Effect of age on acoustic reflex thresholds in neonates and infants with normal hearing

Dipti Gupta, C. S. Vanaja


Background: High frequency (1000 Hz) probe tone holds substantial promise for carrying out acoustic reflexes in neonates and infants. A limited number of studies indicates that acoustic reflex thresholds (ART) also change significantly with age as the newborn hearing system matures. However, there is a need for obtaining more data before using it in a clinical population. The aim was to investigate effect of age of infants on ARTs. Effect of activator signal was also explored. 

Methods: ARTs were monitored using a 1 kHz probe tone for the 500 Hz, 1 kHz, 2 kHz, and 4 kHz pure tone activators in neonates and infants in the age range of 6 to 8 weeks were analysed.

Results: The mean ARTs for neonates were lower compared to infants. Results of repeated measure ANOVA showed that there was a statistically significant age effect. Also, ARTs for high frequency activator signals were significantly higher than the ARTs for low frequency signals.

Conclusions: The acoustic reflexes can be elicited for 500, 1000, 2000, and 4000 Hz when monitored using a 1000 Hz probe tone. There is an effect of age and activator signal on the acoustic reflex threshold. The data obtained in the present study can serve as normative for 0-1-week neonates and 6-8-weeks infants.


Acoustic reflex thresholds, Neonates, Infants, Normal hearing

Full Text:



World Health Organization Ear and hearing disorders survey protocol and software package. 2018. Available at: http://otosagepubcom/content/143/2 _suppl/P2543ful. Accessed on 27 February 2019.

Jewel J, Varghese P, Singh T, Varghese. A Newborn hearing screening. Experience at a tertiary hospital in India. Int J Pediatr Otorhinolaryngol. 2013;2:211-4.

Joint Committee on Infant Hearing. Position statement: Executive summary of joint committee on infant hearing year Position Statement. Pediatrics. 2019;798:817.

Jiang ZD, Wilkinson AR. Normal brainstem responses in moderately preterm infants. Acta Pediatrics. 1978;97(10):1366-9.

Martin PF, Bower CM, Boone RT. Failed newborn hearing screens as presentation for otitis media with effusion in the newborn population. Int J Pediatr Otorhinolaryngol. 2005;69:393-7.

Margolis RH, Hunter LL, Giebink GS. Tympanometric evaluation of middle ear function in children with otitis media. Ann Otology Rhinol Laryngol Suppl. 1994;163:34-8.

Holte LA, Margolis RH, Cavanaugh RM. Developmental changes in multifrequency tympanometry. Audiology. 1991;30:1-24.

Meyer SE, Jardine CA, Deverson W. Developmental changes in tympanometry: A case study. Bri J Audiol. 1997;31:189-91.

Purdy S, Williams MJ. High frequency tympanometry: A valid and reliable immittance test protocol for young infants? N Zealand Audiol Society Bull. 2004;10:9-24.

Kei J, Levick AJ, Dockray J, Harrys R, Kirkegard C, Wong J et al. High-Frequency (1000 Hz) Tympanometry in Normal Neonates. J Am Academy Audiol. 2003;14(1):20-28.

Kei J. Acoustic stapedial reflexes in healthy neonates: a normative data and test-retest reliability. J Am Academy Audiol. 2012;23:46-56.

Rhodes M, Hirsh R. Hearing screening in the newborn intensive care nursery: Comparison of methods. Otolaryngol-Head Neck Surg. 1999;120(6):799-808.

Swanepoel DW, Wernera S, Hugoa R, Louwa B, Owena R, Swanepoel A. High frequency immittance for neonates: a normative study. Acta Oto-Laryngologica. 2007;127(1):49-56.

Geddes NK. Tympanometry and the stapedial reflex in the first five days of life. J Pediatr Otorhinolaryngol. 1987;13:293-7.

Mazlan R. High frequency immittance findings: Newborn vs 6 week old infants. Int J Audiol. 2007;41:711-7.

Kleindienst SJ, Hanks WD. High frequency (1000 Hz) acoustic stapedial reflexes in neonates. Unpublished masters Dissertation. Glaudett University. 2009.

Marchant CD, McMillan PM, Shurin PA, Johnson CE, Turczyk RN. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral reflex thresholds. J Pediatr. 1986;109:590-5.

Hirsch J, Margolis R, Ryken J. A comparison of acoustic reflex and auditory brainstem response screening of high-risk infants. Ear Hearing. 1991;13(3):181-6.

Peterson JL, Liden G. Some static characteristics of stapedial muscle reflex. J Audiol. 1972;11:97-114.

Jerger JF, Burney P, Mauldin L, Crump B. Predicting hearing loss from the acoustic reflex. J Speech Hearing Disorders. 1974;39:11-22.

Mazlan R, Kei J, Hickson L. Test-retest reliability of the acoustic stapedial reflex test in healthy neonates. Ear Hearing. 2009;30:295-301.