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4 Pathematology and pathogenesis 4.1 Pathematology of ARHL Studies on the morphology of the human temporal bone during life and after death have shown that ARHL is caused primarily by damage to cochlear sensory cilia, atrophy of the cochlear vascular stripe, thickening of the basilar membrane, damage to the spiral ligament, and degenerative lesions of the auditory nerve/spiral ganglion