Acoustic reflex testing

What is acoustic reflex testing?

Acoustic reflex testing measures a tiny, automatic muscle reflex deep in the middle ear. When you hear a loud sound, a small muscle (the stapedius) tightens by itself to stiffen the chain of hearing bones a little. You cannot feel or control this; the test simply detects it using the same kind of soft probe used for tympanometry.

During the test the probe plays brief, loud tones and measures whether — and at what loudness — the reflex appears. The quietest level that triggers it is called the acoustic reflex threshold. The test is usually done as part of middle-ear testing and a wider hearing assessment.

The test provides information; it does not treat anything. Because the reflex depends on the middle ear, the inner ear, the hearing nerve and part of the nerve that moves the muscle, the pattern of results can give clues about where a problem might lie. A result guides what to do next and is read alongside your other tests, rather than giving a diagnosis on its own.

The loud tones can be momentarily startling but are brief and not harmful at the levels used. The test is not suitable for everyone, and the audiologist will judge whether it is appropriate for you.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Tympanometry vs acoustic reflex testing

Both use the same soft probe and are often done together. Tympanometry checks how the eardrum moves; the reflex test checks the ear's automatic response to loud sound.

Preparing for your test

• Keep your ear free of anything blocking it; tell the team if you think you have a lot of earwax, as it can affect the test.
• Mention any recent ear infection, cold, ear surgery or a known hole in the eardrum.
• Tell the team if loud sounds are very uncomfortable for you, or if you have a sound sensitivity such as hyperacusis.
• Let them know about any facial weakness, dizziness or ringing in the ears.
• There is no special preparation otherwise — you can eat, drink and take your medicines as usual.
• Bring details of any previous hearing or middle-ear tests to compare.

What happens

A soft probe is placed in the opening of your ear canal to make a gentle seal, just as for tympanometry. You sit still and avoid talking or moving for a short time while the test runs.

The probe plays brief, loud tones at different pitches and measures whether the middle-ear reflex appears and at what loudness. For contralateral testing, a sound is played in one ear while the reflex is measured in the other. The loud tones can be momentarily startling, but they are brief and not harmful at the levels used, and you do not need to respond — the machine detects the reflex automatically.

The test usually takes only a few minutes and is often done as part of middle-ear testing. The result is typically explained on the day, alongside your standard hearing test and tympanogram.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Acoustic reflex testing is usually not painful and safe at the sound levels used, though the brief loud tones can startle and may be uncomfortable for people with sound sensitivity — tell the team if loud sounds bother you. The test is not used in everyone, and the absence of a reflex does not, by itself, diagnose a problem. Results are read alongside your other tests. Ask what the pattern means for you and what the plan is if it is abnormal.

Published figures to discuss

Acoustic reflex testing is non-invasive and safe at the sound levels used, so meaningful complication rates are not the issue. What matters is interpretation: the reflex can be absent in some healthy people and is affected by earwax, a poor seal or a middle-ear problem, so an abnormal result shows the pathway is affected rather than giving a specific diagnosis. There are no robust adverse-event rates to quote, so none are given here.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no recovery from acoustic reflex testing. You can carry on with your day straight away. What matters afterwards is how the result is explained alongside your other hearing and middle-ear tests.

• A brief startle from the loud tones, which passes immediately
• No physical after-effects
• Having the result explained alongside your other hearing tests
• Sometimes repeating the test for a clear reading

Aftercare

• Ask what your reflex pattern means in plain terms, and how it fits with your other tests.
• Mention if the loud tones were very uncomfortable, especially if you have sound sensitivity.
• If the result points to a nerve or middle-ear issue, ask what further tests are suggested.
• Keep a copy of your result so future tests can be compared.
• Attend any follow-up or further tests that are arranged.
• Report any new facial weakness, sudden hearing change or dizziness promptly.

• Ear free of blockage, with earwax mentioned if present
• Recent ear infection, surgery or perforation flagged
• Sound sensitivity (such as hyperacusis) mentioned beforehand
• Any facial weakness, dizziness or tinnitus noted
• Previous hearing or middle-ear results brought to compare
• Questions written down about the result and next steps

⚠ Get urgent help if…

• Sudden hearing loss, especially in one ear — this should be assessed urgently, separately from a routine test
• New facial weakness or drooping on one side — seek prompt medical advice
• Hearing loss with dizziness or severe headache — seek prompt medical advice
• New ringing in one ear with hearing loss, which should be reviewed promptly
• Severe ear pain or discharge that is getting worse

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

The result is described by whether the reflex is present, absent or raised, and how the two ears compare. A reflex that appears as expected is reassuring about that part of the system. A reflex that is absent or only appears at very high levels can point towards a middle-ear problem, a hearing loss, or sometimes a problem along the hearing nerve or the nerve that moves the muscle.

Results have limits. The reflex depends on several parts of the hearing system, so an abnormal result shows that something in the pathway is affected, not exactly what or where. It can also be affected by earwax, a poor seal or a middle-ear problem. The reflex is normally absent in some healthy people too. Your clinician interprets the pattern alongside your tympanogram, standard hearing test and symptoms, and may add further tests.

The result reflects how things are now. The middle ear and hearing can change, so the test may be repeated if your symptoms change or if other results raise new questions. It is often used as one part of a battery of tests rather than something repeated on its own.

Related tests, treatments or support

Acoustic reflex testing is usually done together with tympanometry, using the same probe, and alongside pure tone audiometry. The pattern across these tests, with your symptoms and an ear examination, helps decide whether further tests (such as more detailed hearing-nerve tests or a scan) or referral are needed.

Follow-up & long-term care

The result is usually explained on the day, as part of your overall hearing assessment. If the pattern suggests a middle-ear, inner-ear or nerve problem, further tests or referral are arranged. The test is generally interpreted as part of a wider picture rather than repeated alone.

Repeat, follow-on and what comes next

• The test is often repeated if you moved or talked, or if earwax affected the seal.
• It is usually interpreted as part of a battery rather than repeated alone.
• An abnormal pattern may prompt further hearing-nerve tests or a scan rather than immediate conclusions.
• A normal-sounding reflex does not rule out every problem, and absence can be normal in some people.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A plain-English explanation of your reflex pattern and what it adds.
• Clear advice on whether further tests, a scan or referral are needed.
• Attention to comfort, especially for people sensitive to loud sound.
• A written record so future tests can be compared.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether it is part of a fuller hearing assessment or done with tympanometry
• The clinician's time and equipment
• Whether ipsilateral, contralateral and decay testing are all included
• Whether a standard hearing test and ear examination are included
• Any follow-up appointment to discuss results
• Further tests if results are unclear

• Which tests are included in the appointment
• The clinician's and facility fees
• Whether a written report and results discussion are included
• Whether tympanometry and a standard hearing test are included
• Any follow-up appointment cost
• What happens, and what it costs, if more tests are needed

On the NHS? Acoustic reflex testing is available on the NHS as part of audiology and ENT assessment when clinically indicated; private testing may be used for speed, convenience or choice of provider.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• What does my reflex pattern mean, and how does it fit with my other tests?
• Does an absent or raised reflex suggest a middle-ear, inner-ear or nerve problem?
• Do I need any further tests, such as a scan, because of this result?
• Could earwax or a middle-ear problem have affected the result?
• Should I be concerned about the loud sounds if I have sound sensitivity?
• What happens if the result is normal but my symptoms continue?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my test, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this test not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for acoustic reflex testing

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Hearing tests British Society of Audiology — Recommended procedures British Academy of Audiology Acoustic reflexes: should we be paying more attention? — International Journal of Audiology ENT UK — patient information

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.