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Tympanometry

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Image showing Type A tympanogram
Image showing Type B tympanogram
Type C Tympanogram.

Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal.

Tympanometry is an objective test of middle-ear function. It is not a hearing test, but rather a measure of energy transmission through the middle ear. The test should not be used to assess the sensitivity of hearing and the results of this test should always be viewed in conjunction with pure tone audiometry.

Tympanometry is a valuable component of the audiometric evaluation. In evaluating hearing loss, tympanometry permits a distinction between sensorinueural and conductive hearing loss, when evaluation is not apparent via Weber and Rinne testing. Furthermore, in a primary care setting, tympanometry can be helpful in making the diagnosis of otitis media by demonstrating the presence of a middle ear effusion.

Operation

A tone of 226hz is generated by the tympanometer into the ear canal, where the sound strikes the tympanic membrane, causing vibration of the middle ear, which in turn results in the conscious perception of hearing. Some of this sound is reflected back and picked up by the instrument. Most middle ear problems result in stiffening of the middle ear, which causes more of the sound to be reflected back.

The general term used to describe how energy is transmitted through the middle ear is admittance. The instrument measures the reflected sound and expresses it as an admittance or compliance, plotting the results on a chart known as a tympanogram.

Normally, the air pressure in the ear canal is the same as ambient pressure. Also, under normal conditions, the air pressure in the middle ear is approximately the same as ambient pressure since the eustachian tube opens periodically to ventilate the middle ear and to equalize pressure. In a healthy individual, the maximum sound is transmitted through the middle ear when the ambient air pressure in the ear canal is equal to the pressure in the middle ear.

Procedure

After an otoscopy (examination of the ear with an otoscope) to ensure that the path to the eardrum is clear and that there is no perforation, the test is performed by inserting the tympanometer probe in the ear canal. The instrument changes the pressure in the ear, generates a pure tone, and measures the eardrum responses to the sound at different pressures.

Type A tympanogram is considered normal. There is a normal pressure in the middle ear with normal mobility of the eardrum and the conduction bones.

Type B and C tympanograms may reveal fluid in the middle ear , perforation of the tympanic membrane, scarring of the tympanic membrane, lack of contact between the conduction bones of the middle ear or a tumor in the middle ear.

In contrast to the above information: Typing of tympanometric data should NOT be used as a diagnostic indicator. It is merely a description of shape. There is no CLEAR distinction between type A (not to mention A sub-S and A sub-D) and type B and/or type C).

Only measures of static acoustic admittance, ear canal volume, and tympanometric width/gradient compared to gender, age, and race specific normative data can be used to somewhat accurately diagnose middle ear pathology along with the use of other audiometric data (e.g. air and bone conduction thresholds, otoscopic examination, normal word recognition at elevated presentation levels, etc...).

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