The document discusses human ear tests of hearing. It describes three main types of hearing loss - conductive, sensorineural, and mixed - and explains what each type is caused by. It also outlines several common tuning fork tests used to evaluate hearing, including Rinne's test, Weber test, and Schwabach test. Finally, it provides an overview of pure tone audiometry testing procedures and how to interpret audiogram results.
In this PPT u will know about Tuning Fork and its types.
u can also know the principle , purpose , procedure and implications of types of tuning fork test.
hope this will help you all.
u can suggest me for better
@ - anantarun27@gmail.com
In this PPT u will know about Tuning Fork and its types.
u can also know the principle , purpose , procedure and implications of types of tuning fork test.
hope this will help you all.
u can suggest me for better
@ - anantarun27@gmail.com
Short 10 Min Presentation on Speech Audiogram & Audiometry. Delivered by Abubakkar Raheel (4th Year Mbbs)
Frontier Medical College, Abbottabad, Pakistan.
One can conduct an otoscopic examination at home with the help of an otoscope. Depending on the quality of the product, the otoscope price ranges between Rs. 10,000 and Rs. 20,000.
Short 10 Min Presentation on Speech Audiogram & Audiometry. Delivered by Abubakkar Raheel (4th Year Mbbs)
Frontier Medical College, Abbottabad, Pakistan.
One can conduct an otoscopic examination at home with the help of an otoscope. Depending on the quality of the product, the otoscope price ranges between Rs. 10,000 and Rs. 20,000.
Audiology (pure tone audiometry, speech audiometry) .pptxAmro1988
Pure tune audiometry
Air- and bone-conduction thresholds
Recruitment
Carhart’s tone decay test
Bekesy audiometry
Speech audiometry
Impendence audiometry
Tympanometry
Acoustic reflex
Acoustic reflex decay test
Auditory Refexes
A tutorial found on the website
Template / concept Copyright (c) 2001, 2002 AuDStudent.com All rights reserved.
Content Copyright (c) 2002 Nova Southeastern University Teri Hamill, Ph.D., FAAA, CCC-A
http://audsim.com/tutorials/reflex/ReflexTutorial.htm
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Hearing tests
1. HUMAN EAR & TESTS OF
HEARING
DR. RAJENDRA SINGH LAKHAWAT
MS ENT (SMS MEDICAL COLLEGE, JAIPUR)
FIND THIS PRENSENTATION AT SLIDESHARE.NET/RSLAKHAWAT
2.
3.
4. What hearing tests do??
Hearing tests should answer 3 questions:
Is there a hearing loss?
If there is, how bad is it?
What kind of hearing loss does patient have?
Is it conductive?
Is it sensorineural?
Is it a mix of the two?
Is it bilateral or just one ear i.e. unilateral?
5. types of hearing loss
1. Conductive Hearing Loss
“Caused by an abnormal reduction or attenuation of
sound as it travels from the outer ear to the cochlea”
6. 2. Sensorineural Hearing Loss
“Caused by a failure in the cochlea to transduce the sound
from the middle ear to neural impulses in the VIII Nerve.”
7. 3. Mixed Hearing Loss
“A loss with both conductive and sensorineural
component.”
10. Rinne’s Test
First: Bone Conduction
Vibrating Tuning Fork held on Mastoid
process
Patient covers opposite ear with hand
Patient signals when sound ceases
11.
12. Next: Air Conduction
Move the vibrating tuning fork over the ear canal
(Near, but not touching the ear)
Patient indicates when the sound ceases
13.
14. Normal: Air Conduction is better than Bone Conduction
Air conduction usually persists twice as long as bone
Referred to as "positive test"
Abnormal: Bone conduction better than air conduction
Suggests Conductive Hearing Loss.
Referred to as "negative test"
15. False Negative Rinne :
It is seen in severe unilateral SNHL. Patient
doesn’t perceive any sound of tuning fork by AC
but responds to BC testing.
This response to BC is, in reality, from the
opposite ear because of transcranial
transmission of sound.
In such cases, correct diagnosis can be made by
masking the non- test ear with Baraney’s noise
box while testing for bone conduction.
