Hyperactive Acoustic Reflexes and Perilymphatic Hypotension

To the Editor.—Downs et al reported in theArchives(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.1Such 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 I have serially tested patients trying to withdraw from benzodiazopines (unpublished data, 1979).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