wave to Auditory CortexPinnaEACEar CanalMiddle EarTympanicMembraneOssiclesMalleus→Incus→StapesCochleaBasilar membrane+ Hair cellsCN VIIIAuditory NerveBrainstemCochlear nucleiSup. olivarycomplexInf. colliculus(midbrain)MGBThalamusA1 CortexSuperior temporal gyrusOUTER EARMIDDLE EARINNER EARPERIPHERALCENTRAL PATHWAYSoundwave
The auditory pathway traced from a sound wave entering the pinna, through the ossicular chain of the middle ear, into the cochlea, along CN VIII to the brainstem relay nuclei (cochlear nuclei → superior olivary complex → inferior colliculus), through the medial geniculate body (MGB) of the thalamus, and finally to the primary auditory cortex (A1) in the superior temporal gyrus.

The diagram above illustrates the serial processing architecture of the auditory system. Sound first enters the external acoustic canal (EAC), which acts as a resonant tube amplifying frequencies near 3 kHz — the range most critical for speech intelligibility. The tympanic membrane converts airborne pressure fluctuations into mechanical vibrations of the ossicles. The three ossicles — malleus, incus, and stapes — form a lever system whose footplate pushes on the oval window. Because the oval window's area is roughly 17× smaller than the tympanic membrane, pressure is amplified (pressure = force ÷ area). This area ratio, combined with the lever advantage of the ossicles, achieves the impedance matching needed to efficiently transfer energy into the fluid-filled cochlea.

Within the cochlea, the vibrations generate a traveling wave on the basilar membrane. The wave's peak displacement location encodes frequency: high-frequency sounds peak near the base, low-frequency sounds near the apex. At the peak, inner hair cells (IHCs) transduce mechanical motion into receptor potentials, while outer hair cells (OHCs) actively sharpen frequency tuning through electromotility — a prestin-dependent process that amplifies the traveling wave by up to 40 dB. The neural signal then ascends through the brainstem relay nuclei, where successive levels extract increasingly complex features: the cochlear nuclei process basic spectrotemporal features, the superior olivary complex computes binaural cues, and the inferior colliculus integrates multisensory information before the signal reaches the thalamic medial geniculate body and ultimately the primary auditory cortex (A1) in the superior temporal gyrus.

SECTION 4

Mechanotransduction and Signal Encoding

The process by which mechanical displacement becomes an electrical signal is the heart of auditory transduction. Within the organ of Corti, the basilar membrane vibration causes shearing forces between the basilar membrane and the overlying tectorial membrane. This shear deflects the stereocilia of hair cells, gating mechanically sensitive ion channels.

The Endocochlear Potential and K⁺ Influx

The cochlea maintains a unique ionic environment. The scala media (cochlear duct) is filled with endolymph, a K⁺-rich, Na⁺-poor fluid maintained by the stria vascularis. The stria vascularis establishes the endocochlear potential of approximately +80 mV. Because the resting potential of a hair cell is about −45 mV, the total driving force for K⁺ entry through open transduction channels is approximately 125 mV — an unusually large electrochemical gradient that ensures rapid, reliable transduction. Note that unlike most neurons, K⁺ entry depolarizes hair cells because the driving force is directed inward due to the high endolymph [K⁺] and the positive endocochlear potential.

DRIVING FORCE FOR K⁺ ENTRY

Vdriving=Eendolymph−Vhaircell≈(+80mV)−(−45mV)=+125mVV_driving = E_endolymph − V_hair cell ≈ (+80 mV) − (−45 mV) = +125 mV

Eendolymph = endocochlear potential (+80 mV); Vhair cell = resting membrane potential of hair cell (−45 mV). The large net driving force ensures high sensitivity of mechanotransduction.

Inner vs. Outer Hair Cells

The cochlea contains approximately 3,500 inner hair cells (IHCs) arranged in a single row and about 12,000 outer hair cells (OHCs) arranged in three rows. Despite being outnumbered ~3.5:1, IHCs are the primary sensory receptors: approximately 95% of afferent auditory nerve fibers (Type I spiral ganglion neurons) synapse on IHCs. OHCs receive predominantly efferent innervation from the medial olivocochlear bundle. Their role is cochlear amplification — OHCs contain the motor protein prestin, which causes them to change length in response to voltage changes (somatic electromotility). This active process sharpens frequency tuning and amplifies quiet sounds by ~40–60 dB.

