Abstract
Acoustic reflex is a sensitive indicator of middle ear lesions when the tympanic membrane is in-tact and tympanometry is normal. Acoustic reflex is not usually observed in conductive hearing loss caused by disruption of the ossicular chain including ossicular discontinuity and fixation. Ossicular disruption can show at least partially intact acoustic reflex under a certain condition. Moreover, ossicular discontinuity with a nearly intact acoustic reflex is quite rare and there have been few reports published to date. We here present a rare case of conductive hearing loss with a nearly intact acoustic reflex, and the patient was surgically confirmed to have ossicular discontinuity.
Highlights
An air-bone gap (ABG) in pure-tone audiometry (PTA) within the normal bone conduction threshold typically represents disruption of the ossicular chain including ossicular discontinuity and fixation, when the tymapanictympanic membrane (TM) is intact and tympanometry is normal
Conductive hearing loss with an intact TM is caused by congenital malformations, otosclerosis, ossicular chain fixation, enlarged vestibular aqueduct (EVA), superior semicircular canal dehiscene (SSCD), or an overhanging facial nerve (FN) to the stapes at the tympanic portion [4]
When SNHL is excluded by PTA, Acoustic reflex (AR) is a sensitive indicator of middle ear lesions, and an ossicular disruption is strongly suspected when ABG reaches nearly 40 - 50 dB
Summary
An air-bone gap (ABG) in pure-tone audiometry (PTA) within the normal bone conduction threshold typically represents disruption of the ossicular chain including ossicular discontinuity and fixation, when the tymapanictympanic membrane (TM) is intact and tympanometry is normal. Acoustic reflex (AR) is a sensitive indicator of middle ear lesions, and is not usually observed in such cases of conductive hearing loss. At least partially present AR is occasionally observed in certain types of ossicular disruption. There have been a few reports about present AR in an ossicular discontinuity in the English literature [1]-[3]. Nearly intact AR in ossicular discontinuity is quite rare. We here report a rare case of nearly intact AR, and the patient was surgically confirmed as having ossicular discontinuity. (2014) Conductive Hearing Loss with Present Acoustic Reflex: A Case Report.
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