To the Editor.\p=m-\Weagree with Jerger and Hayes1 that the latency characteristics of the acoustic reflex are not a helpful indicator of an eighth-nerve tumor. We have found other indicators, eg, reflex decay and abnormalities of the auditory-evoked potential, to be much more relevant in the diagnosis of acoustic neuromas. In our series of patients, with eighth-nerve tumors we also have not noted an increase in latency. We have noted, however, a decrease in the rate of rise of the acoustic reflex in the ear contralateral to an acoustic tumor (only crossed reflexes were used). This decrease in slope would be consistent with a decrease in conductivity in the cochlear nerve on the side of the tumor.We have had a considerable experience (with more than 1,000 patients) with acoustic reflex latency, amplitude, and slope characteristics in a population of patients with vertigo with normal hearing.2 None of these patients had an acoustic neurinoma.We noted, as did Bosatra et al,3 that prolongation of latency, reductions in amplitude, and decreases in slope occurred in these patients. Resolution of the vertigo was often accompanied by resolution of the abnormal find¬ ings on acoustic reflex testing.4 We have noted abnormal stapedial reflex characteristics in patients with ear fullness, central auditory dysfunction, and polyneuritis of the cranial nerves.We, therefore, believe this test is sen¬ sitive for brain-stem abnormalities, but is not specific as to the pathology involved.We have noted, as have Jerger and Hayes,1 that acoustic reflex measure¬ ments vary when different equipment is used. Our studies have shown marked variations in latency and slope. Amplitude measurements have not differed substantially, however, when different equipment was used. It is imperative that each laboratory or clinical facility establish its own nor¬ mative data for all measurements involved.We have not used an oscilloscope as did Jerger and Hayes1 and Bosatra et al,3 but have displayed the reflex by the use of a strip recorder. The strip recorder is a superior record to that of the oscilloscope in that the latency, slope, and amplitude are more defini¬ tively displayed. of the acoustic reflex in eighth-nerve tumor. Arch Otolaryngol 1983;109:1-5. 2. Lehrer JF, Poole DC: Abnormalities of the stapedius reflex in patients with vertigo. Am J Otol 1981;3:96-103. 3. Bosatra A, Rossolo M, Poli P: Modifications of the stapedius reflex under spontaneous and experimental brain-stem impairment. Acta Otolaryngol 1975;80:61-66. 4. Lehrer JF: Dynamic changes in the stapedius reflex in patients with vestibular neuronitis.This is an attractive effort at a new approach to organizing and presenting an overview of our specialty to medical students and physicians in other fields. It represents the product of a collaborative effort between the publisher and an academic university department to produce a new kind of textbook that embodies the concept of integrated learning processes and problem-oriented learning. The book is organized into eight categorical "...