Effect of the acoustic reflex on the impedance at the eardrum

Generalizability of clinically measured acoustic reflexes to brief sounds

Middle ear muscle contractions (MEMC) can be elicited in response to high-level sounds, and have been used clinically as acoustic reflexes (ARs) during evaluations of auditory system integrity. The results of clinical AR evaluations do not necessarily generalize to different signal types or durations. The purpose of this study was to evaluate the likelihood of observing MEMC in response to brief sound stimuli (tones, recorded gunshots, noise) in adult participants (N = 190) exhibiting clinical ARs and excellent hearing sensitivity. Results revealed that the presence of clinical ARs was not a sufficient indication that listeners will also exhibit MEMC for brief sounds. Detection rates varied across stimulus types between approximately 20% and 80%. Probabilities of observing MEMC also differed by clinical AR magnitude and latency, and declined over the period of minutes during the course of the MEMC measurement series. These results provide no support for the inclusion of MEMC as a protective factor in damage-risk criteria for impulsive noises, and the limited predictability of whether a given individual will exhibit MEMC in response to a brief sound indicates a need to measure and control for MEMC in studies evaluating pharmaceutical interventions for hearing loss.

Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

BACKGROUND

Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis.

PURPOSE

To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis.

RESEARCH DESIGN

A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group.

STUDY SAMPLE

The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female).

DATA COLLECTION AND ANALYSIS

Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears.

RESULTS

Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic.

CONCLUSIONS

Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.

Reversed Ipsilateral Acoustic Reflex: A Study on Subjects Treated With Muscle Relaxants

OBJECTIVES

To rule out any possible involvement of the middle ear muscles in the genesis of the reversed ipsilateral acoustic reflex (RIAR).

DESIGN

Prospective study to evaluate the effects of muscle relaxants on the RIAR of otosclerotic ears as well as on the acoustic reflex of individuals with normal middle ear function. Admittance recording during ipsilateral acoustic stimulation was performed in patients undergoing pharmacological treatment for surgical procedures. Fentanyl, propofol, and a muscle relaxant were sequentially administered intravenously. Ipsilateral acoustic reflexes were recorded before and after each drug injection. Three patients were affected from otosclerosis, whereas 14 individuals had normal middle ear function. Moreover, the ipsilateral acoustic reflex obtained in normal subjects after their treatment with muscle relaxants was compared with that of 10 otosclerotic patients who were not treated pharmacologically.

RESULTS

The RIAR of three otosclerotic ears was not inhibited by muscle relaxants as well as by fentanyl and propofol. Moreover, muscle relaxants, when administered in normal subjects, always induced the block of the stapedial reflex that was replaced by a reversed reflex strictly similar to the RIAR of the 10 otosclerotic patients not treated pharmacologically. Propofol could also induce, in most of the cases, the reduction and in some occasion even the reversal of the stapedial reflex, whereas fentanyl did not affect it significantly.

CONCLUSION

The RIAR does not appear to be related to the contraction of the middle ear muscles.

The influence of sound stimulus parameters on the acoustic reflex waveform

The transient increase in admittance seen at the beginning of the acoustic reflex response in man was investigated with a view to reaching a better understanding of its possible mechanisms. The sound stimulus intensity, its duration and its off-time were varied to investigate their effects on the morphology of the admittance waveform. The results found suggest that the transient increase may not be due to a temporary partial decoupling of the ossicular chain during the initial stages of stapedial contraction, but rather that it may be caused by a slight improvement in the coupling between the middle ear components.

Concomitant changes in the acoustic impedance and the cochlear microphonic potentials during twitch contractions of the middle ear muscles in cats

The effect of twitch contractions of the middle ear muscles in cats on sound transmission through the middle ear (as measured by the cochlear microphonic potential of the inner ear) was compared with the simultaneous changes in the acoustic input impedance of the middle ear at the same frequency. It was found that decreases in impedance were related to an increase in the amplitude of the cochlear microphonics and vice versa. This may imply that decreases in impedance measured during the initial phase of the acoustic reflex in man are true decreases and are not due to transient decoupling of the ossicular chain at any point.

The acoustic reflex pattern studied by the averaging technique

The acoustic reflex threshold and its pattern in response to stimuli of different intensities, were investigated by means of the signal-averaging technique in 20 normal, 20 sensorineural-impaired and 10 successfully stapedectomized ears. Trains of tone bursts between 110 and 0 dB HL were used. The frequencies tested were 500, 1 000, 2 000 and 4 000 Hz. In all normal subjects, the pattern of the acoustic reflex for stimuli between 110 and 100 dB HL was biphasic with an initial positive plateau followed by a longer negative one. For stimuli below 80 dB HL, the pattern of the reflex was monophasic with a single positive peak. In the sensorineural-impaired ears, the same double pattern of the waveform was obtained. In the stapedectomized ears, no compliance changes were observed for any sound stimuli. By the averaging technique, the difference between the acoustic reflex threshold and the auditory threshold was found to be between 7.5 and 32.5 dB, in normal and sensorineural-impaired ears.

Properties of acoustic reflex adaptation

The dynamic behavior of the acoustic reflex to continuous sinusoidal stimuli was investigated. The major purpose was to determine the temporal characteristics of reflex adaptation as frequency (0.5, 1.0, 2.0, 3.0, 4.0 kHz) and suprathreshold level (6, +12, +18 dB re reflex threshold) were systematically varied. Repeated measurements were made with an impedance bridge on six normal listeners. Both relative and absolute impedance changes were analyzed. The results revealed large intersubject variability. Four general conclusions were reached regarding the effect of stimulus frequency and suprathreshold level on adaptation: 1) as the stimulus frequency increases, the rate of adaptation increases; 2) the adaptation curves appear to form distinct groups, at the low frequencies adaptation rates are significantly slower than those at 2.0 kHz and above; 3) the onset of adaptation occurs at an earlier time for the higher frequencies; and 4) the rate of adaptation was found to be independent of suprathreshold level. The changes in adaptation with frequency of the stimulus may be expressed by an equation involving inter-related time constants for the growth and adaptation portions of the reflex curve in accordance with a descriptive model suggested by Tietze.