SOUND INTENSITY IN DECIBELS

β=10×log10(I/I0)β = 10 × log₁₀(I / I₀)

β = sound level in dB; I = intensity of the sound (W/m²); I₀ = reference intensity = 10⁻¹² W/m². A 10 dB increase corresponds to a 10-fold increase in intensity. Doubling perceived loudness requires approximately a 10 dB increase.

Frequency Encoding: Place and Temporal Codes

Frequency information is encoded via two complementary mechanisms. Place coding relies on the tonotopic organization of the basilar membrane: different frequency components activate hair cells at different positions. This mechanism is most reliable for frequencies above ~4 kHz. Temporal coding (or phase-locking) utilizes the timing of action potentials, which fire in synchrony with the phase of the sound wave. Individual neurons can phase-lock up to about 1 kHz; however, through the volley principle, groups of neurons collectively encode frequencies up to ~4–5 kHz. Above 5 kHz, temporal coding becomes unreliable, and the system relies almost exclusively on place coding.

SECTION 5

Central Auditory Pathway and Cortical Processing

Central Auditory Pathway — Ascending Relay StationsCochlea (Hair Cells)CN VIII (Auditory Nerve)Cochlear Nuclei(Dorsal & Ventral — Ipsilateral)IpsilateralContralateralSuperior Olivary Complex (SOC)First site of binaural convergence — computes ITDs & ILDsLateral LemniscusInferior Colliculus (Midbrain)Medial Geniculate BodyPrimary Auditory Cortex (A1)← Sound localization← Multisensory integration← Thalamic relay
The ascending central auditory pathway. After leaving the cochlea, fibers synapse in the cochlear nuclei (ipsilateral, in the medulla). Many fibers then cross the midline to reach the superior olivary complex (SOC), the first station for binaural processing. Signals ascend via the lateral lemniscus to the inferior colliculus, then to the medial geniculate body (thalamus), and finally to A1.

Several key processing principles emerge from the central auditory pathway. First, bilateral representation begins early: fibers from one ear project to both cochlear nuclei, and by the level of the SOC, binaural input has converged. This contrasts with the visual system, where contralateral representation dominates until the cortex. Second, tonotopic maps are maintained at every level — from cochlea to A1. Third, the pathway includes both ascending (lemniscal) projections and descending (corticofugal) projections that modulate processing at lower levels, providing top-down attentional control over auditory processing.

StructureLevelKey Function
Cochlear NucleiMedullaFirst central synapse; spectral and temporal feature extraction; onset/offset coding
Superior Olivary ComplexPonsFirst binaural station; computes ITDs (MSO) and ILDs (LSO) for sound localization
Inferior ColliculusMidbrainIntegrative hub; virtually all ascending fibers synapse here; multisensory convergence
Medial Geniculate BodyThalamusThalamic relay to cortex; gates auditory information; modulated by attention
Primary Auditory Cortex (A1)Temporal lobeTonotopically organized; processes complex sounds; feeds into association cortex (Wernicke's area)

Summary of central auditory relay stations

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MCAT Pearl

Unlike unilateral lesions of the visual pathway (which produce contralateral visual field deficits), unilateral lesions of the central auditory pathway above the cochlear nuclei rarely cause complete deafness in one ear. This is because of the extensive bilateral projections — each ear is represented bilaterally by the level of the SOC. Unilateral cortical lesions may impair sound localization and complex auditory processing but typically spare basic tone detection.

SECTION 6

Worked Example: Tracing a Sound Through the Auditory System

Consider the following MCAT-style scenario: A 440 Hz tone (concert pitch A) at 60 dB is presented to the right ear of a patient. Trace the signal through the auditory system and identify the coding mechanism for frequency and the first brainstem nucleus where this input converges with input from the left ear.

