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Tympanometry is an acoustic evaluation of the condition of the
middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...
eardrum (
tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the a ...
) and the conduction bones by creating variations of
air pressure Atmospheric pressure, also known as barometric pressure (after the barometer), is the pressure within the atmosphere of Earth. The standard atmosphere (symbol: atm) is a unit of pressure defined as , which is equivalent to 1013.25 millibars ...
in the ear canal. Tympanometry is an objective test of middle-ear function. It is not a
hearing test A hearing test provides an evaluation of the sensitivity of a person's sense of hearing and is most often performed by an audiologist using an audiometer. An audiometer is used to determine a person's hearing sensitivity at different frequencies ...
, but rather a measure of energy transmission through the middle ear. It is not a measure of TM or middle ear mobility. It is an acoustic measure, measured by a microphone, as part of the ear canal probe, inserted into the ear canal. 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 Pure-tone audiometry is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss and thus providing a basis for diagnosis and management. Pu ...
. Tympanometry is a valuable component of the audiometric evaluation. In evaluating hearing loss, tympanometry permits a distinction between sensorineural and
conductive In physics and electrical engineering, a conductor is an object or type of material that allows the flow of charge (electric current) in one or more directions. Materials made of metal are common electrical conductors. Electric current is gene ...
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 Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...
by demonstrating the presence of fluid build up in the middle ear cavity.


Operation

A tone of 226 Hz is generated by a probe tip inserted into the external 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. While 226 Hz is the most common probe tone, others can be used. In infants under 4 months of age, research has shown a 1000 Hz tone yields more accurate results. Multi-frequency tympanometry is conducted at multiple frequencies between 250 and 2000 Hz and is used to help identify ossicular abnormalities. Admittance is how energy is transmitted through the middle ear. 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 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 An otoscope or auriscope is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate ear symptoms. An otoscope potentially gives a view o ...
(examination of the ear with an otoscope) to ensure that the path to the eardrum is clear and 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. This produces a series of data measuring how admittance varies with pressure, which is plotted as a tympanogram: Tympanograms are categorized according to the shape of the plot. A normal tympanogram (left) is labelled Type A. There is a normal pressure in the middle ear with normal mobility of the eardrum and ossicles. Type B tympanogram may reveal (a) fluid in the middle ear, (b) perforation of the tympanic membrane or patent pressure equalization tube, or (c) a tumor in the middle ear. Type C tympanograms are consistent with negative pressure in the middle ear space resulting from compromised eustachian tube function and a retracted tympanic membrane. The categorising of tympanometric data should ''not'' be used as a diagnostic indicator. It is merely a description of shape. There is a distinction between the three types as well as the two subtypes of type A, namely AS and AD. For example, AS (a shallow tympanogram) will show a stiff middle ear system or AD (a deep tympanogram) consistent with ossicular discontinuity or a monomeric membrane. Only measures of static acoustic admittance, ear canal volume, and tympanometric width/gradient compared to sex, 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.).


Tympanometry on smartphones

There have been a few efforts to lower the cost of tympanometers by using smartphones. In 2022, University of Washington researchers had demonstrated an end-to-end smartphone-based tympanometer system that consists of a portable phone attachment used to change the air pressure in the ear. The smartphone computes and displays a tympanogram and reports peak acoustic admittance in real-time. The smartphone-based system operated at 226 Hz and in proof-of-concept testing showed comparable results to commercial tympanometers. Given the ubiquity of smartphones across the world, these mobile systems may help make these audiology tools accessible across the world.


References


External links


Medscape article
by Kathleen C M Campbel

{{Outer and middle ear disease Ear procedures Medical tests