Challenges in using pupil dilation responses to sounds as a reliable alternative to standard audiometric tests.

Assessing hearing in neonates and uncooperative patients can be challenging. Pupil dilation response (PDR) as an objective physiological measure may offer a solution. To test its feasibility, PDRs were averaged in response to a sequence of 60-100 audible tones (same frequency and amplitude). This was performed in subjects with normal hearing and communication abilities, who were exposed to two different lighting levels. We evaluated whether averaged post-stimulus intervals of PDRs were significantly different from randomly generated averages of pupil traces recorded in the absence of sound stimulation from the same subject. This analysis was repeated for the first, second, and third block of PDRs to account for possible adaptation phenomena. Although all the participants clearly perceived the tones, significant PDRs in response to sound were only detected in a fraction of subjects, primarily in the low luminance condition. Consequently, only in the low luminance group, the grand average of individual PDRs was significantly larger than that obtained for traces recorded in the absence of sound input. In this most favorable condition, when the three blocks of PDRs were averaged separately, significant PDRs were observed in 40 % of the subjects in at least one of the blocks. Therefore, the PDR to sound input is not a reliable indicator of hearing perception when standard audiometric stimuli of the same amplitude and frequency are used. Possible modifications to sound input and stimulation protocols for obtaining reliable PDRs in diagnosing and treating hearing impairments are discussed.