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Impedance audiometry part2

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audiometry

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Impedance audiometry part2

  1. 1. Aditya Ghosh Roy PGT2 MS ENT
  2. 2.  MIDDLE EAR PATHOLOGY TWO TYPES  STATIC COMPLIANCE REPRESENTIVE OF THE MORE LATERAL PATHOLOGY EAC T M MEC COCHLEA
  3. 3.  1.STAPEDIAL FIXATION AND COMMON COLD  -- MEP WITH LOW COMPLIANCE EXPECTED  BUT -- MEP WITH LOW COMPLIANCE  OTITIS MEDIA WITH EFFUSION
  4. 4.  STAPEDIAL FIXATION AND SCARRED / HEALED TM  NORMAL MEP WITH HIGH COMPLIANCE  BUT NORMAL MEP WITH HIGH COMPLIANCE  OSSICULAR DISCONTINUITY
  5. 5.  THICKENED TM OT TYMPANOSCLEROTIC PATCH  NORMAL MEP WITH LOW COMPLIANCE  NORMAL MEP WITH LOW COMPLIANCE  STAPEDIAL OTOSCLEROSIS
  6. 6.  SMALL PERFORATION OF TM  FLAT TYPE TYMPANOGRAM WITH NORAL VOLUME  FLAT TYPE TYMPANOGRAM WITH NORAL VOLUME  ADHESIVE OTITIS MEDIA, OTITIS MEDIA WITH EFFUSION
  7. 7.  OSSICULAR DISCONTINUITY WITH THIKENED TM  NORMAL MEP WITH LOW COMPLIANCE  NORMAL MEP WITH LOW COMPLIANCE  STAPEDIAL OTOSCLEROSIS
  8. 8. FUNCTION OF EUSTACHIAN TUBE MAINTAINANCE OF EQUALITY OF AIR PRESSURE BETWEEN THE MIDDLE EAR AND AMBIENT ATMOSPHERE DRAINAGE OF MUCUS FROM EAR TO THE NASOPHARYNX
  9. 9.  AIR IN MIDDLE EAR CAVITY CONSTANTLY BEING ABSORBED  STEADY FALL IN MIDDLE EAR PRESSURE  CONTRACTION OF TENSOR PALATINI AND LEVATOR PALTINI MUSCLE DURING SWALLOWING  INTERMITTENT OPENING OF ET  AIR PASSING THROUGH IT INTO MEC  PRESSURE IN MEC BROUGHT BACK TO NORMAL
  10. 10.  FOR TESTING WE SEE WHETHER VALSALVA SWALLOWING DECREASE MEP INCREASE MEP
  11. 11.  TWO TYPES OF TEST ARE AVAILABLE WILLIAMS TOYNBEES PERFORATED TM INTACT TM
  12. 12.  MEP MEASURED RESTING PRESSURE SWALLOING WITH NOSE MOUTH CLOSED VALSALVA
  13. 13. NORMAL PARTIALLY IMPAIRED GROSSLY IMPAIRED RESTING PRESSURE 0 mm WATER SWALLOING WITH NOSE MOUTH CLOSED NEGATIVE NEAGATIVE NO CHANGE NO CHANGE VALSALVA POSITIVE NO CHANGE POSITIVE NO CHANGE
  14. 14. NORMAL RESTING PRESSURE 0 mm WATER SWALLOING WITH NOSE MOUTH CLOSED NEGATIVE VALSALVA POSITIVE
  15. 15. PARTIALLY IMPAIRED SWALLOING WITH NOSE MOUTH CLOSED NEAGATIVE NO CHANGE VALSALVA NO CHANGE NEAGATIVE
  16. 16. GROSSLY IMPAIRED SWALLOING WITH NOSE MOUTH CLOSED NO CHANGE VALSALVA NO CHANGE
  17. 17.  AUDIOMETER  ARTIFICIALLY INC OR DEC MEP  RECORD CHANGE IN PRESSURE EACH TIME PT. SWALLOWS  TEST CARRIED OUT FOR FIXED DURATION  40SEC TO MAX 160 SEC
