Examining The Middle Ear

What is Tympanometry?

Tympanometry is a simple medical test that allows us to measure the function and movement of the eardrum and middle ear. It helps us determine whether your hearing loss can be helped by hearing aids or if another one of our treatments would be more suitable. Even if you aren't experiencing hearing loss, tympanometry can pick up middle ear problems, especially in children.

You might be wondering, what is the middle ear?

To give a quick explanation of the structure of your ear, this is made up of three parts – the outer ear, the middle ear, and the inner ear. When there is a problem within the middle ear, this makes it harder for sound to move from your outer ear to your inner ear and then to your brain.

Process

How does Tympanometry work?

Tympanometry is how we test the function of the middle ear and we can use it to determine if your hearing loss is likely to require hearing aids or another treatment path.

We use a highly sophisticated machine which exerts a small (and painless) amount of pressure in your ear as well as a low tone.

With this, we can measure the movement of your eardrum to see whether the middle ear is functioning as we would expect. Abnormal tympanogram results may
suggest:

  • Blockage or fluid build-up in your middle ear (most common).
  • Blocked or clogged eustachian tubes (the tubes that open and close to control air pressure
    inside your ears).
  • Growths in your middle ear.
  • Abnormal movement of the middle ear bones (malleus, incus and stapes)
  • A perforation of the eardrum not observed during otoscopy.
  • A scarred eardrum (from an infection or fluid).
    Tympanometry can also be used to tell if an eardrum is fully healed following an infection or
    perforation.

The tympanometre will use a probe and probe tip to form a seal in the ear canal and produce a probe tone.

The tone variation will depend on the patient's age and other factors. This is why we recommend consulting with our audiologists to ensure the test is tailored to your needs. The audiologist may also decide to use a wideband stimulus, such as a wideband click, that works for both adults and children to run the test.

After the tone is introduced to the ear, the admittance (ease of energy flow) is recorded. Simultaneously, the pump changes the pressure in the ear canal to assess how the admittance is affected under different pressure conditions.

A microphone is placed in the ear canal alongside the probe and pump to measure the admittance. Using this microphone, the tympanometre maintains a consistent sound pressure level in the ear canal.

The admittance is derived from the electrical current needed to maintain the sound level throughout the measurement. The idea is that under different pressure conditions, varying energy levels will pass into the middle ear.

These data points are then plotted on a graph called a tympanogram, which displays the admittance measured into (mm) as a function of the middle ear pressure measured in (data).

Usage

Why is Tympanometry used?

Used by Audiologists to detect several things within the middle ear. Such as, the presence of fluid, a middle ear infection or a perforated ear drum. This test is particularly important for children but may also be offered to adults as part of a standard hearing consultation. This test may sometimes help the Audiologist determine the cause of your hearing loss.

Adults and children, who require the medical approval to use hearing aids, will require a tympanometry test. This will be to ensure there is no fluid within your middle ear, as this may indicate hearing aids are not actually necessary and in fact this fluid has been the cause of your hearing loss. If this is the case, your Audiologist will suggest ways to treat this, as fortunately this condition is temporary and treatable.

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What to expect

What to expect during your Tympanometry appointment

Tympanometry comes as part of our standard hearing consultation. Once you're seated and comfortable, we'll place the device inside your ear. This isn't an uncomfortable experience, in fact, it just feels like an earplug.

The tool then gets to work on causing the air pressure in your ear canal to change, a sensation which is often compared to that of taking-off and landing in a plane. Whilst this pressure is changing, the device will measure and record your eardrum's movement, so it's important that you're quiet and still during the test.

Before the audiologists begin the tympanogram test procedure, they will request your medical history to look for any contraindications. The exam may include general questions such as whether you have had any ear infections in the recent past and other medications you may be on. This will help ensure the test results are accurate and the test is adjusted to meet your needs.

What Happens After Tympanometry Testing?

Depending on the results' findings, we may also recommend some steps, which may include other tests necessary to diagnose the ear conditions. If the ear results are consistently abnormal, the problem could be that there is more fluid behind the ear drum, which could require additional testing.

The audiologist will advise on the most appropriate steps to take after the test and, where necessary, may refer you to the specialist you need to see for further diagnosis and treatment.

During the test your Audiologist will see a graph on a device called a Tympanogram. This device will display the results of your middle ear test. Highlighting any problems within the middle ear.

Tympanometry Appointment Process

What to Expect at Your Tympanometry Consultation?

Step 1

The first step in tympanometry is otoscopy, a test procedure that checks the condition of the ear canal and ear drum and also checks for any occluding wax and other contraindications that may affect the procedure's outcome.

Step 2: Probe Tip Selection

Based on the outcome of the first step, the audiologist will choose the appropriate probe for the test. This tip should be single-use silicone or rubber, and the size selected should be large enough to form a tight seal in the ear canal without being so large that it pushes itself loose during the measurement.

Step 3: Start the Measurement

When the seal is obtained, the measurement begins. The ear canal pressure starts at atmospheric pressure and increases to maximum pressure during the test, resulting in a maximum of 200 to 300 data points.

Step 4: Remove the Probe

After measuring the admittance at the minimum ear canal pressure, the air pressure is returned to zero before the probe is removed. This step is essential to ensuring that the eardrum is not damaged if the probe is removed while the ear canal is pressurised. After the test is completed, the final step is to repeat the otoscopy to ensure that the pressurisation does not damage the ear canal or ear drum.

Step 5: Interpreting the Test Results

The test results are normally displayed as a graph called a tympanogram. You don't have to worry about reading the technical results yourself. The audiologist will help you with this and provide you with simplified, easier-to-understand results.

FAQ’s

Tympanometry FAQ's

  • Is tympanometry safe for all patients?
    The tympanometry test is safe for patients under normal conditions. However, it may not be recommended in patients with contraindications such as otorrhoea, acute otitis media, and excessive wax. This is why an otoscopy is necessary before proceeding with the test.
  • What are the side effects of tympanometry test?
    Most people don’t report any side effects after the test. However, young children may be confused about what’s happening during the test. We do our best to help them understand each step of the process to reduce the confusion.
  • Can talking during the tympanogram affect the results?
    When taking the test, you will be required to sit up and remain still. Movement, coughing, laughing and even talking and swallowing can interfere with the accuracy of the results because these activities cause a change in the pressure in the ear canal.
  • Can a tympanometry be wrong?
    A tympanometry test conducted by a skilled audiologist under the right conditions cannot be wrong. However, various factors, such as movements and swallowing during the test, may affect the quality and accuracy of the results.
  • How do I know if my tympanometry test results are normal?
    The audiologist will closely monitor the test and the tympanogram and advise you on the functioning of your ear. If additional tests are necessary, we will inform you of the next course of action.
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