This document discusses tympanometry, which is a test used to measure the mobility or compliance of the eardrum and middle ear structures. It does this by measuring the impedance of the middle ear system as air pressure in the ear canal is varied. A tympanogram graphs compliance against pressure and can help diagnose various middle ear conditions. Normal tympanograms have a peak compliance at typical ear canal pressure, while other patterns indicate conditions like otitis media, ossicular problems, or Eustachian tube dysfunction. The document outlines the clinical significance of different tympanogram patterns and parameters measured.

1. Aditya Ghosh Roy
PGT2
MS ENT

2. • USE
• TEST
TYMPANOMETRY
EUSTACHIAN TUBE
FUNCTION
STAPEDIAL
REFLEX

3. SOUND WAVE
SOUND WAVE
SOLID
AIR
AIR
ABSORBED
SOUND

4. SOUND
AIR
SOLID
IMPEDANCE
STIFF
NESS
MASS
FRICTIO
N

5. AIR
COCHLEA
SOUND
MIDDLE EAR
IMPEDANCE
MATCHING
DEVICE
COCHLE
A
EAC
T
M

6. • CHANGE IN PRESSURE --- CHANGE IN TM
STIFFNESS ---SOUND ENERGY REFLECTED
BACK DEPENDS ON STIFFNESS OF TM OR
PRESSURE CHANGE
PROBE
TONE AMPLIFIER
MANOMETE
R
S
O
U
N
D
TYMPANIC MEMBRANE
REFLECT
ED
SOUND
P
R
E
S
S
U
R
E

7. • THEREFORE TYMPANOMETRY MAY BE
DEFINED AS MEASUREMENT OF
CHANGE IN IMPEDANCE OF MIDDLE
EAR CAVITY AT THE TM PLANE IN
RELATION TO CHANGE IN PRESSURE
IN EAC.
• TYMPANOGRAM
Y or ORDINATE
IMPEDANCE OR STIFFNESS
X OR ABSCISSA
AIR PRESSURE

8. • IMPEDANCE
• NONE OF THE PARAMETERS
MEASURED INDIVIDUALLY
SO AS A RESULT ACOUSTIC ADMITTANCE IS
MEASURED
ADMITTANCE IS RECIPROCAL OF IMPEDANCE
STIFFNESS
MASS
FRICTION
IMPEDANCE
OPPOSITION TO FLOW OF
ENERGY
ACOUSTIC OHM
ADMITTANCE
EASE TO FLOW OF ENERGY
ACOUSTIC MHO

9. • AUDIOMETERS
STILL AUDIOMETERS DO NOT
MEASURE ADMITTANCE DIRECTLY
COMPLIANCE
LOW FREQUENCY PROBE TONE USED
IMPEDANCE
EASE OF MOVEMENT OR
SPRINGINESS OF MIDDLE EAR
SYSTEM
IS ALSO RECIPROCAL OF
STIFFNESS

10. • HENCE IF COMPLIANCE IS MEASURED
USING LOW FREQUENCY TONE
• IMPEDANCE OF MIDDLE EAR SYSTEM
• MOST OF THE IMPEDANCE
AUDIOMETERS MEASURE
COMPLIANCE

11. • C1 – COMPLIANCE
VALUE AT +200mm
water
• C2 – COMPLIANCE
VALUE AT
(MAXIMUM)
• CX – STATIC
COMPLIANCE (C2-
C1=CX)

12. • PRESSURE AT WHICH
COMPLIANCE VALUE
IS MAXIMUM IS
CALLED AS MIDDLE
EAR PRESSURE IE
PRESSURE OF AIR IN
MIDDLE EAR CAVITY.

13. THE COMPLIANCE VALUE
AT +200mM water IS THE
VOLUME OF EAC .

14. TYMPANOMETRY
MEASUREMENT OF
STATIC COMPLIANCE
MEASUREMENT OF
MIDDLE EAR
PRESSURE

15. • cc/ ml if COMPLIANCE
• Millimho if SUSPECTANCE
• IF A 220 Hz PROBE– 1MILLIMHO OF
SUSPECTANCE = 1 CC/ML OF COMPLIANCE
TYMPANOGRAM
ABSOLUTE
RELATIVE
COMPENSATED

16. • BASELINE IS COMPLIANCE AT +200
• SHADED AREA IS VOLUME OF EAC
• ALSO CALLED NON COMPENSATED
TYPE
ABSOLUTE
• BASELINE IS 0 AT ORDINATE
• BRACKET PORTION IS COMPLIANCE
RELATIVE
• BASELINE IS 0 AT ORDINATE
• BRACKET PORTION IS COMPLIANCE
• SHADED AREA BESIDE THE
TYMPANOGRAM IS VOLUME OF EAC
COMPENSATED

17. • NORMAL RANGE COMPLIANCE
• IMP POINT– CLINICAL CONDITION OF TM TO BE
ALWAYS NOTED
• STUDY BY A.S. FELDMAN– HEALED TM
INVALIDATES COMPLIANCE AS ONE OF THE
TESTS OF TYMPANOMETRY
.35 TO 1.40 ML
>
2.50mL
<
.28 mL
ABNORMALLY
HIGH
ABNORMALLY
LOW

