IMMITTANCE AUDIOMETRY

Objective test of hearing

Ms. Tejaswini S
M.Sc. Audiology
 OUTLINE CONCEPTS OF IMMITTANCE TYMPANOMETRY

1 TYMPANOMETRY

2 INSTRUMENTATION/EQUIPMENT

3 PROCEDURES

4 TYPES OF TYMPANOGRAM

5 INTERPRETING RESULTS

6 PATHOLOGICAL CORRELATIONS

7 IMPORTANCE
 IMMITTANCE/TYMAPNOMETRY
5-Step Ordering Process

1
‘‘Tympanometry is a dynamic
2
measure of the acoustic
3
immittance in the external ear
4 canal as a function of ear canal
5 air pressure change.’’
6

7
1
TYMPANOMETRY EQUIPMENT
2

7
 INSTRUMENTATION/EQUIPMENT
1

A probe is inserted in the ear

2
canal that contains a
loudspeaker, a microphone, and a
3
pump.
4 A tone (226Hz) is delivered into
the ear while the pressure is
5
changed within the sealed canal.
6 Measurement taken at the probe
- plots the flexibility of the TM
7
and the ossicles.
Plot is displayed in a graph called
the tympanogram.
 OTOSCOPY
1

NO WAX
3

5
NO MOVEMENTS
PROCEDURE
6

PATIENT IS INSTRUCTED
TO RELAX AND SIT

PROBE INSERTION WITH

GOOD SEAL
 1 2 3 4 5
Ear canal is Air pump Pressure changes While pressure Wave that is
sealed with a creates a gradually: is changing, a
Positive +200 daPa
reflected from
probe tip change in sound the TM is then
(forces TM inward)
pressure in ear transmitter picked up by a
Negative – 200 daPa
canal (forces TM outward)
sends a sound mic in the
wave to the TM probe

THE TYMPANOMETER
MEASURES ENERGY OF THE
REFLECTED SOUND
5-Step Ordering Process
 IMMITTANCE/TYMAPNOMETRY CONCEPTS

1
01 02
2
WAVE STRIKES SOME OF SIGNAL IS
THE TM. ABSORBED BY TM
3

4 03
SOME OF SIGNAL IS
5 REFLECTED BACK OUT
THE EXTERNAL
6 CANAL.

7
REFLECTED ENERGY IS
PICKED UP AND DIPLAYED ON
THE SCREEN AS
TYMAPNOGRAM
5-Step Ordering Process
 WHAT IS A TYMPANOGRAM?
1

2 IT IS A GRAPHICAL
3 REPRESENTION OF
TYMPANOMETRIC
4 VALUES
5

6
THE SHAPE OF THE
7 TYMPANOGRAM WILL SHOW
WHETHER YOUR RESULTS
ARE NORMAL OR ABNORMAL
 TYMPANOMETRIC FEATURES
5-Step Ordering Process

SHAPES OF EQUIVALENT STATIC TYMPANOMETRIC TYMPANOMETRIC

TYMPANOGRAM EAR CANAL ACOUSTIC PEAK WIDTH
VOLUME COMPLIANCE PRESSURE

MIDDLE-EAR COMPLIANCE
PRESSURE OF MIDDLE-EAR
EAR CANAL
VOLUME
Type Type Type Type Type Type
A As Ad B C Cs

NORMAL SHALLOW STEAP FLAT NEGATIVE NEGATIVE

PEAK PEAK PEAK NO PEAK PEAK AND
SHALLOW
 NORMATIVE VALUE
1

3 MIDDLE-EAR PRESSURE
+60 and -60 daPa
4

5 EAR CANAL VOLUME

0.3 and 2 mm
6

7 COMPLIANCE OF
MIDDLE-EAR SYSTEM
0.3 and 1.6 mm
 SHAPE TYPE A
NORMAL TYMPANOGRAM

MIDDLE-EAR PRESSURE INTACT &

+60 and -60 daPa MOBILE TM

NORMAL
EAR CANAL VOLUME EUSTACHIAN TUBE
0.2 and 2 mm FUNCTION

COMPLIANCE OF ABSENCE OF MIDDLE

MIDDLE-EAR SYSTEM EAR PATHOLOGY
0.3 and 1.6 mm

IF THERE IS A HEARING
LOSS, IT IS LIKELY TO BE
SNHL!
5-Step Ordering Process
 SHAPE TYPE AS
SHALLOW TYMPANOGRAM
OSSICULAR FIXATION
MIDDLE-EAR PRESSURE OR TM SCARRING
+60 and -60 daPa PRESENCE OF MIDDLE
EAR FLUID

