Safety and clinical performance of acoustic reflex tests

Objective: Safety and effectiveness of acoustic reflex tests are important issues because these tests are widely applied to screen for retrocochlear p athology. Previous studies have reported moderately high sensitivity and sp ecificity for detection of acoustic neuroma. However, there have been repor ts of possible iatrogenic hearing loss resulting from acoustic reflex thres hold (ART) and decay (ARD) tests. This study assessed safety and clinical p erformance of ART tests for detection of acoustic neuroma. Design: We report a case in which ARD testing resulted in a significant bil ateral permanent threshold shift. This case was the impetus for us to inves tigate the clinical utility of ART and ARD tests. We analyzed sensitivity a nd specificity of ART, as well as asymmetry in pure-tone thresholds (PTT) f or detection of acoustic neuroma in 56 tumor and 108 non-tumor ears. Results and Conclusions: Sensitivity and specificity were higher for PTT as ymmetry than for ART. Ipsilateral ART at 1000 Hz had poor sensitivity and s pecificity for detection of acoustic neuroma, and involves some potential r isk to residual hearing for presentation levels higher than 115 dB SPL. App roximately half of the acoustic neuroma group had ipsilateral ARTs that wou ld require administration of ARD tests at levels exceeding 115 dB SPL. Ther efore, we conclude that PTT asymmetry is a more effective test for detectio n of acoustic neuroma, and involves no risk to residual hearing. Future stu dies of contralateral reflex threshold and ARD in combination with PTT asym metry are recommended.