COMD 3700 Basic Audiology

Lesson 12
Tympanometry

Highlighted information refers to a change between the audio

recording (using 10th edition) and the 11th edition of the textbook

1. COMD 3700 for Distance Education. This is lesson 12 on

tympanometry. This lesson will cover pages 157-162 in Chapter 7 of
your textbook. We will go into more depth about tympanometry than
the textbook does. I feel as if tympanometry results are important
because as I mentioned before it is in the scope of practice for SLPs
as well as audiologists. In our clinic, the SLP students have to
complete an audiometric and immittance screening on all of their
clients. Tympanometry is an area many of the SLP students struggle
to understand. So I am hoping to go into it in enough detail to help
you understand the concepts behind it, without overwhelming you. At
the end of the lesson we will review several tympanograms to make
sure you can correctly interpret a tympanogram. My goal is for
tympanometry to not be so intimidating when you are in graduate
school.

2. We have discussed the concepts behind immittance testing. So now

we will begin studying the specific immittance measures. In this
lesson we will cover static compliance and tympanometry.

3. These tests are conducted using immittance equipment similar to

those shown here, commonly known as a tympanometer. A
tympanometer is an instrument, which provides information on the
functioning and status of the middle ear.

4. I want to start by giving you an overview of tympanometry.

Basically a tympanogram is a dynamic measurement of the activity of
the tympanic membrane (TM) and middle ear structures. It is a
measure of the compliance of the TM with varying degrees of positive
and negative pressure in the external auditory cancel. Tympanometry
is one of the principal subtests of immittance audiometry. As we
discussed in lesson 11, immittance audiometry is an objective
procedure that assesses, in an individual ear, the relative impedance
(resistance offered to the flow of energy in acoustic signals) and
admittance or compliance (the reciprocal of impedance, and the case
with which the ear accepts the flow of energy in an acoustic signal).
The other two subtests of immittance audiometry are static
admittance/ compliance and the acoustic reflex test. The general term
immittance is used to indicate the principle of evaluating energy flow.
Tympanometry assesses the ability of the tympanic membrane to
accept sound, and is therefore a test of the conductive mechanism of
the ear. It is a dynamic measure, meaning that the tympanic
membrane is in motion during the test. The basic approach in
tympanometry is to introduce a pure-tone, usually 220 or 226 Hz,
into the external auditory meatus and to measure how much of that
sound wave is accepted (admitted) or rejected (impeded) by the
tympanic membrane. So the probe plays a continuous tone, and
measures the amount of sound reflected off the TM at different air
pressures. The use of different frequencies can be used if additional
diagnostic information is needed. In a normal ear the tympanic
membrane will accept most of the sound and will do this when the air
in the external auditory meatus is at or very close to normal
atmospheric pressure. So, tympanometry measures sound reflection
from the tympanic membrane, while the immittance machine varies
air pressure in the ear canal. During tympanometry, air pressure,
expressed in dekapascals (daPa) or millimeters of water (mm h2o), is
varied continuously in the ear canal from values greater than normal
atmospheric pressure (usually + 200 daPa), through normal
atmospheric pressure (0 daPa), to values less than atmospheric
pressure (usually- 200 daPa). This causes the tympanic membrane to
move in the response to the positive and negative pressure applied to
it. Tympanometry is useable with children, adults, and seniors. It is
an effective and efficient objective procedure that permits us to get a
great deal of high-quality information quickly without any overt effort
on the part of the patient. In fact, the patient doesnt have to do
anything except sit still.

5. The tympanometry results are recorded on a tympanogram. The

name tympano is taken from the tympanic membrane. So basically
this is a tympanic membrane gram or graph. Tympanometry results
are plotted, either automatically or manually, on a tympanogram, a
graph of impedance/admittance values against air pressure values.
This is an example of a diagnostic tympanogram on a right and left
ear. As you can see they both look very different and have different
results reported below the drawing of the results. The shape and the
various measurements provide us with information about what is
occurring in the middle ear space and eustachian tube.