Signal Tracing: 440 Hz Tone at 60 dB to Right Ear

  1. 1

    Step 1 — Outer Ear Collection & Resonance

    The 440 Hz sound wave enters the right pinna, which provides modest direction-dependent filtering. It travels through the external acoustic canal (~2.5 cm), which resonates near 3 kHz. Since 440 Hz is well below the resonant peak, the canal provides minimal amplification at this frequency.
    Sound reaches the tympanic membrane with minimal canal gain at 440 Hz.
  2. 2

    Step 2 — Middle Ear Impedance Matching

    The tympanic membrane vibrates, transferring energy to the malleus → incus → stapes chain. The area ratio (~17:1 for tympanic membrane to oval window) and ossicular lever ratio (~1.3:1) together provide approximately 22 dB of gain: 20 × log₁₀(17 × 1.3) ≈ 20 × log₁₀(22.1) ≈ 26.9 dB (theoretical), with real measurements closer to 20–25 dB in the physiological range.
    Impedance mismatch overcome; ~20–25 dB gain transmitted to oval window.
  3. 3

    Step 3 — Cochlear Traveling Wave

    Stapes footplate vibration creates a traveling wave in the perilymph of the scala vestibuli. This wave propagates along the basilar membrane. At 440 Hz (a relatively low frequency), the traveling wave reaches its peak displacement near the apex of the cochlea, where the membrane is widest and most compliant.
    Peak displacement at apical region; tonotopic place code for 440 Hz established.
  4. 4

    Step 4 — Frequency Coding Mechanism

    440 Hz falls below the ~4 kHz boundary, so both place coding and temporal (phase-locked) coding contribute. Auditory nerve fibers fire at specific phases of the 440 Hz cycle. Individual neurons can phase-lock at 440 Hz, and the volley principle provides additional fidelity.
    Dual coding: place code (apical basilar membrane) + temporal code (phase-locking at 440 Hz).
  5. 5

    Step 5 — Binaural Convergence

    Type I spiral ganglion neurons (right CN VIII) carry the signal to the right cochlear nuclei. From there, many fibers cross the midline (via the trapezoid body) to reach the contralateral superior olivary complex. The superior olivary complex (SOC) is the first brainstem nucleus where input from both ears converges. The medial superior olive (MSO) within the SOC would process interaural time differences for this 440 Hz tone — ideal for low-frequency ITD computation.
    First binaural convergence = Superior Olivary Complex (SOC). The MSO computes ITDs for this low-frequency stimulus.

SECTION 7

Types of Hearing Loss & Clinical Correlates

Understanding auditory anatomy directly informs the classification of hearing loss, a topic frequently tested on the MCAT. Hearing loss is broadly divided into conductive and sensorineural types, with distinct etiologies, affected structures, and clinical presentations. The Weber and Rinne tests — which use a tuning fork to compare air conduction (AC) and bone conduction (BC) — are classic exam topics.

FeatureConductive Hearing LossSensorineural Hearing Loss
Affected StructureOuter or middle ear (e.g., cerumen impaction, otitis media, otosclerosis)Cochlea (hair cells) or CN VIII (e.g., noise damage, presbycusis, acoustic neuroma)
Weber TestLateralizes to the affected ear (bone conduction bypasses the block, and ambient noise masking is reduced)Lateralizes to the unaffected ear (the damaged cochlea/nerve cannot transduce the signal)
Rinne TestAbnormal (negative): BC > AC in affected earNormal (positive): AC > BC bilaterally, but both diminished in affected ear
ReversibilityOften reversible (antibiotics for infection, surgery for otosclerosis)Usually irreversible; cochlear implants may bypass damaged hair cells
Frequency RangeTends to attenuate all frequencies relatively equallyOften preferentially affects high frequencies first (noise-induced, presbycusis)

Comparison of conductive vs. sensorineural hearing loss

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KEY TAKEAWAY

A useful mnemonic for the Weber test: in conductive loss, the sound lateralizes toward the affected ear — think of it as the affected ear being in a 'quiet room' (less ambient noise masking), so bone-conducted sound seems louder there. In sensorineural loss, the sound lateralizes away from the affected ear because the cochlea/nerve is damaged and cannot process the signal. This distinction is analogous to a speaker system: conductive loss is a blocked cable (fixable), while sensorineural loss is a blown speaker (structural damage).

SECTION 8

Connections to Higher-Order Auditory Processing

Beyond basic transduction and relay, the MCAT expects familiarity with how auditory information interfaces with language processing, emotional evaluation, and attention. The primary auditory cortex (A1) feeds into secondary and association areas, including Wernicke's area (posterior superior temporal gyrus), critical for speech comprehension. Dual-stream models of auditory cortical processing posit a ventral ('what') stream for sound identification and a dorsal ('where') stream for spatial localization — analogous to the visual system's ventral and dorsal streams.