NORMAL
EAR CANAL VOLUME EUSTACHIAN TUBE
0.2 and 2 mm FUNCTION

COMPLIANCE OF PRESENCE OF
MIDDLE-EAR SYSTEM MIDDLE EAR
<0.3 mm
PATHOLOGY

MAY RESULT IN A FAIRLY

FLAT, NON-FLUCTUATING
HEARING LOSS, IT IS
LIKELY TO BE CHL!
5-Step Ordering Process
 SHAPE TYPE AD
DISARTICULATION: ABNORMAL
TYMPANOGRAM

MIDDLE-EAR PRESSURE ASSOCIATED WITH

OSSICULAR
+60 and -60 daPa
DISARTICULATION

NORMAL
EAR CANAL VOLUME EUSTACHIAN TUBE
FUNCTION
0.2 and 2 mm

PRESENCE OF
COMPLIANCE OF
MIDDLE EAR
MIDDLE-EAR SYSTEM
PATHOLOGY
>1.6 mm
MAY RESULT IN A FAIRLY
FLAT, NON-FLUCTUATING
HEARING LOSS, IT IS
LIKELY TO BE CHL/MHL!
5-Step Ordering Process
 SHAPE TYPE B
FLAT TYMPANOGRAM

MIDDLE-EAR PRESSURE ASSOCIATED WITH

PERFORATED TM AND
+60 and -60 daPa
WAX IN EAC

NORMAL
EAR CANAL VOLUME EUSTACHIAN TUBE
FUNCTION
<0.2 mm OR >2 mm

PRESENCE OF
COMPLIANCE OF
MIDDLE EAR
MIDDLE-EAR SYSTEM
PATHOLOGY
<0.2 mm

MAY RESULT IN A FAIRLY

FLAT, NON-FLUCTUATING
HEARING LOSS, IT IS
LIKELY TO BE CHL!
5-Step Ordering Process
 SHAPE TYPE C:
NEGATIVE TYMPANOGRAM

MIDDLE-EAR PRESSURE ASSOCIATED WITH ME

PRESSURE AND ET
> -100 daPa
FUNCTION

EUSTACHIAN TUBE
EAR CANAL VOLUME
DYSFUNCTION
0.2 and 2 mm

PRESENCE OF
COMPLIANCE OF
MIDDLE EAR
MIDDLE-EAR SYSTEM
PATHOLOGY
0.3 and 1.6 mm

MAY RESULT IN MILD

CONDUCTIVE LOSS, OR
HEARING CAN BE WNL
5-Step Ordering Process
 SHAPE TYPE CS
NEGATIVE SHALLOW TYMPANOGRAM

MIDDLE-EAR PRESSURE ASSOCIATED WITH ME

PRESSURE AND ET
> -100 daPa
FUNCTION

EUSTACHIAN TUBE
DYSFUNCTION
EAR CANAL VOLUME
PRESENCE OF ME
0.2 and 2 mm FLUIDE

PRESENCE OF
COMPLIANCE OF
MIDDLE EAR
MIDDLE-EAR SYSTEM
PATHOLOGY
<0.3 mm

MAY RESULT IN MILD

CONDUCTIVE LOSS, OR
HEARING CAN BE WNL
5-Step Ordering Process
1
IMPORTANCE OF 1
OBJECTIVE MEASURE OF THE MIDDLE-EAR
2 TYMPANOMETRY SYSTEM

3 5-Step Ordering Process

2
4
MOBILITY OF THE EARDRUM
5

6
3
CONDITION OF MIDDLE EAR BONES
7

4
EUSTATION TUBE FUNCTIONING

5
DIFFERENTIAL DIAGNOSIS
Thank you