Validity of the ipsilateral acoustic reflex as a screening parameter

Area of Science:

• Audiology
• Otoacoustic Emissions
• Hearing Diagnostics

Background:

• The ipsilateral acoustic reflex (IAR) was historically significant in middle ear screening but was removed from guidelines due to concerns about high false-positive rates.
• Conflicting research exists regarding the IAR's efficacy, with some studies supporting its diagnostic value and others highlighting its limitations in screening.

Purpose of the Study:

• To investigate the conflicting results regarding the efficacy of the ipsilateral acoustic reflex (IAR) in middle ear screening protocols.
• To identify optimal parameters for eliciting the IAR to improve its accuracy and reduce over-referral in hearing screening.

Main Methods:

• Analysis of data from studies using different middle ear analyzer operating systems to elicit the IAR.
• Evaluation of IAR detection using pulsed elicitation immittance systems (multiplexing circuit) and specific intensity levels.
• Assessment of automated immittance systems with equivalent volume change criteria for IAR detection.

Main Results:

• Conflicting results on IAR efficacy are attributed to variations in middle ear analyzer operating systems.
• An optimal IAR screening protocol involves a pulsed elicitation immittance system with a maximum intensity level of 105 dB HL.
• For automated systems, an equivalent volume change criterion of >= 0.03 ml is recommended for IAR detection.

Conclusions:

• The ipsilateral acoustic reflex (IAR) can be a sensitive and contributory measure in hearing screening when implemented with optimized protocols.
• Specific operating parameters, including pulsed elicitation and intensity levels, are crucial for the effective use of IAR in middle ear screening.
• Standardizing IAR screening protocols can enhance diagnostic accuracy and minimize unnecessary referrals in audiological assessments.