Click evoked middle ear muscle reflex: Spectral and temporal aspects

2021 ◽  
Vol 149 (4) ◽  
pp. 2628-2643
Author(s):  
Sriram Boothalingam ◽  
Shawn S. Goodman
Keyword(s):  
Middle Ear ◽  
Temporal Aspects ◽  
Muscle Reflex

scholarly journals The middle ear muscle reflex in the diagnosis of cochlear neuropathy

2016 ◽  
Vol 332 ◽  
pp. 29-38 ◽  
Author(s):  
Michelle D. Valero ◽  
Kenneth E. Hancock ◽  
M. Charles Liberman
Keyword(s):  
Middle Ear ◽  
Muscle Reflex ◽  
Cochlear Neuropathy

Design Factors in the Characterization and Identification of Otitis Media and Certain Related Conditions

1979 ◽  
Vol 88 (5_suppl) ◽  
pp. 13-28 ◽  
Author(s):  
Charles D. Bluestone ◽  
Erdem I. Cantekin
Keyword(s):  
Otitis Media ◽  
Sensitivity And Specificity ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Interobserver Reliability ◽  
Diagnostic Value ◽  
The State ◽  
Related Condition ◽  
Muscle Reflex ◽  
High Degree

Because the state of our knowledge of many aspects of the etiology and pathogenesis of otitis media and related conditions is deficient, precise characterizations of certain aspects of the disease may not be possible. In fact although most studies in the past have failed to define the specific disease state to be investigated, the specific type of otitis media or related condition to be studied must be as clearly defined as is clinically possible in order for any prospective study of otitis media to be valid. The state of the art of the presently available methods to identify these conditions also poses certain limitations; at present, there are five methods to identify otitis media and related conditions: history, audiometry, tympanocentesis/myringotomy, otoscopy (including otomicroscopy), and impedance measurements (tympanometry and assessment of the middle ear muscle reflex), and they all have inherent elements of unreliability. Historical information obtained from parents or the child is usually unreliable; a positive history may aid in defining the problem, but a negative otologic history does not rule out the presence of otitis media since it is frequently asymptomatic. Audiometry has been shown to be a poor method of identifying otitis media. Although tympanocentesis or myringotomy is the most reliable way to identify otitis media with effusion (OME), it is invasive, frequently requires an anesthetic, and is usually a confounding variable. In an effort to establish the diagnostic value of otoscopy, tympanometry, and the presence or absence of the middle ear muscle reflex in identifying OME, the diagnostic findings by these three methods were compared with the findings at myringotomy in 239 children (425 ears). The study showed that even experienced clinicians had some difficulty in identifying those ears with effusion (sensitivity) and had even greater difficulty in making a diagnosis of those ears without an effusion (specificity). Tympanometry employing patterns that have been validated with myringotomy findings was found to be as accurate as expert otoscopy. On the other hand, the presence or absence of the middle ear muscle reflex was found not to be a useful method of diagnosing the presence of OME due to its extremely low specificity. An algorithm derived from the combination of the three methods had highest sensitivity and specificity. From this study, the following recommendations regarding the identification of OME are suggested. All investigators who employ otoscopy should be validated by comparing their assessments either with the findings at myringotomy or with a previously validated otoscopist. Interobserver reliability of all otoscopists should be established prior to and maintained during clinical studies of OME. Only electroacoustic impedance instruments in which the tympanometric patterns have been validated should be used. Tympanometry employing validated tympanometric patterns has a high degree of sensitivity and specificity, and as such can provide an objective method to identify OME. Middle ear muscle reflex measurements should not be used as the only method to identify OME. An algorithm that includes otoscopy, tympanometry, and, to a lesser degree, the middle ear muscle reflex measurement should be employed for research purposes when a noninvasive method to identify OME is required.

The White Noise Middle Ear Muscle Reflex Threshold in Patients with Sensorineural Hearing Impairment

1976 ◽  
Vol 5 (3) ◽  
pp. 131-135 ◽  
Author(s):  
N. J. Johnsen ◽  
D. Osterhammel ◽  
K. Terkildsen ◽  
P. Osterhammel ◽  
F. Huis in't Veld
Keyword(s):  
White Noise ◽  
Hearing Impairment ◽  
Middle Ear ◽  
Sensorineural Hearing ◽  
Sensorineural Hearing Impairment ◽  
Reflex Threshold ◽  
Muscle Reflex

scholarly journals Weak Middle-Ear-Muscle Reflex in Humans with Noise-Induced Tinnitus and Normal Hearing May Reflect Cochlear Synaptopathy

eNeuro ◽  
2017 ◽  
Vol 4 (6) ◽  
pp. ENEURO.0363-17.2017 ◽  
Author(s):  
Magdalena Wojtczak ◽  
Jordan A. Beim ◽  
Andrew J. Oxenham
Keyword(s):  
Middle Ear ◽  
Normal Hearing ◽  
Muscle Reflex

scholarly journals The Impacts of Noise Exposure on the Middle Ear Muscle Reflex in a Veteran Population

2021 ◽  
Author(s):  
Naomi Bramhall ◽  
Kelly M. Reavis ◽  
M. Patrick Feeney ◽  
Sean Kampel
Keyword(s):  
Animal Models ◽  
Middle Ear ◽  
Noise Exposure ◽  
Outer Hair Cell ◽  
Auditory Brainstem ◽  
Nerve Fibers ◽  
Intensity Level ◽  
Physiological Indicators ◽  
Brainstem Response ◽  
Muscle Reflex

Noise-induced cochlear synaptopathy, the loss of the synaptic connections between inner hair cells and afferent auditory nerve fibers, has been demonstrated in multiple animal models, including non-human primates. However, given that synaptopathy can only be confirmed with post-mortem temporal bone analysis, it has been difficult to determine whether noise-induced synaptopathy occurs in humans. Human studies of noise-induced synaptopathy using physiological indicators identified in animal models (auditory brainstem response [ABR] wave I amplitude, the envelope following response [EFR], and the middle ear muscle reflex [MEMR]) have yielded mixed findings. Differences in the population studied may have contributed to the differing results. For example, due to differences in the intensity level of the noise exposure, noise-induced synaptopathy may be easier to detect in a military Veteran population than in populations with recreational noise exposure. We previously demonstrated a reduction in ABR wave I amplitude and EFR magnitude for young Veterans with normal audiograms reporting high levels of noise exposure compared to non-Veteran controls. In this report, we expand on the previous analysis in the same population to determine if MEMR magnitude is similarly reduced. The results of the statistical analysis, although not conventionally statistically significant, suggest a reduction in mean MEMR magnitude for Veterans reporting high noise exposure compared with non-Veteran controls. In addition, the MEMR appears relatively insensitive to subclinical outer hair cell dysfunction and is not well correlated with ABR and EFR measurements. When combined with our previous ABR and EFR findings in the same population, these results suggest that noise-induced synaptopathy occurs in humans. In addition, the findings indicate that the MEMR may be a good candidate for non-invasive diagnosis of cochlear synaptopathy/deafferentation and that the MEMR may reflect the integrity of different neural populations than the ABR and EFR.

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