16.
17. Weber Test
Tuning Fork placed at midline forehead
Normal: Sound radiates to both ears equally
Abnormal: Sound lateralizes to one ear
Ipsilateral – Conductive Hearing Loss
Contralateral -Sensorineural Hearing Loss.
18.
19. Absolute Bone Conduction test
Bone conduction is a measure of cochlear function.
In ABC test, patient’s bone conduction is compared with that of
examiner ( presuming that the examiner has normal hearing)
External auditory meatus of both the patient & examiner should
be occluded( by pressing the tragus inwards), to prevent the
ambient noise entering through AC route
In conductive deafness, the patient and the examiner hear the
fork for the same duration of time
In sensorineural deafness, the patient hears a fork for shorter
duration
20. Schwabach Test
It compares pt’s hearing sensitivity with that of an examiner
(assuming that he/she has a normal hearing)
Examiner places TF on patient’s mastoid
Patient lets examiner know when they no longer hear tone.
Examiner places TF on their own mastoid.
Interpertation :
If examiner hears longer patient has a diminished schwabach
which is consistent with a sensorineural loss.
If patient hears tone longer patient has a prolonged
schwabach consistent with a conductive loss.
21. Bing Test
Assesses the presence of CHL
Tuning fork is placed on the pt.'s mastoid, while the ear canal
is alternatively opened and closed by the examiner by
depressing tragus and the pt. is asked to state which position
is louder
When the ear canal is closed on a person with normal hearing
or SNHL, low-frequency bone conducted signals are heard more
loudly (Occlusion Effect), the is a "Positive Bing“
Pts. with CHL will not experience this sensation and the tone
will be the same when the ear canal is open and closed and the
test will be a "Negative Bing" because the ear already has a
conductive impairment
22. Gelle’s Test
It is also a test of bone conduction & examines the effect of
increased air pressure in ear canal on the hearing.
It is performed by placing a vibrating fork on the mastoid while
changes in air pressure in the ear canal are brought about by
Siegle’s speculum.
Normally, when air pressure is increased in the ear canal by
Seigle’s speculum, it pushes the TM & ossicles inwards, raises the
intra labyrinthine pressure & causes immobility of basilar
membrane & decreased hearing, but no change in hearing is
observed when ossicular chain is fixed or disconnected.
Positive in Normal persons & in SNHL.
Negative when ossicular chain is fixed or disconnected.
23.
24.
25. Pure Tone Audiometry (PTA)
“The aim of pure tone audiometry is to establish
hearing threshold sensitivity across the range of
audible frequencies important for
communication”
26. A pure tone is a single frequency tone with no
harmonic content (no overtones). This
corresponds to a sine wave.
27. The Audiometer
• Components
Pure tone oscillator
Attenuator
Interrupter switch
Output transducer
o Headphones
• Supra-aural
• Insert
o Bone conduction vibrators
• Forehead
• Mastoid
o Loudspeakers
28.
29.
30.
31. Pure tone Audiometry procedure
In a sound proof room person is seated comfortably.
Ear phones are applied which are color coded. (Red for
right ear, Blue for left ear.)
Masking sound is delivered to the non-test ear.
Start with a frequency of 125Hz. & 0 dB.
Gradually increase the dB. till person hears the sound &
respond.
Mark the threshold intensity on the audiogram paper.
32. Find the threshold of hearing from 125 Hz. to 8000Hz. &
mark on the audiogram paper.
Join the points to make air conduction audiogram.
Place the bone vibrator over the mastoid process.
Deliver the sound through the vibrator & find out the
threshold of hearing for different frequencies of sound.
33. Use different sign to mark the bone conduction
audiogram.
Select the other ear and repeat the whole procedure.
35. masking
“Masking presents a constant noise to the non-test ear so
that the non-test ear is acoustically blocked and doesn’t
participate in the hearing test”
The purpose of masking is to prevent the non-test ear
from detecting the signal, so only the test ear can
respond.
36. Conductive Hearing loss
The abnormality reduces the effective intensity of the air-
conducted signal reaching the cochlea, but it does not affect the
bone-conducted signal that does not pass through the outer or
middle ear.
