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AUDE 5340 AUD DIAG II > Immitance Intro > Flashcards

Immitance Intro Flashcards

1
Q

What type of testing does immittance testing encompass?

A

Tympanometry

Ear canal volume measurement

Acoustic reflex testing
Acoustic reflex threshold
Acoustic reflex decay

Tests of Eustachian tube function

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2
Q

What structures are assessed using immittance measures?

A

tymp middle ear
reflexes - effect on middle ear, auditory nerve, cochlea, b.s., facial nerve

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3
Q

What are the components of an immittance meter?

A

probe signal (tone)
air pressure
microphone

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4
Q

How is immittance testing conducted?

A

based on changing the pressure in the ear canal and measuring sound levels in the ear canal

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5
Q

describes the flow of sound energy

A

immittance

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6
Q

how much sound doesn’t get through the middle ear -

A

acoustic impedance

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7
Q

how much sound does get through the middle ear -

A

acoustic admittance (height of the peak)/ compliance

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8
Q

3 tubes (probe) = tymp

A

air pressure generator
microphone
tone generator

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9
Q

how do you prepare the pt for a tymp?

A

Otoscopy first

Ask about ear-related symptoms
Discomfort, pain, drainage
Previous surgeries

Seat patient comfortably, instruct to remain still
Child may need to be gently restrained

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10
Q

what is the probe tip

A

part that comes off - finding right size for patient - gets tight seal and couples to ear canal

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11
Q

black only tube only generates just the tone

A

acoustic reflexes

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12
Q

probe itself has 3 components

A

tone that is played when tymp is ran
microphone picks up sound in me space while running it
air pressure - changes air pressure

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13
Q

explain the process of a tymp

A

sound goes into the ear, changes the pressure and measure the sound in the ear as the pressure changes by the microphone

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14
Q

what is plotted on a tymp axis

A

x is pressure and y is admittance

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15
Q

what can evaluate the middle ear function and identify middle ear disorders?

A

tympanometry
volume measures
Eustachian tube function measures

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16
Q

what differentiates cochlear from retrocochlear

A

site-of-lesion testing
acoustic reflex thresholds
acoustic reflex decay

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17
Q

do we expect a middle ear disorder with purely snhl?

A

no
abg shows it is conductve = middle ear
snhl = cochlear vs retrocochlear and no middle ear abnormalities

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18
Q

what are tymp contradictions?

A

Complete stenosis or atresia

Otorrhea

Acute otitis media with red and bulging tm

Tenderness/soreness, otitis externa
In this case, test healthy ear and allow patient to judge
If proceed, let pt. know how to signal to stop test

Foreign bodies should be removed prior

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19
Q

what is the right side of a tymp plot?

A

positive

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20
Q

middle line on tymp?

A

line represents 0 (same atmosphere pressure as the room)

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21
Q

left side of tymp plot?

A

left is negative
gives measurement in dcpascals
relative to the room

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22
Q

what is the pressure in the ear canal the same as?

A

environment

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23
Q

how can you manipulate pressure in the ear canal?

A

seal it off with probe tip

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24
Q

explain what the peak of a tymp means

A

middle ear system operates the most effectively and letting the most sound through is the peak
other sides of peak is that sound is being opposed

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25
Q

higher admittance

A

more sound is going through the middle ear
floppy

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26
Q

lower admittance

A

less sound
stiffness in the system

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27
Q

when does middle ear operate most efficiently?

A

ear canal and middle ear should be equal, when those are equal, middle ear operates the most efficiently
peak means no neg middle ear pressure - et is working properly

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28
Q

what tymp would we see if et is not ventilating the middle ear?

A

it is more negative
peak shifts to the left - negative middle ear pressure, leading to fluid

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29
Q

when would excessive cerumen contradict tymps?

A

Do not test if probe insertion will push against impacted cerumen

Soft wax can damage probe

Remove cerumen prior to tympanometry

In some cases, tympanometry is performed when view of tm is obscured
Do this only if deemed safe to do so!

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30
Q

when should tymps be done with previous ear surgery

A

Not within 2 months of ear surgery unless formally approved and documented

Reconstruction of ossicles or tm
Only if given medical advice that it is safe

If in doubt, ask medical advice

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31
Q

P.E. tubes- to test or not to test?

