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December 1981

Hyperactive Acoustic Reflexes and Perilymphatic Hypotension

Arch Otolaryngol. 1981;107(12):774. doi:10.1001/archotol.1981.00790480050015

To the Editor.—Downs et al reported in the Archives (1981;107:324-325) that they found acoustic reflex hyperactivity in an infant with meningitis and thought this indicated a central auditory processing disorder. After meningitis, hearing loss may be absent, unilateral, total, slight, notched, progressive, delayed, temporary, low tone, high tone, and postotitic.1 Such heterogeneity and asymmetry clearly implicates a peripheral site of action, so why invoke a separate central site of the lesion? In fact, sensitive reflexes are found in other disorders where a simple peripheral cause can be proposed.

I have serially tested patients trying to withdraw from benzodiazopines (unpublished data, 1979). While the data were too meager to be conclusive, they did suggest a syndrome comprising (1) intolerance to noise, (2) large falls in acoustic reflex levels to as low as a 55-dB hearing level, (3) a few decibels improvement in pure-tone thresholds, (4) a slight reduction of