Tympanometry flashcards |

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Anatomy of the ME

-TM

-Ossicles

-ET

-Mastoid

-Muscles

TM

as it moves it makes the ossicles move; move sound from the TM to the oval window

Ossicles

enhance sound from air to sound, impendence mismatch transformer, sensitive to change

Eustachian Tube (ET)

lets fresh air into air, equalizes ME space

Mastoid

air pockets and is continuous into the ME, impacts the pressure as well

Muscles

-when we hear a loud sound the muscles will pull back and tense up the muscles to protect the ossicles, prevent the sound from traveling (e.g., tensor tympani, stapedius)

Background Concepts:

Size of a Hard-walled Cavity

Dictates the loudness

Background Concepts:

Equal Impedance

-For sound to travel it's best, will take more effort to move fluid than air

-Without equal pressure, or fluid in the ME will make it harder for the sound to go through

-The ET helps equalize, so the ossicles can enhance (boost) the sound.

Background Concepts:

Compliance

-We want to know how well the TM moves

-We can measure in a theoretic manner

-EX: The TM is complaint, meaning there isn't much impedance

-We do this by using equivalent volumes

Background Concepts:

Equivalent Volume

-Imaginary, not real volumes

-A theoretic volume that we are estimating that gives us a volume

-We put a sound in and measure how much comes back

-What does not bounce back is the same sound in a bigger "room" if there is a hole or perf.

-What bounces back is the equivalent volume

Immittance Devices:

Inside Component

-Probe tone generator: creates a standard ongoing sound (typically, 226 Hz at a standard level and always there)

-Signal generator: creates other signals, like pure-tones for acoustic reflexes

-Pressure pump: changes pressure in the EC

Immittance Devices:

Probe Components

-Probe tone: has the ongoing 226 Hz tone coming out of it; doing the MEASURING

-Pressure: measures pressure

-Mic: measures the bounce back

Immittance Devices:

How it Works

-Probe tone

-Pressure varied

-Reflected sound

-Mic measures

-Compare baseline

-Plot results

Phsyical Volume

-FIRST, perform Otoscopy

-Hermetic seal: get a good seal; pick the correct sized tip so there isn't a leak

-+200 daPa: read what the equivalent volume coming back

-Volume in ml (actual volume) will give you a REAL volume of the EC

Normal Volume

-Adult: .6 - 1.5 ml

-Child: .4 - 1.0 ml

-Type B: With normal volume: suggests poor mvmt of the TM or poor ME function

Small Volume

-Adult: > .6 ml

-Child: > .4 ml

Type B: with small vol. suggests obstruction of the EC wax or blockage

Large Volume

-Adult: < 1.5 ml

-Child: < 1.0 ml

-Type B: with large vol. suggest a perforation or PE tube in TM

Tympanometry: Procedure

1. Otoscopy

2. Hermetic seal

3. +200 daPa vary in 50 daPa steps (when equal you will get the max compliance)

4. Compare to baseline

5. Compare results

Pressure

+50 to -150 daPa

-B/w -100 to -150 it may still cause a conductive loss

-Low: > -150 = Type C, suggests they have negative pressure (ET tube isn't opening and letting air in)

-High: > +50 = suggests positive pressure

Static Compliance

peak - base = compliance (use this formula if the base is not at 0)

-Adults: .3 - 1.4 ml

-Child: .2 - .9 ml

Width

-Half the height of the tympanogram on both sides, and look at the width b/w the two points

-Adult: 40-110 daPa

-Child: 60-150 daPa

Type A

peak b/w +50 to -150, compliance w/in normal range

Type A(S)

-compliance < .3 (adults) or .2 (child) = shallow; normal peak

- Suggests stiffness of the ME system

Type A(D)

-compliance < .3 (adults) or .2 (child) = shallow; normal peak

- Suggests stiffness of the ME system

Type B

no peak: suggests poor mvmt of the TM or poor ME function (w/ normal vol.)

Type B w/ small volume

Suggests obstruction of the EAC, wax/blockage

Type B w/ a large volume

Suggests a perforation of the TM or PE tubes

Type C

-peak > -150

-Suggests they have negative pressure (ET tube isn't opening and letting air in)

Multifrequency Tympanometry

-Tympanometry

-Change Probe Frequency

-Look for notching: called 3Ys or notched A for type, if a tympanogram had a notch, comes back up

-Has a peak and we need to test with a different probe Hz than 260 Hz,

-Do it again, to make sure it's there. Then repeat at different freq.

Abnormal Physical Volume

strictly a conductive disorder

Abnormal Tympanometry

conductive disorder

Abnormal Multifrequency Tympanometry

There will be some component that is a conductive component, but regular tymp. didn't catch it

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