Clinical application of nonacoustic middle ear muscle stimulation

Several clinical situations exist when only nonacoustic stimuli will provide data necessary for the correct neuro-otologic diagnosis. The tactile stapedius and the orbital air-jet reflexes have been used to aid in detecting the middle ear status in severe hearing losses, retrocochlear hearing losses, ossicular fixation, and facial paralysis. These reflexes also are useful in localization in some cranial nerve disorders. The equipment required to elicit these reflexes is inexpensive, and the test can be performed rapidly. Some pitfalls in interpretation are caused by the lack of precise correlative data. When properly used, performed, and interpreted, nonacoustic reflex response data supply information to the clinician that is otherwise unobtainable.