December 1, 2013 Features

A Most Multi-talented Nerve

The vagus nerve performs a host of functions as it wanders throughout the body, many of them central to audiologists' and speech-language pathologists' work.

see also

An inexperienced speaker takes the stage. He squints into the spotlight, sensing an expectant audience out there in the dark. As stage fright tightens its grip, his throat goes dry and he feels short of breath. Dizziness leads to a queasy feeling in his stomach, and soon he's struggling to remember the opening words of his speech. Although this scenario seems like the outcome of a complicated interplay between many cranial nerves, in fact just one is at work: the vagus.

Cranial nerve X, also known as the vagus, is an intricate nerve that emerges from four different nuclei in the brainstem, each of which performs a distinct function. True to the meaning of the word's Latin base, it is a "wandering" nerve, the most widely distributed of the 12 cranial nerves. From its origin in the brainstem, it meanders throughout the head and neck to the thorax and abdomen, all the way to the colon, stimulating and receiving information from numerous muscles and organs along its path.

Many branches of the vagus nerve contain both sensory and motor fibers. As the fibers of the vagus exit the skull through an opening in the base, they synapse on two clusters of nerve cells, the superior and inferior ganglion. All branches of the vagus emerge from these two ganglia. The branches travel down the neck, nestled between the internal carotid artery and internal jugular vein. To add to the nerve's complexity, some branches of the vagus take different paths on the right and left sides of the body.

The vagus is classified as one of five branchiomeric cranial nerves. Together these nerves serve all the muscles and mucosa of the face and neck. These complex muscles control a range of functions including facial expression, speaking, chewing and swallowing. Although branches of the vagus extend into the thorax and abdomen—the esophageal, cardiac, pulmonary and gastrointestinal branches—we'll focus on the components most closely associated with audiologists' and speech-language pathologists' work. Let's take a tour and see where the vagus leads us: download and print the poster-sized vagus nerve chart [PDF], which illustrates the nerve's motor and sensory pathways that affect speech and hearing.

Melody Harrison, PhD, CCC-SLP, is professor and coordinator of master's studies in speech and hearing sciences at the University of North Carolina, Chapel Hill, where she teaches neuroanatomy. She is associate coordinator of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

cite as: Harrison, M. (2013, December 01). A Most Multi-talented Nerve. The ASHA Leader.


Braswell, J., & Rine, R. M. (2006a). Evidence that vestibular hypofunction affects reading acuity in children. International Journal of Pediatric Otorhinolaryngology, 70, 1957–1965.

Braswell, J. & Rine, R. M. (2006b). Preliminary evidence of improved gaze stability following exercise in two children with vestibular hypofunction. International Journal of Pediatric Otorhinolaryngology, 70, 1967–1973.

Brookhouser, P. E., Cyr, D. G., Peters, J. E., & Schulte, L. E. (1991). Correlates of vestibular evaluation results during the first year of life. Laryngoscope, 101, 687–694.

Colebatch, J. G., Halmagyi, G. M., & Skuse, N. F. (1994). Myogenic potentials generated by a click-evoked vestibulocollic reflex. Journal of Neurology, Neurosurgery & Psychiatry, 57, 190–197.

Cushing, S. L., Chia, R., James, A. L., Papsin, B. C., & Gordon, K. A. (2008). A test of static and dynamic balance function in children with cochlear implants: The vestibular olympics. Archives of Otolaryngology-Head and Neck Surgery, 134, 34–38.

Cushing, S. L., Gordon, K. A., Rutka, J. A., James, A. L., & Papsin, B. C. (2013). Vestibular end-organ dysfunction in children with sensorineural hearing loss and cochlear implants: An expanded cohort and etiologic assessment. Otology & Neurotology, 34(3), 422–428.

De Kegel, A., Maes, L., Baetens, T., Dhooge, I., & Van, W. H. (2012). The influence of a vestibular dysfunction on the motor development of hearing-impaired children. Laryngoscope, 122, 2837–2843.

Erbek, S., Erbek, S. S., Gokmen, Z., Ozkiraz, S., Tarcan, A., & Ozluoglu, L. N. (2007). Clinical application of vestibular evoked myogenic potentials in healthy newborns. International Journal of Pediatric Otorhinolaryngology, 71, 1181–1185.

Guinand, N., Pijnenburg, M., Janssen, M., & Kingma, H. (2012). Visual acuity while walking and oscillopsia severity in healthy subjects and patients with unilateral and bilateral vestibular function loss. Archives of Otolaryngology-Head and Neck Surgery, 138, 301–306.

Hall, C. D., Schubert, M. C., & Herdman, S. J. (2004). Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction. Otology & Neurotology, 25, 746–751.

Huang, Y. C., Yang, T. L., & Young, Y. H. (2012). Feasibility of ocular vestibular-evoked myogenic potentials (oVEMPs) recorded with eyes closed. Clinical Neurophysiology, 123, 376–381.

Jacot, E., Van Den Abbeele, T., Debre, H. R., & Wiener-Vacher, S. R. (2009). Vestibular impairments pre- and post-cochlear implant in children. International Journal of Pediatric Otorhinolaryngology, 73, 209–217.

Jin, Y., Nakamura, M., Shinjo, Y., & Kaga, K. (2006). Vestibular-evoked myogenic potentials in cochlear implant children. Acta Oto-Laryngologica, 126, 164–169.

Kaga, K., Shinjo, Y., Jin, Y., & Takegoshi, H. (2008). Vestibular failure in children with congenital deafness. International Journal of Audiology, 47, 590–599.

Licameli, G., Zhou, G., & Kenna, M. A. (2009). Disturbance of vestibular function attributable to cochlear implantation in children. Laryngoscope, 119, 740–745.

Martin, W., Jelsma, J., & Rogers, C. (2012). Motor proficiency and dynamic visual acuity in children with bilateral sensorineural hearing loss. International Journal of Pediatric Otorhinolaryngology, 76(10), 1520–1525.

O'Reilly, R. C., Morlet, T., Nicholas, B. D., Josephson, G., Horlbeck, D., Lundy, L. et al. (2010). Prevalence of vestibular and balance disorders in children. Otology & Neurotology, 31, 1441–1444.

Rine, R. M., & Braswell, J. (2003). A clinical test of dynamic visual acuity for children. International Journal of Pediatric Otorhinolaryngology, 67, 1195–1201.

Rine, R. M., Braswell, J., Fisher, D., Joyce, K., Kalar, K., & Shaffer, M. (2004). Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment. International Journal of Pediatric Otorhinolaryngology, 68, 1141–1148.

Rine, R. M., Cornwall, G., Gan, K., LoCascio, C., O'Hare, T., Robinson, E. et al. (2000). Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction. Perceptual and Motor Skills, 90, 1101–1112.

Rosengren, S. M., McAngus Todd, N. P., & Colebatch, J. G. (2005). Vestibular-evoked extraocular potentials produced by stimulation with bone-conducted sound. Clinical Neurophysiology, 116, 1938–1948.

Sheykholeslami, K., Megerian, C. A., Arnold, J. E., & Kaga, K. (2005). Vestibular-evoked myogenic potentials in infancy and early childhood. Laryngoscope, 115, 1440–1444.

Wang, S. J., Hsieh, W. S., & Young, Y. H. (2013). Development of ocular vestibular-evoked myogenic potentials in small children. Laryngoscope, 123, 512–517.

Whitney, S. L., Marchetti, G. F., Pritcher, M., & Furman, J. M. (2009). Gaze stabilization and gait performance in vestibular dysfunction. Gait & Posture, 29, 194–198.


Advertise With UsAdvertisement