A standard clinical immittance test battery includes measurements of the acoustic reflex, or more specifically, the middle ear muscle reflex (MEMR). The MEMR is the contraction of the stapedius muscle in response to high-level acoustic stimulation. Clinical MEMR measurements are made according to the American National Standards Institute standard for immittance instruments (S3.39–2012) by use of a 226-Hz probe tone in conjunction with a reflex-activating stimulus presented to the ipsilateral or contralateral ear. The MEMR is a bilateral response, which means that presenting the activator to one ear will elicit the response in both ears. In traditional clinical measurements, the reflex activator stimulus is a pure tone (500, 1000, 2000, or 4000 Hz) or a broadband noise, and the MEMR is measured at tympanometric peak pressure (TPP) as measured on the tympanogram. If the admittance of the test ear decreases by a criterion amount in the presence of the activator, for example, 0.02 to 0.03 mmho, the reflex is considered to be present. The lowest level at which an activator is presented and reliably elicits at least the criterion change in admittance is considered the MEMR threshold. The MEMR is typically present in ears with pure-tone behavioral thresholds of ≤60 dB HL at the activator frequencies (Gelfand 2009).

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What do hip-huggers, HEMI engines, and behind-the-ear (BTE) hearing aids have in common? Not a whole lot except that all three were trendy in the 1960s and 1970s, then fell into decline, and now, in the new millennium, are selling like those proverbial hotcakes! They have also all come back in somewhat different forms. Chrysler's new HEMI engine, introduced in 2002, is a little smaller than that of yesteryear. The old hip-huggers have been reincarnated as “low-rise jeans.” And the BTE's return to dominance of the hearing aid market has been fueled by the appearance of smaller instruments with open-canal (OC) fittings, beginning in 2003 with the GN ReSound Air®. Today, every manufacturer offers smaller BTEs, mostly fitted with an open canal, and often categorized under new names, such as post-auricular-canal, over-the-ear, and mini- and micro-BTEs. This new breed of products is also showing up in an amazing range of shapes and colors, as that old industry dream of stylish hearing aids is finally coming true. The Hearing Industries Association (HIA), the main source of U.S. market sales data, recently reported that 51.45% of all hearing aids sold in 2007 were of some BTE style. However, it remains uncertain how much of the boom in BTE sales has resulted from smaller open-fit BTE hearing aids, herein referred to as OC mini-BTEs. To find out the extent of the OC mini-BTE boom—and also what dispensers and their patients think of this product type—the 2008 Hearing Journal/AudiologyOnline (HJ/AO) survey included a special section of 10 questions for audiologists, hearing instrument specialists, and other hearing professionals about their experiences with and opinions on these devices. The survey also included questions on many other topics, which will be reported on next month. But this Cover Story focuses on what our survey learned about OC mini-BTEs—their popularity and their perceived benefits and drawbacks. First though, here's a quick look at how the survey was conducted and who took part.

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This session is developed by, and presenters invited by, Hearing, Balance, Tinnitus – Assessment and Intervention: Adult. This presentation will provide an overview of contemporary measures of vestibular function with a focus on advantages, limitations, and clinical usefulness. The implementation and outcome of a triage clinic for patients suspicious of benign paroxysmal positional vertigo will also be described.

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