Exam 2 Flashcards
Tympanometry
dynamic measurement of middle ear function.
tracks admittance during changes in ear canal pressure
Tympanogram peak pressure
maximum air pressure in a tympanogram
tympanometric width
pressure range over which the tymp attains 50% of its peak in admittance.
ASR
acoustic stapedius reflex
requires functional cochlea, 8th cranial nerve, brainstem, 7th cranial nerve, and normal middle ear
ATF
Acoustic transfer functions
used to meausre responses in the ears of adults and kids
clinical signal detection of conductive hearing loss
impaired ears fell out of the 10th-90th percentiles of normal responses. so they created an error function to predict conductive HL using tymp and ambient-pressure energy absorbance responses
laser doppler vibrometry
relatively new technique that is also being used to make wideband measurements of middle ear function
calibration for tymps
3 cavities: .5, 2.0, 5.0 from ANSI S3.39
constraints of tympanometry
- acoustic immittance measures the acoustic energy that flows INTO the middle ear, and no what flows THROUGH the middle ear to the cochlea. some energy is lost or absorbed before the cochlea. cannot use tymps to regard hearing sensitivity.
- when immittance probe is sealed into the ear canal, measurements are made into a virtual “black box”. cant be used to determine middle ear structure/s in the ear contributed to change in stiffness or change in mass.
Tympanogram width
most common measure to describe the sharpnes of the tymp peak.
. Take height of peak and come down half way and see how wide it is.
• There were hopes that using the width we could tell about the conditions of the middle ear but that never panned out. So now we move on to acoustic reflexes
Low admittance = ?
MEE, otosclerosis, thickened ear drum, malleus fixation
High peak Ytm = ?
trophic scarring, tympanosclerotic plaques, ossicular replacement prostheses, ossicular discontinuity
abnormally high peak Ytm =?
medical referral when there is significant conductive/mixed hearing loss
Effects of gender, age, and race
females: broader and lower peak
chinese: increase in TW in chienese adults possibly because of smaller body size. 48% of chinese kids failed tymp when white kids were normal
Kids < 1yr; broader TW and lower Peak Ytm (maybe from residual effects of otitis media)6
what does frequency depend on?
stiffness and mass. these determine what its period of motion should be
impedance
opposition to the transport of energy through a medium. Impedance can be measured in different types of media like mechanical system, electrical, or acoustic.
how do we get to impedance? You need force to move anything/create motion…so the easiest example is using force (F) in a mechanical system. Electrical is Voltage (V). acoustic needs pressure to move anything (P)
next. We calculate the impedance of each system. Take force divided by velocity and whatever we get out of it is the impedance/opposition.
PRESSURE over VOLUME VELOCITY
Reactance
putting in energy at the entrance of the ear drum, and getting SOME at the stapes. If it was perfectly efficient then we would get all we put in into the oval window. But we don’t. why are we losing energy? What is causing it. There are some elements that contribute to resistance and some that contribute to reactance. Reactance conserves/keeps it. So that part of the energy doesn’t show up at the other end. Resistance dissipates and could turn to heat or whatever. But whether its kept or dissipated, it doesn’t make it to the other end. Resistance can be more of less friction. So anything that is vibing in air, you have friction cuz its vibing against the air molecules.
Reactance is the contribution of the mass and stiffness to conserving energy.
How does mass and stiffness of a system depend on frequency?
Why freq? cuz the impedance of a system is not independent of freq. any given acoustic system is more or less efficient at a certain freq. that change is primarily controlled by mass and stiffness
reflectance
- an idea of how efficient the middle ear is in transporting sound across a range
- Instead of having a pressure axis on x like tymps, you would have freq. so several are working to see if this is more efficient. Where we are today is to say where is the normative range. 100,200,1000 people…what is the 95% confidence interval. Problem 1: defining normal confidence interval. 2nd: when I have a pathology (otosclerosis, ear drum hole) u have to garuntee that that line will fall outside the normal confidence interval. Otherwise the test cant perform. By looking at the reflectance u wouldn’t get the info the tymp is giving u today. Reflectance is hard to measure. How much comes back? Ratio is the reflectance. So in a hard wall cavity youd put in x and get back x cuz nothing would go thru. So conceptuatlly its easy to grasp. Whether its clinically useful is still on the table.
what roles does the middle ear play in reflexes?
has to let sound through; reflect actually happens in the middle ear so we have to be able to detect it. You cant get a reflex if the cochlea doesn’t work.
what happens when the middle ear is full of fluid in terms of reflex?
If its full of fluid then the stiffness is already raised…so you cant see whats happening. Stiffness is already at max. if fluid in the R ear…u could get to cochlea and send the reflex over to the L ear. 2 complicating things with reflexes: neurons work or they don’t…so if anythings wrong there youre screwed. But if theres something wrong with the middle ear even tho its really really small, it becomes very hard to see the reflex even tho it happens (if it happens). 2nd is for purely cochlear losses. The loss keeps getting bigger and biger and likelihood of getting reflex gets smaller and smaller. However, we have recruitment. Abnormal growth in loudness (“cant hear, cant hear, too loud!”). this is a tell tale sign of pure cochlear loss.
Hermetic seal
So now the hermetic seal becomes important. Its important because without having this you cant change the pressure. But ALSO you need the seal to keep everything on the right side of the seal.
what measures can you pull from tymps?
