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Peripheral hearing impairment comprises the majority of cases and arises from gross cochlear malformations, dysfunction of cochlear hair cells, which detect auditory stimuli and transmit the signal to spiral ganglion neurons SGNs, dysfunction of the constant ionic current flow within the cochlea necessary for normal hair cell transduction, and or dysfunction of the auditory nerve, which contains SGN axons and relays the auditory signal to the brainstem cochlear nucleus CN can i purchase cheap cytotec no prescription