FeatureBasic Auditory Processing (This Lesson)Higher-Order Auditory Cognition
Key StructuresCochlea, CN VIII, brainstem nuclei, MGB, A1Wernicke's area, Broca's area, arcuate fasciculus, amygdala, prefrontal cortex
Primary FunctionTransduction, frequency analysis, basic sound localizationSpeech perception, music appreciation, emotional prosody, auditory scene analysis
Processing TypePredominantly bottom-upTop-down modulation (expectations, attention, context)
Lesion EffectsHearing loss (conductive or sensorineural)Auditory agnosia, pure word deafness, amusia

Peripheral/basic vs. higher-order auditory processing

The MCAT also draws connections between auditory processing and broader psychological concepts, including selective attention (cocktail party effect, studied by Cherry in 1953), habituation (decreased responsiveness to a repeated auditory stimulus), and sensory adaptation (auditory nerve firing rate decreases with sustained stimulation). These phenomena illustrate that perception is not a passive readout of transduction but an active, constructive process shaped by neural circuitry at every level.

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Looking Ahead

Foundational Concept 6 connects auditory processing to broader themes of sensation and perception that span all sensory modalities. Understanding how the auditory system encodes frequency via place and temporal codes provides a conceptual template for understanding how other systems (e.g., somatosensory, visual) encode stimulus dimensions. The principle of labeled line coding — where the identity of the activated neuron determines the quality of perception — applies across all sensory systems.

SECTION 9

Practice Problems

Question 1: CONCEPTUAL

The endolymph of the scala media is unusual among extracellular fluids because it has a high concentration of K⁺ and a positive electrical potential. Explain why K⁺ entry into hair cells is depolarizing rather than hyperpolarizing, despite K⁺'s usual role in repolarization.
Show answer
In most neurons, K⁺ flows outward during repolarization because the equilibrium potential for K⁺ (EKE_K ≈ −90 mV) is below the resting potential. In the cochlea, however, the endocochlear potential is +80 mV and endolymph K⁺ concentration is ~150 mM, creating a ~125 mV driving force (from endolymph into the hair cell). Therefore, when mechanotransduction channels open, K⁺ flows inward down this massive electrochemical gradient, depolarizing the hair cell from its resting potential of approximately −45 mV. This is a special adaptation that enables high-sensitivity transduction without relying on Na⁺, which would require energy-expensive Na⁺/K⁺-ATPase activity at the stereocilia.

Question 2: BASIC CALCULATION

A sound has an intensity of 10⁻⁶ W/m². Using the formula β = 10 × log₁₀(I/I₀), where I₀ = 10⁻¹² W/m², calculate the sound level in decibels. What does this intensity level correspond to in everyday experience?
Show answer
Substituting: β = 10 × log₁₀(10⁻⁶ / 10⁻¹²) = 10 × log₁₀(10⁶) = 10 × 6 = 60 dB. A 60 dB sound corresponds roughly to normal conversational speech at a distance of about 1 meter. This is well within the comfortable hearing range and below levels that cause damage (sustained exposure above ~85 dB can cause noise-induced sensorineural hearing loss). Note that because the decibel scale is logarithmic, each 10 dB increase represents a 10-fold increase in physical intensity.

Question 3: INTERMEDIATE

A patient presents with hearing loss in the left ear. A Weber test (tuning fork on the vertex of the skull) lateralizes to the left ear. The Rinne test on the left ear shows bone conduction louder than air conduction (BC > AC). On the right ear, AC > BC normally. What type of hearing loss does this patient have, and name two possible etiologies.
Show answer
This patient has left-sided conductive hearing loss. The Weber test lateralizes to the affected ear in conductive loss because bone conduction bypasses the outer/middle ear obstruction, and the lack of ambient sound reaching the cochlea through the air pathway effectively reduces masking noise in the affected ear, making the bone-conducted tone appear louder. The negative Rinne (BC > AC) on the left confirms that air conduction is impaired relative to bone conduction. Two possible etiologies include: (1) otosclerosis, in which abnormal bone remodeling fixes the stapes footplate to the oval window, and (2) chronic otitis media with effusion, in which fluid in the middle ear dampens ossicular vibration.

