Audiology Test 3- Tympanometry flashcards |

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when is the visual otoscopic inspection performed?

before tympanometry

Purpose of the Visual Otoscopic Inspection?

NOT to diagnose a disorder, but to assess the outer ear and TM and middle ear for something obviously atypical
(can assist in interpreting other audiological evaluation results)

Obviously atypical things to look for in the Otoscopic Inspection

structural defect of the ear, head or neck
ear canal abnormalities
tympanic membrane abnormalities

Describing ear canal abnormalities for results of the Otoscopic Inspection

Blood or effusion (drainage)
inflammation
excessive cerumen or foreign object

Describing tympanic membrane abnormalities for results of the Otoscopic Inspection

color: not normal if white or grey.
Bulging or Retraction
Fluid line or Bubbles
Perforation
Mass

Immitance

this term reflects what the test measures; combination of the words "impedance" and "admittance"

Impedance:

opposition to flow of acoustic energy at the middle ear

Admittance

acoustic energy passed by the tympanic membrane into the middle ear

Major Tests of immittance

Tympanometry
Acoustic Reflex Thresholds

Tympanometry- 3 parts

peak admittance (sometimes static compliance)
physical volume (aka ear canal volume)
peak pressure

Acoustic Reflex Thresholds

measure stapedial muscle reflex, which stiffens the middle ear system when elicited by high intensity sounds.

Immittance Testing-Purposes

Detecting middle ear disorders (tympanometry and reflexes)

Differentiating different types of middle-ear pathology (tymp. and reflexes)

Differentiating cochlear from retrocochlear pathology (reflexes & reflex decay)

Facial nerve (reflex) and eustachian tube function (tympanometry)

The Tympanic Membrane vibrates most easily when air pressure is...

equal on both sides (normal resting position), at 0 daPa

In tympanometry, the microphone can measure...

the probe tone is constantly on and the Microphone can measure how much sound is absorbed/admitted, and how much is reflected into the ear canal

greatest admittance

point where there is most acoustic energy passed

In a normal middle ear, the greatest admittance is at ____, and declines as the air pressure

0 daPa.
admittance (passing of acoustic energy) declines as the air pressure moves away from 0, either positively or negatively.

Tympanometry determines the...

admittance of sound into the middle ear at varying degrees of positive and negative pressure in the external auditory canal.

Tympanometry may not be accurate with children younger than...

7 months

Peak Admittance

admittance of sound at the peak of the tympanometry trace.
in ml, cc or mmho

shown by the hight of the tympanogram at its peak

**need to know Peak Admittance ranges

...

normal peak admittance

0.3 ml - 2.0 ml

High peak admittance

greater than 2.0 ml.
-reflects flaccidity of TM/ossicles, aka excessive compliance

Low Peak admittance

less than 0.3 ml
-reflects stiffness of the middle ear system.

Peak pressure is shown by...

where the tympanogram peak falls horizontally

Peak pressure

relative to the air pressure in the middle ear

Normal Peak Pressure

+100 to -150 daPa

Negative Peak Pressure

less than -150 daPa

when there is negative peak pressure, this means...

middle ear pressure is negative relative to outer ear pressure. Sign of Eustachian Tube Dysfunction

Ear Canal Volume

provided on the screen or print out.
The Physical Volume of the ear canal beyond the probe

Normal Ear Canal Volume

.6 to 2.5 ml
-depends on age, gender, body size, etc

A too small Ear canal volume usually means...

there's an obstruction of the ear canal or improper probe placement

A too large ear canal volume usually means...

the tympanic membrane is not intact (so it picks up the volume of the middle ear too)

Type A

normal middle ear function
normal shape, peak pressure and peak admittance

Type As

stiffened middle ear system.
normal shape, peak pressure, LOW peak admittance: < .3 ml
s: shallow.

Type Ad

excessively middle ear system
normal shape, peak pressure, HIGH peak admittance: >2.5 ml
d: deep

Normal tympanometry indicates normal...

indicates normal middle ear function, NOT normal hearing

Type B tympanogram

flat. no peak (abnormal shape)
very low admittance; so little or no mobility

To interpret Type B tympanogram...

check ear canal volume

If a Type B tymp. has Normal physical volume...

TM is intact, there's no ear canal obstruction, but there's little to no mobility of the TM

A type B tymp with Normal physical volume often reflects...

otitis media with effusion

A type B tymp with a physical volume that is too small means...

either the probe tip was misplaced, or there is an ear canal obstruction

A type B tymp with a physical volume that is too large means...

the TM is not intact

Type C Tympanogram

normal shape, normal peak admittance, excessively negative peak pressure.
<-150 daPa

Type C Tymp. reflects...

eustachian tube dysfunction.
-non-specific finding
-may reflect oncoming of otitis media

Of the following, what pattern of tympanometry results would you expect to be associated with a conductive hearing loss related to a tympanic membrane perforation?
-Type Ad
-Type A with abnormally large ear canal volume
-Type B with normal ear canal volume (not possible)
-Type B with abnormally large ear canal volume

Type B with abnormally large ear canal volume

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