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# Vestibulocochlear nerve (VIII)

The vestibulocochlear nerve (cranial nerve VIII) carries hearing and balance from the inner ear to the brainstem.

Official name: Vestibulocochlear nerve

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## What it is

The nerve from the inner ear to the brainstem, with hearing and balance parts.

## What it does

Hearing and balance; a benign tumour on it (acoustic neuroma) causes one-sided hearing loss.

## Key points

- Enters the brainstem at the cerebellopontine angle (pontomedullary junction), just lateral to the facial nerve
- In the internal acoustic meatus: facial nerve anterosuperior, cochlear nerve anteroinferior, superior and inferior vestibular nerves posterior
- Vestibular schwannoma (acoustic neuroma) grows from vestibular Schwann cells in the meatus and angle; bilateral tumours define neurofibromatosis type 2
- Hearing pathways cross at several levels above the cochlear nuclei, so one-sided deafness points to the ear, the nerve or the cochlear nuclei, not the cortex

## Key facts

**Roots**
Cochlear and vestibular nuclei ([pons](https://durgical.com/en/anatomy/pons/) /medulla); internal acoustic meatus; sensory ganglia: spiral (in the modiolus) and vestibular (Scarpa, in the meatus)

**Moves**
None

**Feeling from**
Hearing (cochlear part); balance (vestibular part)

## Relations

**Course**
From the [cochlea](https://durgical.com/en/anatomy/cochlea/) and the vestibular [sense organs](https://durgical.com/en/anatomy/system/sense-organs/) through the [internal acoustic meatus](https://durgical.com/en/anatomy/internal-acoustic-meatus/), then across the cerebellopontine angle cistern to the pontomedullary junction

**In front**
[Facial nerve](https://durgical.com/en/anatomy/facial-nerve/) and nervus intermedius, which travel with it through the internal acoustic meatus

**Below**
Loops of the anterior inferior cerebellar artery in the angle, giving the labyrinthine artery that runs with the nerve

**Behind**
Flocculus of the [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) and the lateral recess of the [fourth ventricle](https://durgical.com/en/anatomy/fourth-ventricle/)

## How to find it

Seen on MRI or at surgery in the cerebellopontine angle, between the pons and the internal acoustic meatus, below the [trigeminal nerve](https://durgical.com/en/anatomy/trigeminal-nerve/) and above the glossopharyngeal and vagus nerves.

## Examination

- Rinne and Weber: a sensorineural pattern on the affected side (Rinne positive, Weber to the other ear)
- Audiometry: speech discrimination worse than the pure-tone loss suggests a retrocochlear (nerve) lesion
- Auditory brainstem responses: delayed waves on one side point to a lesion of the nerve
- Head impulse and caloric tests examine the vestibular part

## On imaging

Gadolinium-enhanced T1 MRI or high-resolution heavily T2-weighted MRI of the internal acoustic meatus: a schwannoma enhances and fills the meatus, widening into the angle in an «ice cream cone» shape.

## Common problems

- Vestibular schwannoma (acoustic neuroma): a slow benign tumour causing one-sided hearing loss, ringing and imbalance.

## How it is diagnosed

Hearing test and MRI with contrast.

## Treatment

- Watching small tumours.
- Radiosurgery or microsurgery for growing ones.

## Clinical notes

- Large schwannomas press on the trigeminal nerve (loss of the corneal reflex is an early sign), the facial nerve, the cerebellum and the fourth ventricle (hydrocephalus)
- Surgery or radiosurgery for schwannoma puts the facial nerve at risk because it runs on the tumour surface
- Vestibular neuritis is thought to be viral inflammation, usually of the superior vestibular nerve

## Anatomical variants

- A loop of the anterior inferior cerebellar artery often reaches the opening of the internal acoustic meatus or enters it; on MRI it is usually a harmless finding

## Development

The inner ear and the neurons of the cochlear and vestibular ganglia come from the otic placode, a thickening of surface ectoderm beside the hindbrain that sinks in to form the otic vesicle.

## Memory aid

In the internal acoustic meatus the facial nerve (VII) runs on top and the cochlear nerve below it, both in front; the two vestibular nerves lie behind them.

## Related conditions

- [Vestibular schwannoma (acoustic neuroma)](https://durgical.com/en/conditions/vestibular-schwannoma/)
- [Presbycusis (age-related hearing loss)](https://durgical.com/en/conditions/presbycusis/)
- [Neurofibromatosis (types 1 and 2)](https://durgical.com/en/conditions/neurofibromatosis/)
- [Hearing loss (conductive and sensorineural, including sudden hearing loss)](https://durgical.com/en/conditions/hearing-loss/)
- [Vestibular neuritis and labyrinthitis](https://durgical.com/en/conditions/vestibular-neuritis-and-labyrinthitis/)

## Test yourself

Think of the answer, then tap the question to see it.

## From which cells does a vestibular schwannoma (acoustic neuroma) arise, and what do bilateral tumours define?

Schwann cells of the vestibular nerve in the internal acoustic meatus; bilateral tumours define neurofibromatosis type 2.

## How are the nerves arranged in the internal acoustic meatus?

Facial nerve anterosuperior, cochlear nerve anteroinferior, superior and inferior vestibular nerves posterior.

## What is an early sign of a large vestibular schwannoma pressing on the trigeminal nerve?

Loss of the corneal reflex on that side.

## What do the Rinne and Weber tests show with a vestibulocochlear nerve lesion?

A sensorineural pattern: Rinne positive on the affected side and Weber lateralising to the other ear.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
nervus vestibulocochlearis TA2 6307

**Official Spanish (DeCS)**
Nervio Vestibulococlear DeCS D000159

**English (TA2)**
Vestibulocochlear nerve

**Also called**
acoustic nerve · cranial nerve VIII · nervus acusticus · nervus statoacusticus · nervus octavus

## Related

- [Cochlea](https://durgical.com/en/anatomy/cochlea/)
- [Internal acoustic meatus](https://durgical.com/en/anatomy/internal-acoustic-meatus/)
- [Temporal bones](https://durgical.com/en/anatomy/temporal-bone/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=166); [Neuroanatomy, Cranial Nerve 8 (Vestibulocochlear)](https://www.ncbi.nlm.nih.gov/books/NBK537359/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/vestibulocochlear-nerve/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/vestibulocochlear-nerve/