A

This will vary depending on placement
No sooner than within two weeks of placement, otherwise generally ok

32
Q

Pressure is continuously changed in the ear canal from _____ pressure to ______ pressure, relative to ambient pressure

A

negative, positive

33
Q

he most common probe tone

A

220/226 Hz

34
Q

probe tone for under 6 months

A

1,000 Hz

35
Q

pressure expressed in

A

daPa

36
Q

admittance expressed in

A

mmho or ml

37
Q

are mmho or ml equivalent?

A

yes refers to admittance

38
Q

how are tymps classified previouslY?

A

by shapes

39
Q

vary far negative peak

A

type c

40
Q

flat tymp

A

type b

41
Q

has the peak and falls within the box (norms)
not to far high or low or left or right

A

type a

42
Q

very high peak (ossicular disarticulation)

A

a sub d

43
Q

shallow (stiffness/shallow)

A

a sub s

44
Q

point where middle ear system is operating most efficiently

A

peak pressure

45
Q

how close the peak is to 0

A

peak pressure

46
Q

what is the peak pressure norm for adults

A

+50 to -100 daPa

47
Q

what gives us an indication if there is neg pressure or not in the me

A

peak pressure

48
Q

approximates but does not measure middle ear pressure

A

peak

49
Q

what do we see if ET is not functioning (ETD)

A

Possible positive peak early stages of acute OM
Negative peak

50
Q

Measures stiffness or “floppiness” of the ossicular chain/middle ear system

A

static admittance

51
Q

Frequently referred to as compliance or peak compliance

A

static admittance

52
Q

Ytm

A

static admittance

53
Q

0.3 – 1.7 mL

A

static admittance

54
Q

what is considered floppy ossicular chain

A

above 1.7

55
Q

what is considered stiff in ossicular chain

A

lower than .3

56
Q

what part of me is being measured by static admittance

A

ossicular chain plus ™ or middle ear system

57
Q

Static admittance lower in middle ear conditions with increased stiffness

A

OME
Cholesteotoma
Ossicular adhesions
Space occupying lesions that contact TM or ossicular chain
otosclerosis

58
Q

Static admittance higher in middle ear conditions with decreased stiffness

A

Ossicular chain discontinuity
AKA ossicular chain disarticulation

TM atrophy

59
Q

What is tympanometric peak pressure measuring? Will this shift along the x or the y axis? What are adult norms for TPP? Which physical structure(s) will affect this measurement if not functioning properly?

A

ET, shifts right or left on the x axis, +50 to -100 in adults, ET and it is actually measuring the pressure point where the me system is the most efficient

60
Q

What is static admittance measuring? Will this shift along the x or the y axis? What are adult norms for static admittance? Which physical structure(s) will affect this measurement if not functioning properly?

A

it measures how efficient sound transmission is, measuring stiffness vs floppiness, it will shift along the y axis up and down, .3 to 1.7 is norm, ossicular chain and the tm (middle ear system)

61
Q

ECV

A

ear canal volume

61
Q

Vea

A

ear canal volume

62
Q

Noted as Vea or Vec or Veq

A

ear canal volume

63
Q

ear canal volume tells us

A

status of the ™ (if it is intact or not, if PE tubes are open or not)
if there is something significant in the ear canal that we couldnt see

64
Q

Reported in cc or mL

A

ear canal volume

65
Q

Increases with age (developmentally)

A

ear canal volume

66
Q

Clinic norms for adults: 0.9 – 2.0 ml

A

ear canal volume

67
Q

on average, volume is 2.0

A

ear canal volume

68
Q

if somebody lost a dome, bug, hair, etc. in the ear from a ha, will it effect canal volume?

A

will not give an abnormal volume

69
Q

refer to the width of the tympanogram

A

gradient and width

70
Q

measurement at the halfway point

A

width

71
Q

ratio of the peak to the halfway point divided by the whole thing

A

gradient

72
Q

very large width tells us

A

we have a flat tympanogram

73
Q

why is replicability important

A

anytime you have a physiologic measure we have to replicate the response

make sure the response didnt come by chance

run again and make sure you got an unusual result again and it wasn’t your mistake

reflexes always replicate

74
Q
A

AUDE 5340 AUD DIAG II (9 decks)

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