6. Here is a picture of a normal tympanogram. Along the bottom of

the chart, on the X Axis, is the air pressure scale. In the center is zero
mm H2O or dekapascals (daPa). Remember these are essentially
equal and used interchangeably. On the right is +200 mm H2O. On
the left is -200 mm H2O. The ordinate, or Y Axis, records admittance
or compliance of a volume of air (in cubic centimeters or milliliters)
that has equal acoustic admittance, or in absolute physical units
called acoustic millimhos (mmho). So when looking at a
tympanogram and the results, you may see it recorded as compliance
or equivalent volume, measured in cubic centimeters (abbreviated as
cm3 or cc) or measured in milliliters (abbreviated as mL). The
milliliter and the cubic centimeter are identical. Not as often, but
sometimes you will see admittance measured in millimhos
(abbreviated as mmhos). Under standard atmospheric conditions, the
acoustic admittance of a 1 cc cavity is equal to 1 mmho at 226 Hz. So,
this really simplifies calibration. When you see these measurements,
they are also essentially equal. You will hear me refer to them
interchangeably as we interpret the tympanogram results. When
conducting a tympanometric exam, using the immittance meter, a
measurement is taken at +200 then half the pressure (+100 mm H2O)
is removed, then removed half again (+50 mm H2O), then 0 mm H2O,
-50 mm H2O, -100 mm H2O, and finally -200 mm H2O. The machine
is taking measurements at each point. Then it plots the amount of
sound pressure at each of these points, and connects the dots just like
we do with an audiogram, except this time we have plotted a
tympanogram.

7. I want to go over the various measurements that are made using

the tympanometry. In looking at this tympanogram, it is labeled A
through J. I want to briefly introduce all of the different elements.
Then we will go through each measurement in more detail. This is
just one example of a typical printout. Different immittance meters
will display the results differently, but the elements will be the same.
So, A is the Ear Canal Volume. You may also see this abbreviated
ECV. B is the height of the peak static acoustic compliance of the TM
measured in cc. C will indicate R for the right ear and L for the left
ear. D is the peak at which the pressure is located. It is measured in
daPa. E is the tracing that records the compliance of the TM at a
continuous sweep from negative to atmospheric zero to positive
pressure applied to the ear canal. F indicates 200 daPa of positive
pressure in the ear canal. G indicates 0 atmospheric pressure in the
canal. H is showing daPa. Dekapascals are the unit of measure of
pressure in the external ear canal for this tympanogram. As I
mentioned earlier, you may also see tympanograms that are
measured using mm H2O. But it is essentially the same. I indicates
400 daPa of negative pressure in the ear canal. J is the recording for
the gradient.