  18. 18.  MEP CHANGED EITHER TO +250 OR -250  PT. ASKED TO SWALLOW  CHANGE IN MEP EITHER DEC OR INC NOTED IN A STEP LADDER PATTERN
  19. 19.  MEP WHEN TUBE CLOSED  SUDDEN OPENING OF TUBE  DEC IN MEP  AGAIN PASSIVE CLOSURE OF TUBE  MEP BECOMES STEADY  AGAIN PT. ASKED TO SWALOW  CHANGE IN MEP  HENCE A STEP LADDER PATTERN GRAPH OBTAINED
  20. 20. OPENING OF TUBE DEC IN MEP PASSIVE CLOSURE OF TUBE MEP BECOMES STEADY
  21. 21. NORMAL PRESSURE NEUTRALISES BY 3 TO 4 SWALLOWS PARTIALLY IMPAIRED SOME PRESSURE PERSISTS EVEN AFTER MORE THAN 5 SWALLOWS GROSSLY IMPAIRED NOT NEUTRALISED AT ALL BY EPEATED SWALLOWING
  22. 22. NORMAL PRESSURE NEUTRALISES BY 3 TO 4 SWALLOWS
  23. 23. PARTIALLY IMPAIRED SOME PRESSURE PERSISTS EVEN AFTER MORE THAN 5 SWALLOWS
  24. 24. GROSSLY IMPAIRED NOT NEUTRALISED AT ALL BY EPEATED SWALLOWING
  25. 25. MIDDLE EAR CAVITY STAPEDIUS TENSOR TYMPANI 7TH NERVE 5TH NERVE EFFECT OF CONTRACTION OF STAPEDIUS MUSCLE MORE PRONOUNCED THAN THAT OF TENSOR TYMPANI ACOUSTIC REFLEX TESTED BY CONTRACTION OF STAPEDIUS MUSCLE
  26. 26.  CONTRACTION OF TENSOR TYMPANI TESTED SEPARATELY  STIMULATION OF TRIGEMINAL NERVE AND DOING AUDIOMETRY  STARTLE TYPE REFLEX  FATIGUEBLE IN NATURE  UNSTABLE  LONG LATENCY PERIOD  DONE IN PT. WITH SEVERE DEAFNESS IN WHOM ACOUSTIC REFLEX CANT BE PERFORMED BUT MIDDLE EAR STATUS HAS TO BE KNOWN
  27. 27.  DIAGRAMMATIC REPRESENTATION OF ACOUSTIC REFLEX  Stimulus of 85 db of 1 sec
  28. 28. NORMAL EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT ABSENT ABSENT
  29. 29. NORMAL EAR DEAF EARNORMAL EARNORMAL EAR
  30. 30. DEAF EAR DEAF EAR DEAF EAR NORMAL EAR
  31. 31. DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL ABSENT ABSENT ABSENT ABSENT BILATEAL MODERATE TO SEVERE CONDUCTIVE HEARING LOSS
  32. 32. DEAF EAR NORMAL EARDEAF EARDEAF EAR
  33. 33. NORMAL DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT ABSENT PRESENT
  34. 34. NORMAL EAR DEAF EARNORMAL EAR NORMAL EAR
  35. 35. DEAF EAR NORMAL EAR
  36. 36. DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL ABSENT ABSENT ABSENT ABSENT DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT PRESENT PRESENT PRESENT SEVERE NEURAL IN NATURE MODERATE DEGREE AND COCHLEAR IN NATURE
  37. 37. DEAF EAR NORMAL EARDEAF EAR DEAF EAR
  38. 38. NORMAL EAR NORMAL EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT PRESENT ABSENT
  39. 39. CENTRAL LESION
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