Examples of abnormalities include perforated tympanic membranes,
fluid in the middle ear system, or scarring of the tympanic
membrane.
Pure-tone air-conduction thresholds are poorer than bone-conduction
thresholds by more than 10 dB
38. Sensorineural Hearing Loss
This type of hearing loss is secondary to cochlear
abnormality and/or abnormality of the auditory nerve or
central auditory pathways.
Because the outer ear and middle ear do not reduce the
signal intensity of the air-conducted signal, both air- and
bone-conducted signals are effective in stimulating the
cochlea.
Pure-tone air- and bone-conduction thresholds are within
20 dB. (Air bone gap)
40. MIXED Hearing loss
This type of hearing loss has sensorineural and conductive
components.
Pure-tone air-conduction thresholds are poorer than bone-
conduction thresholds by more than 20 dB, and
bone-conduction thresholds are poorer than 25 dB
42. DEGREES OF HEARING LOSS
Normal hearing (0-25 dB)
Mild hearing loss (26-40 dB)
Moderate hearing loss (41-55 dB)
Moderate-severe hearing loss (56-70 dB)
Severe hearing loss (71-90 dB)
Profound hearing loss (>90 dB)
43. COMMON AUDITORY DISORDERS
Presbyacusis (age related hearing loss)
Otitis media: This condition is marked by fluid in the
middle ear space usually secondary to an infection.
Noise-induced hearing loss.
Otosclerosis: The condition is caused by stapedial fixation
in the oval window, stiffening the middle ear system.
Ménière disease
44. audiogram
The audiogram is a chart of hearing sensitivity with frequency
charted on the X- axis and intensity on the Y-axis.
Intensity is the level of sound power measured in decibels;
loudness is the perceptual correlate of intensity.
It shows the softest sounds a person can hear at different
frequencies or pitches. These sounds are called thresholds. The
audiologist marks on a graph patient’s threshold at different
pitches.
45. This is an audiogram of normal hearing.
The red and blue marks show the softest
sounds this person could hear in his right
(red) and left (blue) ears.
The shaded areas show the range of
speech sounds. This is called the "speech
banana“
This person can hear sounds even softer
than the speech sounds.
But if he can't hear sounds in the area of
the speech banana, he will have trouble
understanding what people say.
46. HOW TO READ AN AUDIOGRA
From left to right – Frequency
Frequency refers to how high- or low-pitched a sound is
Frequency is measured in Hertz (Hz).
Low-pitched sounds are towards the left of the audiogram.
(Vowels like "a," e" and "i" are examples of low-pitched sounds)
High-pitched sounds are towards the right of the audiogram.
(Sounds like "th," "f" and "s" are examples of high-pitched sounds)
47. From top to bottom – hearing threshold (loudness)
The loudness of a sound is measured in decibels (dB).
Loud sounds are towards the bottom of the audiogram.
Quiet sounds are towards the top of the audiogram.
The range of speech sounds are shown in the shaded area.
About half of spoken sounds are above the darker area.
48. Mild to Moderate Conductive Hearing
Loss in the Right ear
Mild to moderate means that the
hearing loss can range from 15dB to
40dB. This means that the quietest
sounds the patient can hear range
between 15 and 40 dB.
Conductive hearing loss is when sound
can't reach the inner ear.
49. Bilateral Mild to Moderate Sensorineural
Hearing Loss
Sensorineural hearing loss is when the
cochlea or auditory nerve isn't working
correctly.
The hearing loss in the picture is also
called a "Cookie-Bite" hearing loss. This
kind of hearing loss has the worst hearing
loss in the middle frequencies. Many
children with hearing loss from birth
(or congenital hearing loss) have this kind
of hearing loss.
A pat with this much hearing loss will
need to use hearing aids as well as assistive
listening devices.
50. Bilateral Mild Sloping to Profound
Sensorineural Hearing Loss
This kind of hearing is most often seen in
older adults, but is also seen in some
children.
Because of the very severe hearing loss at
the highest frequencies, this patient may
not be able to hear some speech sounds at
all.
A patient with this amount of hearing loss
will need to use hearing aids as well as
other assistive listening.
