The Acoustic Reflex in Adults with Histories of Otitis Media in Childhood

Stephenson, Helen; Higson, Josephine M.; Haggard, Mark; Dutson, Max; Rogers, Michael E.; Schilder, Anne G. M.

doi:10.1097/00003446-199702000-00006

Cited by 11 publications

(4 citation statements)

References 22 publications

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“…An ascending/descending activator level approach was used to find the ART. Activator presentations typically were initiated at 80 dB HL, then ascended in 5 dB steps until a visually detected change in admittance (≥ 0.03 mmho criterion) was observed (Stephenson et al, 1997). Activator level was then decreased by 10 dB, then increased in 5-dB steps until the criterion change in admittance was observed a second time.…”

Section: Methodsmentioning

confidence: 99%

Wideband acoustic-reflex test in a test battery to predict middle-ear dysfunction

et al. 2010

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A wideband (WB) aural acoustical test battery of middle-ear status, including acoustic-reflex thresholds (ARTs) and acoustic-transfer functions (ATFs, i.e., absorbance and admittance) was hypothesized to be more accurate than 1-kHz tympanometry in classifying ears that pass or refer on a newborn hearing screening (NHS) protocol based on otoacoustic emissions. Assessment of middle-ear status may improve NHS programs by identifying conductive dysfunction and cases in which auditory neuropathy exists. Ipsilateral ARTs were assessed with a stimulus including four broadband-noise or tonal activator pulses alternating with five clicks presented before, between and after the pulses. The reflex shift was defined as the difference between final and initial click responses. ARTs were measured using maximum likelihood both at low frequencies (0.8–2.8 kHz) and high (2.8–8 kHz). The median low-frequency ART was elevated by 24 dB in NHS refers compared to passes. An optimal combination of ATF and ART tests performed better than either test alone in predicting NHS outcomes, and WB tests performed better than 1-kHz tympanometry. Medial olivocochlear efferent shifts in cochlear function may influence ARs, but their presence would also be consistent with normal conductive function. Baseline clinical and WB ARTs were also compared in ipsilateral and contralateral measurements in adults.

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Section: Methodsmentioning

confidence: 99%

Wideband acoustic-reflex test in a test battery to predict middle-ear dysfunction

et al. 2010

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“…A "present" reflex on the Tympstar system was defined as a reduction in admittance of at least 0.03 mmho after activator onset. This criterion was selected because Stephenson et al (1997) reported that inconsistent acoustic reflex responses were observed below 0.03 mmho in their pilot studies using a GSI-33 tympanometer. The starting presentation level for the ART test was 80 dB SPL for tonal stimuli and 60 dB for BBN.…”

Section: Procedures and Art Definitionsmentioning

confidence: 99%

Automated Adaptive Wideband Acoustic Reflex Threshold Estimation in Normal-hearing Adults

et al. 2021

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Objectives: Acoustic stapedius reflex threshold (ART) tests are included in a standard clinical acoustic immittance test battery as an objective cross-check with behavioral results and to help identify site of lesion. In traditional clinical test batteries, middle-ear admittance of a 226 Hz probe is estimated using ear-canal measurements in the presence of a reflex-activating stimulus. In the wideband (WB) acoustic immittance ART test used in this study, the pure-tone probe is replaced by a WB probe stimulus and changes in absorbed power are estimated using ear-canal measurements in the presence of the activator. The ART is defined as the lowest level at which a criterion change in admittance (clinical) or absorbed power (WB) is observed in the presence of the activator. In the present study, ARTs were obtained in adults with normal hearing using the clinical, manual method and with a new WB automated adaptive threshold detection method. It was hypothesized that the WB test would result in lower ARTs than the clinical test because reflex-related changes in power absorbance could be observed across multiple frequency bands in the WB test compared with a single frequency in the traditional test. Design: Data were collected in a prospective research design. ARTs were obtained in ipsilateral and contralateral conditions using 500, 1000, 2000 Hz, and broadband noise (BBN) activators on a clinical system and on an experimental WB system. The bandwidth of the BBN activator was 125 to 4000 Hz on the clinical system and 200 to 8000 Hz on the wideband system. ARTs were estimated at both tympanometric peak pressure (TPP) and ambient pressure on the WB system. Data were collected in both ears of 39 adults (21 males) of mean age 47.7 years (range 23–72 years). Differences in ARTs among the three threshold estimation methods (clinical, WB at TPP, WB at ambient) were examined using the general linear model repeated measures test in SPSS. Post-hoc pairwise comparisons were completed with Bonferroni correction for multiple comparisons. Statistical significance was defined as p < 0.05 for all analyses. Results: ARTs obtained on the WB system at TPP and ambient pressure were significantly lower than obtained on the clinical system. ARTs obtained on the WB system at TPP were significantly higher than at ambient pressure in the 500 and 2000 Hz ipsilateral conditions. Conclusions: WB automated adaptive ARTs in normal-hearing adults were lower than for clinical methods when measured at TPP and ambient pressure. Lower presentation levels required to estimate ART in the WB test may be more tolerable to patients. Patients with ARTs that are not present at the maximum level of a traditional reflex test may have present ARTs with a WB ART test, which may reduce the need to refer for additional testing for possible retrocochlear involvement. Automation of the test may allow clinicians more time to attend to the other requisite tasks of a hearing evaluation and make the system useful for telehealth applications.

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“…However, absolute threshold is a practical rather than a perfect marker for functional capacity in hearing. We found some years ago 7 a sequela that perhaps better justifies concern over eardrum pathology. Adults with strong and verified childhood histories of OM (most of whom had received VTs) had absolute hearing thresholds well within the normal range, consistent with the classical 2–4 dB deficit.…”

Section: Otopathological Side‐effects Of Ventilation Tubesmentioning

confidence: 78%

Surgical intervention policy for OME: interpreting available indirect evidence in the absence of direct evidence

Haggard

2009

Clinical Otolaryngology

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The Acoustic Reflex in Adults with Histories of Otitis Media in Childhood

Abstract: The elevated ARTs in adults with histories of childhood OM result from peripheral sequelae of OM. Further evidence is required to determine any functional significance of these raised reflex thresholds.

Cited by 11 publications

References 22 publications

Wideband acoustic-reflex test in a test battery to predict middle-ear dysfunction

Wideband acoustic-reflex test in a test battery to predict middle-ear dysfunction

Automated Adaptive Wideband Acoustic Reflex Threshold Estimation in Normal-hearing Adults

Surgical intervention policy for OME: interpreting available indirect evidence in the absence of direct evidence

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