title: Acoustic Reflex Screening of Conductive Hearing Loss for Third Window Disorders.
abstract: OBJECTIVE
  This study examines the effectiveness of acoustic reflexes in screening for third window disorders (eg, superior semicircular canal dehiscence) prior to middle ear exploration for conductive hearing loss.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Outpatient tertiary otology center.
  
  
  METHODS
  A review was performed of 212 ears with acoustic reflexes, performed as part of the evaluation of conductive hearing loss in patients without evidence of chronic otitis media. The etiology of hearing loss was determined from intraoperative findings and computed tomography imaging. The relationship between acoustic reflexes and conductive hearing loss etiology was assessed.
  
  
  RESULTS
  Eighty-eight percent of ears (166 of 189) demonstrating absence of all acoustic reflexes had an ossicular etiology of conductive hearing loss. Fifty-two percent of ears (12 of 23) with at least 1 detectable acoustic reflex had a nonossicular etiology. The positive and negative predictive values for an ossicular etiology were 89% and 57% when acoustic reflexes were used alone for screening, 89% and 39% when third window symptoms were used alone, and 94% and 71% when reflexes and symptoms were used together, respectively.
  
  
  CONCLUSIONS
  Acoustic reflex testing is an effective means of screening for third window disorders in patients with a conductive hearing loss. Questioning for third window symptoms should complement screening. The detection of even 1 acoustic reflex or third window symptom (regardless of reflex status) should prompt further workup prior to middle ear exploration.
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA rhong@michiganear.com.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hong
authors.affiliation: Osteopathic Division, St John Providence Health System, Madison Heights, Michigan, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Metz
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Dennis I
authors.initials: DI
authors.lastname: Bojrab
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Seilesh C
authors.initials: SC
authors.lastname: Babu
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: John
authors.initials: J
authors.lastname: Zappia
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sargent
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Eleanor Y
authors.initials: EY
authors.lastname: Chan
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Ilka C
authors.initials: IC
authors.lastname: Naumann
authors.affiliation: Michigan Ear Institute, Farmington Hills, Michigan, USA Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA Neurotology Division, St John Providence Health System, Novi, Michigan, USA Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaRouere
mesh_terms: D000158:Acoustic Impedance Tests; D001301:Audiometry, Pure-Tone; D001844:Bone Conduction / Q000502:physiology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006314:Hearing Loss, Conductive / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012022:Reflex, Acoustic / Q000502:physiology*; D012189:Retrospective Studies; D012665:Semicircular Canals; D014057:Tomography, X-Ray Computed; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
keywords: acoustic reflex; conductive hearing loss; otosclerosis; superior semicircular canal dehiscence; third window