51. Bilateral Mild Precipitously Sloping
to Profound Hearing Loss
This kind of hearing loss is also called "Ski
Slope Loss“
Patient with this kind of hearing loss can
work just fine in quiet rooms. But they
may have a lot more trouble working in big
or noisy rooms.
A patient with this amount of hearing loss
will need to use hearing aids as well as
other assistive listening.
52. Profound means that the hearing loss is 90dB or
greater. This means that the patient may not be
able to hear anything softer than 90dB.
This kind of hearing loss is sometimes called a
"Left Corner" audiogram.
A patient with this much hearing loss may not be
able to hear much, even with hearing aids. So he
may not be able to learn to speak through hearing
alone.
He may benefit from using sign language and by
reading lips.
He may also be a candidate for a cochlear
implant.
64. Immitance Audiometry
Detection of middle ear pathology
Differentiating cochlear from retrocochlear pathology
Estimate sensitivity
Use in cross-check with pure tone results
65. Major components
Probe tone oscillator and loudspeaker
Monitor microphone
Pressure pump and manometer
Ipsilateral reflex oscillator and loudspeaker
Probe tip
66.
67. Immittance is a physical characteristic of all
mechanical vibratory systems, of which the middle
ear is one example”
Immittance audiometry is an objective technique which
evaluates middle ear function by three procedures: ]
static immittance,
tympanometry, and
the measurement of acoustic reflex threshold sensitivity
68.
69. Auditory Immittance
“ A way of assessing the manner in which
energy flows through the outer and middle
ear into the cochlea”
70. Tympanometry
“A way of measuring how acoustic immittance
of the middle ear system changes as air
pressure is varied in the external ear canal”
72. Some Useful Terminology
1) Ear Canal Volume
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.
73.
74. 2) Tympanometric Peak Pressure(TPP)/Middle Ear
Pressure(MEP)
“Ear canal pressure at which the peak of the
tympanogram occurs”
3) Static Compliance
“The greatest amount of acoustic energy absorbed by
the middle ear system (the vertical peak of the
tympanic tracing)”
4) Gradient
“Tympanogram gradient is an objective measure that
describes the steepness of the slope of the tympanogram
near the peak”
76. The blue shaded area in the figures below shows the range for
normal middle ear function.
Jerger classification of Type A tympanogram suggesting normal middle ear
function
77. Tympanometry showed no measureable middle ear pressure or static compliance,
consistent with middle ear pathology.
78. Tympanometry showed significant negative middle ear pressure in the
presence of normal static compliance, consistent with Eustachian tube
dysfunction/middle ear pathology.
79. Tympanometry showed normal middle ear pressure with decreased static
compliance, consistent with a hypomobile tympanic membrane.
80. Tympanometry showed normal middle ear pressure with increased static
compliance, consistent with a hypermobile tympanic membrane.
81. Compliance
Pathologies with
increased compliance
• Ossicular chain
discontinuity
• Scarring of the
tympanic membrane
• Post-stapedectomy
ear
• Very large tympanic
membrane(rare)
Pathologies with
decreased compliance
• Otoscelerosis
• Adhesive or secretory
otitis media
• Tumors in the middle
ear like glomus
jugulare
• Ossicular fixations
like fixed malleus
syndrome
• Some cases of
tympanosclerosis or
thickening of the
tympanic membrane
Pathologies with
normal compliance
• ET obstruction only,
without secretory
changes in the
middle ear.
• Some cases of
otosclerosis.
82. Middle Ear Pressure
Negative middle
ear pressure
• Blocked
Eustachian
tube.
• Secretory
Otitis media.
Normal middle
ear pressure
• Stapedial
otosclerosis.
• Ossicular chain
discontinuity.
• Scarring of TM.
• Fixation or
adhesions
among the
ossicles like
fixed malleus.
Positive middle
ear pressure
• Early acute
otits media.
83. Absence of any peak
pressure
• Adhesive otitis media.
• Perforation of TM.
• Artifact( eg. Blocked
probetip)
• Patent gromet in TM
• External earcanal
completely blocked by
cerumen