Question 4: APPLIED

A researcher records from auditory nerve fibers while presenting pure tones to an experimental animal. At 800 Hz, the fibers show clear phase-locking; at 6,000 Hz, there is no phase-locking but the fibers are tonotopically tuned. At 2,500 Hz, both mechanisms appear active. Explain these findings in terms of place theory and temporal theory, and predict what would happen if outer hair cells were selectively destroyed.
Show answer
At 800 Hz, temporal coding (phase-locking) is robust because individual auditory nerve fibers can fire in synchrony with each cycle — this frequency is well within the phase-locking limit (~1 kHz for single neurons, ~4–5 kHz via the volley principle). At 6,000 Hz, the cycle period (~167 μs) is too brief for reliable phase-locking, so the nervous system relies exclusively on place coding — which fiber is activated encodes the frequency. At 2,500 Hz, both mechanisms overlap, explaining the dual coding observed. If outer hair cells were selectively destroyed (as occurs with ototoxic drugs like cisplatin or aminoglycosides), the cochlear amplifier would be lost. The basilar membrane's frequency tuning would become broad and insensitive, requiring ~40–60 dB greater intensity to achieve threshold. Frequency discrimination would suffer dramatically, as the sharp tuning curves that define precise place coding depend on OHC electromotility.

Question 5: CRITICAL THINKING

A cochlear implant directly stimulates spiral ganglion neurons along the cochlea using an electrode array, bypassing damaged hair cells. Considering what you know about tonotopic organization, place coding, temporal coding, and the role of outer hair cells, analyze: (a) why cochlear implants allow frequency discrimination, (b) what aspect of normal auditory processing is lost, and (c) why cochlear implant users often struggle with music perception and understanding speech in noisy environments.
Show answer
(a) Cochlear implants exploit tonotopic organization: electrodes placed at the base stimulate high-frequency fibers, while those at the apex stimulate low-frequency fibers. By delivering different frequency bands of processed sound to different electrode positions, the implant recreates a coarse version of place coding. (b) Several aspects of normal processing are lost. First, the fine spectral resolution provided by OHC amplification is absent — an electrode stimulates a broad population of neurons rather than the exquisitely narrow band that a healthy basilar membrane peak would activate. Second, temporal fine structure is poorly conveyed because current clinical implants primarily encode the temporal envelope of speech (amplitude modulations) but not the fine temporal structure needed for phase-locking below 4 kHz. Third, the implant cannot reproduce the nonlinear compression provided by OHCs, which normally allows the auditory system to encode a 120 dB dynamic range into a much narrower neural dynamic range. (c) Music perception suffers because pitch perception depends on fine spectral and temporal resolution — both degraded in implant users. Speech-in-noise performance is poor because separating a target voice from background noise (auditory scene analysis) relies on fine spectral cues and binaural processing, both of which are compromised by the limited number of independent channels (~12–22 electrodes versus ~3,500 IHCs in a normal cochlea).

SUMMARY

Auditory System — Comprehensive Review

Summary

The auditory system transforms longitudinal pressure waves into neural representations of pitch, loudness, and spatial location. The outer ear collects and channels sound, the middle ear (ossicles) provides impedance matching via area ratio and lever advantage (~22 dB gain), and the cochlea performs frequency analysis. The basilar membrane is tonotopically organized (base = high frequency, apex = low frequency). Inner hair cells are the primary sensory transducers (95% of afferent fibers), while outer hair cells amplify and sharpen tuning via prestin-mediated electromotility. The endocochlear potential (+80 mV) creates a 125 mV driving force for K⁺ influx, enabling high-sensitivity mechanotransduction.

Frequency is encoded by place coding (dominant >4 kHz) and temporal/volley coding (dominant <4 kHz). The central pathway ascends through the cochlear nuclei → superior olivary complex (SOC) (first binaural station; ITDs and ILDs) → inferior colliculus → medial geniculate body (thalamus) → primary auditory cortex (A1). Tonotopic maps are preserved at every level. Clinically, conductive hearing loss (outer/middle ear) lateralizes toward the affected ear on Weber; sensorineural hearing loss (cochlea/CN VIII) lateralizes away. Bilateral projections above the cochlear nuclei protect against complete deafness from unilateral central lesions.

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