Skip to main content

Research Repository

Advanced Search

Parasympathetic nervous system dysfunction, as identified by pupil light reflex, and its possible connection to hearing impairment

Wang, Yang; Zekveld, Adriana A.; Naylor, Graham; Ohlenforst, Barbara; Jansma, Elise P.; Lorens, Artur; Lunner, Thomas; Kramer, Sophia E.


Yang Wang

Adriana A. Zekveld

Profile Image

Professor of Hearing Sciences

Barbara Ohlenforst

Elise P. Jansma

Artur Lorens

Thomas Lunner

Sophia E. Kramer


Although the pupil light reflex has been widely used as a clinical diagnostic tool for autonomic nervous system dysfunction, there is no systematic review available to summarize the evidence that the pupil light reflex is a sensitive method to detect parasympathetic dysfunction. Meanwhile, the relationship between parasympathetic functioning and hearing impairment is relatively unknown.

To 1) review the evidence for the pupil light reflex being a sensitive method to evaluate parasympathetic dysfunction, 2) review the evidence relating hearing impairment and parasympathetic activity and 3) seek evidence of possible connections between hearing impairment and the pupil light reflex.

Literature searches were performed in five electronic databases. All selected articles were categorized into three sections: pupil light reflex and parasympathetic dysfunction, hearing impairment and parasympathetic activity, pupil light reflex and hearing impairment.

Thirty-eight articles were included in this review. Among them, 36 articles addressed the pupil light reflex and parasympathetic dysfunction. We summarized the information in these data according to different types of parasympathetic-related diseases. Most of the studies showed a difference on at least one pupil light reflex parameter between patients and healthy controls. Two articles discussed the relationship between hearing impairment and parasympathetic activity. Both studies reported a reduced parasympathetic activity in the hearing impaired groups. The searches identified no results for pupil light reflex and hearing impairment.

Discussion and Conclusions
As the first systematic review of the evidence, our findings suggest that the pupil light reflex is a sensitive tool to assess the presence of parasympathetic dysfunction. Maximum constriction velocity and relative constriction amplitude appear to be the most sensitive parameters. There are only two studies investigating the relationship between parasympathetic activity and hearing impairment, hence further research is needed. The pupil light reflex could be a candidate measurement tool to achieve this goal.


Wang, Y., Zekveld, A. A., Naylor, G., Ohlenforst, B., Jansma, E. P., Lorens, A., …Kramer, S. E. (2016). Parasympathetic nervous system dysfunction, as identified by pupil light reflex, and its possible connection to hearing impairment. PLoS ONE, 11(4), Article e0153566.

Journal Article Type Article
Acceptance Date Mar 31, 2016
Publication Date Apr 18, 2016
Deposit Date Oct 31, 2016
Publicly Available Date Oct 31, 2016
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 11
Issue 4
Article Number e0153566
Public URL
Publisher URL
Additional Information Wang Y, Zekveld AA, Naylor G, Ohlenforst
B, Jansma EP, Lorens A, et al. (2016)
Parasympathetic Nervous System Dysfunction, as
Identified by Pupil Light Reflex, and Its Possible
Connection to Hearing Impairment. PLoS ONE 11(4):
e0153566. doi:10.1371/journal.pone.0153566


Wang et al 2016 Parasympathetic nervous system dysfunction as identified by pupil light reflex and its possible connection to hearing impairment.pdf (1.6 Mb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

You might also like

Downloadable Citations