8. Here are 2 more tympanograms. On the right the results for

volume, compliance, pressure and gradient are listed. I just want you
to have a good visual of the results that we will have after completing
the tympanometry testing.
9. The first measurement in the tympanometry portion of the
immittance test battery is the measurement of static acoustic
compliance. The book has it listed separately and you will see it listed
separately in other resources. But it is actually a sub test of
tympanometry and the first results that are calculated from the
tympanometry testing. You will begin the test differently depending
on the equipment you are using; usually it is very simple, such as
pushing a start button. Once a proper seal is ensured, a probe tone is
delivered through the transducers of the probe into the ear. The
microphone of the probe then measures the acoustic energy that
remains in the ear canal. As the ear canal pressure or middle ear
muscle activity alters the mobility of the middle ear system, different
amounts of remaining acoustic energy can be measured at the probe,
depending on the amount of air pressure or muscle activity applied.
The maximum acoustic energy admittance, also known as static
acoustic compliance, is the point at which the most acoustic energy
enters the middle ear. This is obtained when the middle ear mobility
is maximized. This occurs when the ear canal pressure is equal on
both sides of the eardrum or tympanic membrane, and the middle ear
muscles are in a neutral state.
10. So in other words, the immittance meter makes two measures on
a patient. The first is a measure taken while the ear is at the most
non-compliant position. So at this point the TM would be very stiff or
tight. This is found by putting 200 millimeters (+200 daPa) of air
pressure into the TM. This is known as C1. Then the air pressure is
gradually decreased until the most compliant point is found. At this
point the TM would be loose. This is known as C2. The immittance
meter subtracts one from the other which will give a static compliance
measurement. This measurement will be reported on the screen or
printout from the tympanometer. So if you look at the tympanogram
shown here, you can see the arrow at the peak is C2. It is at about .90
ml and C1 is at 0 ml. So the static compliance for this ear is .90 ml.
Why is +200 daPa used? Why don't we deal with 400 daPa of
pressure? The reason is if you apply 200 daPa of air pressure to the
tympanic membrane that forces the tympanic membrane toward the
middle ear. It locks it in place so it becomes as if it were a solid wall.
So, 200 daPa is sufficient to lock the tympanic membrane into a
position where it behaves as a solid membrane.
11. In your textbook, Margolis & Hunter, 2000 listed the normative
ranges for static compliance in children to be 0.25 to 1.05 and in
adults to be 0.30 to 1.70. However there is some variation in what is
considered to be within normal limits. If the value of the result is very
low then it could indicate that the TM or the ossicular chain is stiff.
This could be caused by otosclerosis, fluid or tympanosclerosis. If the
number is high then it could mean that the ossicular chain is
interrupted. This could be caused by disarticulation of the ossicles or
a flaccid TM. We will cover details about these in lessons 14 and 15.
12. So this picture actually shows 3 different tympanograms to show
the difference between high compliance, normal compliance and low
compliance.
13. On this printout of a tympanogram you can see the compliance
results on the side. This patient had compliance results of 0.43 ml in
the left ear and 0.91 in the right ear. So although the results in the left
ear are low, they are still considered within normal limits. So both of
these tympanograms have normal compliance results. I want to point
out one thing that might confuse you. Although this tympanogram
lists compliance as such on the report, many times the tympanogram
will list the compliance peak rather than the compliance. Basically
this is the C2 measurement we discussed. This is the peak amplitude
or peak compliance of the TM. Because the C1 recording is usually
near 0, then the compliance peak is usually very close to the overall
compliance. But you will see it reported both ways. The compliance
peak is considered to be within normal limits for adults if it is
between 0.2 to 1.4 cc.
14. The static acoustic compliance results are extremely variable. By
itself, static compliance is the least helpful of all immittance tests
because of this variability. Results that do not fall within the normal
range cannot be considered abnormal unless one of the extremes is
clearly exceeded. Sometimes abnormal compliance result can be
found even in individuals with normal middle ear. The values of static
compliance results vary with both age and gender. The results need to
be reviewed in conjunction with the rest of the immittance testing to
determine validity. It is important to note that although we are
discussing static acoustic compliance as an individual test, it is
actually a subtest of tympanometry in which several measurements
are made. Each test provides significant information by itself, but
immittance tests are not performed or interpreted in isolation.
Diagnostic information from immittance measures is strengthened
when results from all test procedures are interpreted together.
15. The interpreter must examine both the graph of the compliance
curve and the display of the numeric data. In addition to the
compliance, the measurements recorded are the ear canal volume,
middle ear pressure and gradient. Most professionals use all of this
data to define the status of the middle ear and determine what the
proper recommendation should be. So Id like to talk briefly about
these 3 measurements. The first measurement well cover is the ear
canal volume measurement or ECV. This can also be referred to as
Equivalent Ear Canal Volume (Vec or Vea). The equivalent ear canal
volume (ECV) is an estimate of the volume of air medial to the probe,
which includes the volume between the probe tip and the tympanic
membrane if the tympanic membrane is intact, or the volume of the
ear canal and the middle ear space if the tympanic membrane is
perforated. Ear canal volume, measured in mL or cc, indicates the
volume from the probe tip to the tympanic membrane at a pressure of
+200 daPa. The tympanometer automatically calculates the canal
volume. This value varies widely according to the patient's age and
bone structure but usually falls within the range of 0.2 to 2.0 ml or
cubic centimeters. The normative ranges or guidelines vary
depending on the study conducted. But on average for adults the
range is .6 to 1.5 cubic centimeters. The normal range for children is
.4 to 1.0 cubic centimeters and for infants it is 0.3-0.9 cc. If there is
cerumen or other material occluding the ear canal, the volume will
measure abnormally low. An accurate tracing cannot be obtained
until this material is removed. Similarly, if there is a perforation of
the tympanic membrane the tympanometer will measure an
unusually large canal volume, because the space of the middle ear and
mastoid air cells will be included in the volume calculation. ECV is a
range so you have to use common sense when using it to determine if
the patient needs to be referred. If the volume is a larger or smaller
result than expected but the tympanogram shape is normal, it is okay.
ECV should be used to differentiate flat Type B tympanograms, which
we will cover later.

16. Another measurement of the tympanogram is the middle ear

pressure. It is abbreviated MEP. This can also be referred to as
tympanometric peak pressure (TTP), peak pressure or pressure peak.
Pressure peak, measured in daPa, indicates the pressure at which
equalization occurs on both sides of the tympanic membrane. It also
indicates the pressure at which peak compliance or maximum
mobility is attained. This corresponds to the value on the horizontal
axis of the graph. So, peak pressure is the pressure at which the TM is
maximally compliant. The normal range of pressure is approximately
-150 to +100 daPa. However, if the peak is less than negative 100
dekaPascals, it may indicate congestion or serous otitis media (ear
infection with fluid) where air pockets are present, depending on the
other findings. It is recommended that the patient needs a medical
referral.