Now there are many measures that get pulled from the tymp. Imagine a tymp. Peak is right around 0, the two tails are where they should be..whats the first thing you wanna pull out of this graph? Peak pressure (find the peak and draw a line to the x axis). Where do you expect the peak pressure to be? At or near 0. What will you tolerate? Page 161 Table 9.1. youll find 2 interesting tables. Each row in that table is a paper from the literature that gives you normative data for everything we talk about today. The funny thing is that nothing says the same thing. At some point you have to pick what you go with. The narrow the range, the stricter the criteria is. So what is the danger of picking a narrower and narrower range? Well the narrower the range that you consider normal, the more chances any given ear will fall in the given category. The narrower the normative range, the greater the probability that something will fall in that category. Typically with a narrow ranger, you over diagnose.
• Now, with a large range…the problem is opposite. The larger the range, the greater the probability that an abnormal ear falls within that range. So when u have a range too large, you increase probability of missing a disease. So u go from possibly over diagnosing to under diagnosing.
• You will find out what your preceptor thinks is a normal range and just smile and agree
can peak pressure fall outside of the normative range? why? under what circumstances?
- Blocked Eustachian tube: pressure in middle ear is negative. Oxygen gets eaten especially if you have a middle ear disease. The peak pressure could be negative. What type of tymp would jerger call this? Type C!
- Peak pressure is one of the most useless piece of the tymp puzzle. Why? Because its not very sensitive.
- Peak pressure is useful tho to work backwards from the E. Tube and see if its working. Peak pressure changes if you force air into the middle ear or force air out of the middle ear. So when you ask them to swallow or blow they need to hold nose/keep mouth close to keep pressure where you want it.
- How much of a change do u accept to be reliable? 10-15 decapascals. But if its for an official test you should do a test-retest to make sure
- Blocked Eustachian tube: pressure in middle ear is negative. Oxygen gets eaten especially if you have a middle ear disease. The peak pressure could be negative. What type of tymp would jerger call this? Type C!
- Peak pressure is one of the most useless piece of the tymp puzzle. Why? Because its not very sensitive.
- Peak pressure is useful tho to work backwards from the E. Tube and see if its working. Peak pressure changes if you force air into the middle ear or force air out of the middle ear. So when you ask them to swallow or blow they need to hold nose/keep mouth close to keep pressure where you want it.
- How much of a change do u accept to be reliable? 10-15 decapascals. But if its for an official test you should do a test-retest to make sure`
ear canal volume
• Lets back up a whole lot to the 1950s. they worked on if you take a hard walled cavity and that sound cant escape or enter, can you tell what the volume of air is in that cavity, can you tell the volume? Yes. Relatively well. So they came up with this exercise of putting a probe in a 2cc cavity. Drive speaker with x amount of energy. And we have a mic and we’ll measure how much sound we generate. Then do it again at a 5cc cavity. The ratio between these two sound pressure levels should be proportional to the volume between the 2 different types of cc’s. you can get a sense of how much sound pressure you can expect provided you stimulate with energy x. so that caught on and today you have at least 3 calibration cavities per machine. What you do is take probe and put it in the smallest all the way up to get the ratio. Now put the probe in ear canal and don’t know the volume but I stimulate with energy x and get information. Compare to calibration data to the unknown cavity. Predict what the volume of this cavity should be. What is the equivalent volume of air to that cavity?
• You needed a hard walled cavity for this, remember. Because you stimulate the speaker with xvolts and don’t want the energy to escape, but rather turn into sound pressure to measure it. This doesn’t happen in the ear canal! So what are we gonna do about this? How are we going to get a measure of the volume of the ear canal?
Pump a bunch of air in there, push the TM so it’s hard as a rock/stretched out so it can’t move…and the volume u get is the volume of the ear canal. However, you could suck all of the air out too to make it taught the other way. Which one should we do? The negative tail would be smaller. So should we take an average, one, or the other? It doesn’t matter..as long as you can all agree to do it the same way. That’s what has happened. Take pressure at the negative tail and that is going to be the equivalent ear canal volume. The air sucked out is negative. Negative 100
whats the clinical value of knowing ear canal volume?
If the ear canal volume is larger than the ear drum could be perforated and youd be measuring the middle ear too.
• The other way: if its too small it could be a cerumen blockage or some other object. Something that occupies space.
• Bigger volume = measuring bigger than the ear canal. Smaller = something in the ear.
Compensated peak compliance or admittance
- Height of the peak. Draw a line from the peak onto the y axis we get the height which is peak compliance.
- Why compensated? So you’ve got this peak in the tymp. What does the full height to the peak represent? Where the most energy is being passed through. Extreme of the argument: at peak pressure all of the energy is going thru. So the height is the volume of what? We think that the 2 edges are low cuz were keeping all of the sound in. so now at the peak were saying weve made it at flaccid as possible so all of the sound is going into the middle ear…so ear canal and middle ear is getting measured at the peak. The hard wall is now the stapes. So we get the volume of both now! How do we figure out just the middle ear from here? Subtract the edges to get the COMPENSATED peak compliance.
tympanogram height
Table 9.1 in adults it could be anywhere between these two ranges. 0.21.8. that’s all acceptable. Why would it be smaller than that? If its full of fluid/not much volume in there.
Tymp Type As
Otosclerosis could cause this! Anything that is weighing down the vibrations of the middle ear chain so you have very little in terms of the peak and the tymp. That’s a SHALLOW
Tymp Type Ad
Something that was binding before, is now cut loose or or tymp that is lost 2/3 layers of tissue so its really flappy. Something that has increase the movabilty in the chain. DEEP
Tymp Type B
FLAT–If its full of fluid/not much volume in there. Aka you cant move the TM.
Tymp Type C
peak at the right height but at the wrong pressure. Typically way negative