18. LARGE TM
OSSICULAR
DISCONTINUITY
SCARED/HEALED
TM
POST
STAPEDECTOMY
EAR
OTITIS MEDIA
WITH EFFUSION
OSSICULAR
FIXATION
TYMPANOSCLERO
SIS
OTOSCLEROSIS
TUMOUR OF
MIDDLE EAR

19. • EXPRESSED IN mm WATER / DEKA PASCAL
(daPa)
• 1mm WATER = 1.20 DEKA PASCAL
• RANGE = +50 TO -50 mm WATER
• MEP NEGATIVE WHEN P < -100 mm WATER
• PAED AGE GROUP-- +25 TO -100mm WATER

20. NORMAL MEP
• SCARRED TM
• OSICULLAR FIXATION
• OSICULLAR DISCONTUINITY
• STAPEDIAL OTOSCLEROSIS
NEGATIVE MEP
• ET DYSFUNCTION
• SECRETORY OTITIS
MEDIA/EFFUSION

21. ABSENCE OF PEAK
• PERFORATED TM
• ADHESIVE OTITIS MEDIA
• ARTIFACT
• PATENT GROMET IN TM
• CERUMEN
POSITIVE MEP
• EARLY ACUTE OTITIS
MEDIA

22. • SWALLOWING
• CHILD CRYING PHYSIOLOGICAL
• VALSALVA
• HOLD BREATH IN EXPIRATION
• IN EARLY AOM
PUS FORMED IN MEC AND ET DYSFUNCTION
DECREASE VOLUME + INCREASE PRESSURE OF MEC
POSITIVE PRESSURE PEAK

23. TYMPANOGRAMS
J. JERGER
A
B
A.S. FELDMAN

24. • SHARP MAXIMUM AT 0 mm WATER
• NORMAL EAR AND SOME CASES OF
OTOSCLEROSIS

25. • NORMAL MIDDLE EAR PRESSURE
WITH HIGH COMPLIANCE
• SEEN IN OSSICULAR CHAIN
DISCONTUINITY OR SCARRING OF
TM
• NOTCHED PEAK OR DOUBLE MAX
AT 0 mm USUALLY SEEN WITH A
HIGH FREQUENCY PROBE IN
OSSICULAR DISCONTUINITY

26. • NORMAL MIDDLE EAR PRESSURE WITH LOW
COMPLIANCE
• OTOSCLEROSIS AND THICKENED TM

27. • FLAT TYMPANOGRAM
• LITTLE OR NO COMPLIANCE AND NO SHARP PEAK
• SEEN IN ADHESIVE OTITIS MEDIA, OTITIS MEDIA
WITH EFFUSION, PERFORATION OF TM

28. • NEGATIVE MIDDLE EAR PRESSURE WITH NORMAL
COMPLIANCE
• ET DYSFUNCTION WITHOUT EFFUSION

29. • NEGATIVE MIDDLE EAR PRESSURE WITH LOW
COMPLIANCE
• ET DYSFUNCTION WITH OTITIS MEDIA WITH EFFUSION

30. PEAK PRESSURE
TYPE OF
CONFIGURATION OF
TYMPANOGRAM
COMPLIANCE OR
AMPLITUDE

31. 1.NORMAL TYMPANO GRAM
• GOOD COMPLIANCE AND PEAK PRESSURE AT 0
mm WATER
• CORRESPONDS TO JAGER TYPE A

32. 2.NORMAL MIDDLE EAR PRESSURE WITH HIGH
COMPLIANCE
• IF 226HZ PROBE USED THEN EITHER OSSICULAR
CHAIN DISCONTUINITY OR SCARRING OF TM
• BUT IF A 660 OR 800 HZ PROBE USED THEN A
NOTCHED PEAK OR DOUBLE MAX AT 0 mm
USUALLY SEEN IN OSSICULAR DISCONTUINITY

33. 3.NORMAL MIDDLE EAR PRESSURE WITH LOW
COMPLIANCE
• OTOSCLEROSIS OR OSSICULAR FIXATION AND
THICKENED TM

34. 4. FLAT TYMPANOGRAM
• LITTLE OR NO COMPLIANCE AND NO SHARP PEAK
• SEEN IN ADHESIVE OTITIS MEDIA, OTITIS MEDIA
WITH EFFUSION, PERFORATION OF TM .
• CORRESPONDS TO JAGER TYPE B.

35. 5.NEGATIVE MIDDLE EAR PRESSURE WITH LOW
COMPLIANCE
• ET DYSFUNCTION WITH OTITIS MEDIA WITH
EFFUSION
• CORRESPONDS TO JAGER TYPE CS

36. 6. POSITIVE MIDDLE EAR PRESSURE NORMAL
COMPLIANCE
• RARELY SEEN
• IN EARLY AOM
IN EARLY AOM
PUS FORMED IN MEC AND
ET DYSFUNCTION
DECREASE VOLUME +
INCREASE PRESSURE OF
MEC
POSITIVE PRESSURE
PEAK

37. 7.NEGATIVE MIDDLE EAR PRESSURE WITH
NORMAL COMPLIANCE
• ET DYSFUNCTION WITHOUT EFFUSION

39. TO BE CONT..