17. The last measurement we will discuss is gradient. Gradient,

usually expressed in daPa, is the tympanometric pressure width at
50% of the compliance peak. It is basically the width of the
tympanogram measured at half the height from the peak to tail. This
is measuring the steepness of the tympanogram. The lower the
gradient value, the steeper the curve. The larger the gradient value,
the broader the tympanometric curve. A smaller value is indicative of
a taller more peaked curve and a larger value indicates a shorter, less
peaked curve. This measure is very sensitive to middle ear effusion.
Infants may show higher gradient values due to the mobility of their
ear canals. Some sources list normal ranges from 60-150 daPa in
children and 50-110 daPa in adults. According to your textbook, the
normal range for the gradient is 51 to 114 daPa in adults and 80-159
in children. If the gradient is greater than 200 daPa or no gradient
can be measured, that is considered abnormal. This is usually
consistent with fluid in the middle ear. This tympanogram measures
gradient in ml. But this is unusual, so just refer to the actual
tympanogram, not the results to help understand gradient.
18. This is a tympanogram showing the measurements for pressure,
gradient, compliance and volume. Hopefully this will help you
visualize how each measurement is made.
19. The final area of tympanogram interpretation I want to cover is
the shape of the tympanogram. As you can see on this slide, the
tympanogram results vary in shape. All of these different shapes are
indicative of what may be happening in the middle ear and
Eustachian tube.
20. In 1970, James Jerger categorized the different types of
tympanograms into 5 areas. The Jerger system is the most commonly
used classification system for tympanograms. While other systems
have been proposed, none are as widespread in clinical use.
The shape of the tympanogram is a very useful description when
referring to a tympanogram. There is some subjectivity to the
classification. So some professionals say that is not a finite way of
describing the result. They'd rather talk about them in other terms,
like we just discussed. However, in most clinics, people will refer to
the tympanograms as a type A or type B, so it is important that you
understand what the differences mean. I will briefly identify some of
the causes and common disorders associated with each type of
hearing loss. Most of the disorders will be unfamiliar to you, dont
worry; we will discuss disorders of the middle ear in lessons 14-15. I
just want to give you a brief overview so you understand what is
associated with each type of tympanogram.

21. The most common tympanogram is the Type A. This is the normal
characteristic shape for a tympanogram. It is low at both ends (+200
mm H2O and -200 mm H20) and rises, like a tent, to a peak in the
middle and must be between 0.3 cc to 1.6 cc above the base. The point
of maximum compliance should be around 0 daPa. The Type A
tympanogram gives us several vital pieces of information. It tells us
that the eardrum is intact. The TM must be in the normal position. It
has to be a cone and function as a cone. There has to be air in the
middle ear space to get a Type A. In order for there to be air in the
middle ear space, the eustachian tube has to work, along with the
intact eardrum, and the normal muscles and ligaments. They have to
be intact, they have to be connected, and they have to move through a
normal range of motion.

22. There are two variations of the Type A. The first is the Type As.
This type suggests a stiffened middle ear system. The S is for shallow
or stiff. Type As, which looks like an extremely flattened Type A. The
difference is that the most compliant point is not very compliant. The
Compliance peak is -150 to +100 daPa, and compliance is less than
0.2 ml. What we're looking at is a non-compliant ear. This can occur
for several reasons. This type may suggest a glue ear, a thickened or
scarred eardrum, or otosclerosis. There may be ossicular fixation of
the bones in the middle ear, or the stapes may have become partially
immobilized. White splotchy calcium deposits can also form on the
TM, making it heavierretarding the subsequent movement of the
TM or making movement stiffer. All of these conditions can impede,
or make more shallow, the movement of the TM into the middle ear.

