Validity of the ipsilateral acoustic reflex as a screening parameter

Historically, the ipsilateral acoustic reflex (IAR) has played a prominent role in middle ear screening protocols. However, in 1990, the American Speech-Language-Hearing Association's revised guidelines, "Screening for Hearing Impairment and Middle Ear Disorders," deleted the IAR as a screening parameter. This decision was based on studies that demonstrated that the inclusion of the IAR resulted in a high false-positive rate without adding to the hit rate and thus was a major contributor to over-referral. However, other investigations demonstrated the converse, that the IAR is a sensitive and contributory measure in a screening protocol. Our data suggest that the conflicting results are due to different operating systems in the middle ear analyzers that were used to elicit the IAR. Based on our findings, an optimal IAR screening protocol would use a pulsed elicitation immittance system (multiplexing circuit) and a maximum intensity level of 105 dB HL. Further, if the IAR screening were to be carried out using an automated (programmed) immittance system with an equivalent volume change criteria for IAR detection, the equivalent volume change of > or = 0.03 ml is recommended.