Usu Comd 3700 Lesson 12

Front 1

What kind of TM is this?

Back 1

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 can’t actually see it on the chart. The gradient is narrow and would be considered borderline. This result would indicate a scarred TM

Front 2

What is the deal with this TM?

Back 2

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.

Front 3

What is the deal with this TM?

Back 3

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.

Front 4

What is the deal with this TM?

Back 4

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.

Front 5

What is the deal with this TM?

Back 5

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.

Front 6

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?

Back 6

Tympanogram on Left: Type As: Normal Ear Canal Volume Restricted Mobility Normal Middle-ear Pressure Borderline-or-Wide GR Possible causes include: Glue-ear
Otosclerosis Severely Scarred Tympanic Membrane Plaque over Tympanic Membrane

Tympanogram on right: Type C Normal Ear Canal Volume Restricted Mobility Negative Middle-ear Pressure Abnormally Wide GR Possible causes include: Serous Otitis Media
Small Air Pockets Present

Front 7

Ear Canal Volume measurement (ECV) Pass/Fail

Back 7

PASS - If patient has Open PE tube; Volume larger than expected for age norms
o FAIL - If Blockage or probe against canal wall; Volume smaller than expected for age norms

Front 8

Peak Pressure Pass/Fail

Back 8

PASS - Normal: between -100 to +50 daPa air
pressure in middle ear similar to atmospheric pressure o PASS - Positive: between +50 to +200 daPa air
pressure in middle ear greater than atmospheric pressure o FAIL - Negative: below -100 daPa air pressure in middle ear less than atmospheric pressure; common with congestion

Front 9

Static Compliance Pass/Fail

Back 9

o PASS - .3 to 2.4 normal range o PASS - Below = minimal compliance o FAIL - Above = flaccid TM

Front 10

Gradiant Pass/Fail

Back 10

FAIL - 200 daPa abnormal, consistent with fluid in the
middle ear

Front 11

Flat tympanogram with large ECV measurement & no known PE tube (Type B)

Back 11

Medical Referral

Front 12

Flat tympanogram with normal ECV measurement (Type B)

Back 12

Re-screen in 2 weeks
Same result at 2nd screening • Medical Referral

Front 13

Negative pressure tympanogram (Type C)

Back 13

Re-screen 2 weeks

Front 14

Fail pure tone any frequency either ear and normal tympanogram

Back 14

Re-screen 2 weeks

Front 15

Fail pure tone any frequency either ear and abnormal tympanogram

Back 15

Re-screen in 2 weeks-Same result at 2nd screening
• Medical Referral

Front 16

Describe The Type C tympanogram

Back 16

Negative pressure; Peak is -150 to -200; Normal compliance; eustachian tube dysfunction, developing or resolving otitis media

Front 17

Describe Type B tympanogram

Back 17

TM does not move due to Probe Placement, Perforation, Fluid, Disease, No pressure Peak, Refer to ECV

Front 18

Describe Type AD Tympanogram

Back 18

D=Deep or Disarticulated or Discontinuous; Normal Pressure; High compliance; Monomeric TM; Ossicular Discontinuity

Front 19

Describe Type As Tympanogram

Back 19

S=Shallow or Stiff; Normal pressure; low compliance; ossicular fixation; tympanosclerosis

Front 20

Describe Type A Typmanogram

Back 20

Normal shape, intact eardrum, functioning eustachian tube, normal muscles and ligaments

Front 21

Average ear canal volumes for children and adults

Back 21

average ear canal volumes for children are 0.4-1.0 mL. Average adult volumes are 0.6- 1.5 mL.

Front 22

Normal range for gradient

Back 22

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.

Front 23

explain measurement-gradient.

Back 23

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.

Front 24

Low value gradient

Back 24

Steep, Tall, Greater Peak

Front 25

High Value gradient

Back 25

Broad, short, lower peak

Front 26

Explain MEP measurement

Back 26

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.

Front 27

Normal range of MEP and what abnormal results suggest

Back 27

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.

Front 28

Explain ECV measurement

Back 28

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.

Front 29

Normal ECV ranges and what abnormal results suggest

Back 29

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.

Front 30

The static acoustic compliance results are extremely ______. By itself, static compliance is the least _______ of all immittance tests because of this ___________.

Back 30

The static acoustic compliance results are extremely variable. By itself, static compliance is the least helpful of all immittance tests because of this variability.

Front 31

The compliance peak is considered to be within normal limits for adults if it is between

Back 31

0.2 to 1.4 cc.

Front 32

normative ranges for static compliance in children and adults

Back 32

normative ranges for static compliance in children to be 0.25 to 1.05 and in adults to be 0.30 to 1.70.

Front 33

What does low/high static compliance mean?

Back 33

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.

Front 34

What are the static acoustic compliance procedure?

Back 34

Positive pressure is incrased to +200 dzPa using pressure pump. Measure equivalent volume (C1) (Typmanic Membrane is Tight). Then decrease pressure until theTM is maximally compliant or until outer ear pressure is at 0 daPa (C2) (Tempanic Membrane is loose) Static Compliance= C2-C1

Front 35

sub test of tympanometry and the first results that are calculated from the tympanometry testing

Back 35

Static Acoustic Compliance

Front 36

maximum acoustic energy admittance

Back 36

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.

Front 37

x axis of tympanogram

Back 37

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.

Front 38

y axis of tympanogram

Back 38

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.

Front 39

definition of tympanometry

Back 39

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 canal. Tympanometry is one of the principal subtests of immittance audiometry.

Front 40

3 principle subtests of immitance audiometery

Back 40

tympanometry; static admittance/ compliance and the acoustic reflex test.

Front 41

Explain basic approach of tympanometry (high level)

Back 41

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.

Front 42

what is air pressure expressed in

Back 42

dekapascals (daPa) or millimeters of water (mm h2o)

Front 43

what is admittance or compliance of a volume of air expressed in

Back 43

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)