23. The opposite of the impeded movement of the TM that we see in

the Type As is Type AD. The D is for deep or disarticulated. Basically
we are experiencing deeper movement into the middle ear. In this
type the compliance peak is higher than the recording parameters and
can be off the chart. The compliance peak is -150 to +100 daPa, and
compliance is more than 2.5 ml. If you look in the bottom right, we
have a positive 200 units of pressure in the eardrum. As we swing
from positive 200 dekaPascals to minus 200 dekaPascals of air
pressure, see how the compliancy increases dramatically until it
exceeds the limits of our instrumentation. Then it comes back on the
chart. We lose compliancy down to minus 200 dekaPascals. This is a
representation of a middle ear system that is abnormally compliant.
Like Type As, the TM is intact, but there is an anomaly relative to TM
movement. The first and most visible case of Type AD is a flaccid TM.
This can occur in the case of the monomeric membrane. This usually
stems from a perforation in the TM, over which only a single layer of
the normal skin grows back. This layer of skin is very thin, very
elastic, and essentially inflates when pressurized. The other cause
associated with Type AD is ossicular discontinuity or disarticulation,
which means that the middle ear bones have become separated from
one another. This tends to make the TM hypermobile or floppy. These
types of conditions can result from sporting accidents such as water
skiing, as well as from fights or abuse in which the patient has been
slapped over the ear or had their ears boxed (cupped hands struck
simultaneously over the ears). It is possible for the bones of the
middle ear to become broken, or dislodged, and the height and
flaccidity of the tympanogram will reflect this abnormal movement.

In the type A, type A shallow, type A deep, they are all A because in
each, the most compliant point is centered above zero dekaPascals of
air pressure.

24. In addition to the three types of Type As, there are the Type B and
Type C tympanograms. The Type B represents an ear in which, no
matter what you do, you cannot get the TM to move. Type B's can
result from a number of things. The first is that if, when you put the
probe tip down the canal, it rests against the canal wall or a foreign
object like wax, and the air pressure of the testing system does not
work. So no pressure is being exerted on the TM. When this occurs,
you get a relatively flat line across the bottom of the graph and very
low ECV with no compliance, gradient or pressure results. Another
possibility with a type B shape is that the recording shows a flat line
but the ECV is within normal limits. This indicates that you have
something in the middle ear space keeping the system from moving
with the pressure change. This is indicative of middle ear fluid.
Another possibility is that if you put the probe down into the ear and
there is even a very small hole in the TM, the result will also be a Type
B. The air pressure produced by the probe tip will go right through;
instead of pushing against the TM, it is filling the middle ear space
(i.e., pushing against the medial wall of the middle ear). When this
occurs, a flat-line tympanogram will also be produced. This is because
you're measuring the volume of not only the ear canal but also adding
the volume of the middle ear cavity. You can't expand or contract
those cavities. They're hard walled so you don't get a compliance
change. With a hole in the membrane, you have to put in a lot of
sound pressure to balance your meter. So you'll have an abnormally
large ear canal volume result. You should recognize a type B
tympanogram due to the flat trace with no observed compliance or
immittance peak. But type B tympanograms must be interpreted in
conjunction with ear canal volume readings. As we discussed, average
ear canal volumes for children are 0.4-1.0 mL. Average adult volumes
are 0.6-1.5 mL. So if you have a Type B tympanogram with normal ear
canal volume this usually suggests otitis media. A Type B with small
ear canal volume may suggest that the ear canal is occluded with
wax/debris or that the immittance probe is pushed against the side of
the ear canal. A Type B with a large ear canal volume suggests a
patent (open) pressure equalization (PE) tube or perforation of the
tympanic membrane.
25. The Type C tympanogram has a normal shape and peak, but the
peak is shifted to the negative side. This is the left side of the
tympanogram. A Type C is defined as a tympanogram with a peak,
where the peak is more negative than -200 mm H2O. In general, we
only measure out to -200 mm, so if it is between -150 mm and -200
mm, it is usually called a Type C. So in a Type C tympanogram the
immittance peak is measurable, but compliance peak is less than -150
daPa. This is an ear in transition. Slight negative pressure is fairly
common in normal ears, but when the shift equals or exceeds -150
mm, there is reason for concern. This means the middle ear system is
retracted or pulled in towards the head. This suggests significant
negative pressure in the middle ear system without fluid and may
suggest developing or resolving otitis media (ear infection). This type
usually means that the Eustachian tube is not working properly which
causes the TM to retract and interferes with the normal vibrations of
the TM. How can you tell if the condition is getting worse or getting
better? If you see a Type C and the acoustic reflexes are present
(which we will study in lesson 13), you know it is getting better. If the
acoustic reflexes are absent, it is getting worse and becoming a Type B
tympanogram.

26. This chart is a summary of the various tympanogram types.

Hopefully this will help you to differentiate between the different
shapes.

