In literature, Well known that RIAR is not elicited from Stapedius Muscle. Because It can be only seen in İpsi way and with high intensity. Even though profound sensorineural hearing loss present, RIAR could be detectable.
In attachment article, Researchers think; "RIAR comes into existence when the stapedius muscle could not affect the ossicular system." and "The pressure effect of acoustic stimuli stimulates a mechanical opposite reaction of the tympanic membrane and mobile malleus-incus system."
In my clinical practice, I observed this reflex pattern from many patients. Not only from patient who has cochlear pathology, but also from patient who has conductive pathology . Practically, I do not use this observation for any comment.
When I repeat a. reflex measurement at the different instrument. I can't see RIAR! For example, I can see RIAR in Interacoustics AT235 device but I can't see RIAR in GSI Tympstar. I thought, This is maybe stimulus artifact by the manufacturer immitance system.
Do you have any experience about RIAR? What is your opinion?
Article Reversed Ipsilateral Acoustic Reflex Pattern
I recall seeing reverse reflexes in cases of what turned out to be very early otosclerosis, which has been reported (for example Ried, Acta Otorrinolaringol Esp. 2000 Aug-Sep;51(6):463-7) but am baffled why one would see it on one instrument and not another, unless the two measures were at different times and the otosclerosis had progressed.
I have seen few patients for whom RIAR was obtained. But when I asked the patient to keep his head straight, RIAR disappeared and normal reflex was obtained.
Then i asked one of my students to sit for reflex by turning his head slightly to one side and then keep it straight. I observed RIAR when his head was turned and normal reflexes when the head was straight.
So i feel its the patient's head position rather than two different instruments which made this difference findings in your case.
Thomas
I don't have more experience in clinical practice and i don't see it in my observations up to now, but according to the one of audiology field references(Handbook of clinical Audiology,JACK KATZ,SIXTH EDITION), in a study, Ciardo et al.(2005) administered a muscle relexant to block stapedius reflex activity during sergery.The mucle relaxant did not obliterate the RIARs of otosclerosis patients, but it did block the real ipsilateral reflexes of patients withe normal middle ear functioning.In a other study, Ciardo et al.(2003) found that RIARs occoured in normal ears, in ears with monaural deafness or otosclerosis with normal otoscopy and type A tympanograms, and in ears on the side of facial nerve palsy.Based on these observationThe RIAR is due to the subtractive (eardrum)artifact ratger than representing a clinical entity.
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