27. So, you have just conducted a school screening or tested your
client and now you need to know what the next step is. So you will
look at the shape of the tympanogram as well as all of the data and
determine what to tell the patient. This is a chart (based on ASHA
guidelines) that you could refer to:
Tympanometry
Ear Canal Volume measurement (ECV)
PASS - Open PE tube Volume larger than expected
for age norms
FAIL - Blockage or probe against canal wall Volume
smaller than expected for age norms
Peak Pressure
PASS - Normal: between -100 to +50 daPa air
pressure in middle ear similar to atmospheric pressure
PASS - Positive: between +50 to +200 daPa air
pressure in middle ear greater than atmospheric
pressure
FAIL - Negative: below -100 daPa air pressure in
middle ear less than atmospheric pressure; common
with congestion
Static Compliance
PASS - .3 to 2.4 normal range
PASS - Below = minimal compliance
FAIL - Above = flaccid TM
Gradient
FAIL - 200 daPa abnormal, consistent with fluid in the
middle ear
28. This chart represents the American Speech-Language-Hearing
Association Guidelines for Audiologic Screening. These guidelines
will help you determine if a medical referral is necessary following
immittance measures in a child. Referral Guideline:
Flat tympanogram with large ECV measurement & no known
 PE tube (Type B)
Medical Referral
Flat tympanogram with normal ECV measurement (Type B)
Re-screen in 2 weeks
Same result at 2nd screening
Medical Referral
Negative pressure tympanogram (Type C)
Re-screen 2 weeks
Fail pure tone any frequency either ear and normal
tympanogram
Re-screen 2 weeks
Fail pure tone any frequency either ear and abnormal
tympanogram
Re-screen in 2 weeks
Same result at 2nd screening
Medical Referral

29. So now I want to make sure that when you look at this
tympanogram, you can recognize the shape of the tympanogram as
well as the measurements made for volume, compliance, pressure and
gradient. The ranges of normal results are listed to the right. Many
tympanometers, especially screening devices will have a box printed
in the middle of the tympanogram. Basically this is a guideline. If the
tympanogram fits in the box, then it usually indicates normal result.
If the tympanogram is outside of the box, then it is not normal. I want
to make sure you understand how to interpret a tympanogram. So we
will review 5 tympanograms. You should be able to determine the
shape as well as if they would be considered normal or would they
need a medical referral.
30. This tympanogram is a normal tympanogram. The shape is type
A. In looking at the results, it has normal mobility, ECV, compliance,
pressure and gradient.

31. This is the type of tympanogram you would expect to see in a

patient that has fluid in the middle ear. Because the shape of the tymp
is flat, it would be considered a type B. So we know that the next step
for a type B tymp is to look at the ECV. In this case, the ECV is
normal. A type B tymp with normal volume suggests an ear infection,
with fluid. As you can see it has no mobility, compliance, pressure or
gradient.

32. Here is another type B tympanogram. So we refer to the ECV.

However, this time the ECV is abnormally high. So we can determine
that the patient either has an open PE tube or a perforated TM. Again,
they have no mobility, compliance, pressure or gradient.

33. This tympanogram is a type C, noted by the abnormal middle ear

pressure. The peak pressure is at negative 195 daPa. The patient has
normal ECV and compliance. But they have a borderline wide
gradient and restricted mobility. This result would be consistent with
a poorly functioning Eustachian tube.

34. This tymp shows a type Ad shape with hyperflaccid mobility. The
ECV and pressure are normal but the compliance peak is abnormal. It
is very high, so much that you cant actually see it on the chart. The
gradient is narrow and would be considered borderline. This result
would indicate a scarred TM.

35. Here are 2 tympanograms to test yourself. If you cant read the
printed results well enough, I also put them below each tymp. At this
point, you should be able to answer the following questions regarding
the tymps:
What type/shape is it? What does this shape indicate?
What is the volume? Is it normal?
What is the peak static compliance? Is it normal?
What is the gradient? Is it normal?
What is the peak pressure? Is it normal?
For any results that are not normal, what does it indicate?
What are possible causes for this type of tympanogram?
Considering that this is a child, is a medical referral necessary? What
if it is an adult?

Conclusion: Although tympanograms are useful, by themselves they

arent enough. At its most basic level, the purpose of screening or
testing via tympanometry is to answer the question, Do I or do I not
need to refer this patient for a medical evaluation? If the patient has
Type A tympanograms and normal or SNHL, the question is
answered well by the findings. However, if there is an abnormality in
the tympanogram, then the indicators are that the patient needs to be
referred. As I mentioned, tympanometry is one of a battery of
procedures referred to as acoustic immittance measures. We will
discuss another immittance measure, acoustic reflexes, in the next
lesson.