PERAN TES ELEKTROAKUSTIK

IMITANS DI BIDANG AUDIOLOGI

Jenny  Bashiruddin  

Departemen  THT  FKUI-­‐RSCM  

Jakarta  
A NATOMY
M IDDLE E AR
 HEARING ANATOMY & PHYSIOLOGY

Auditory Tympanic
Pinna Ossicles
Canal Membrane

Malleus (hammer) Amplitude reduction

Incus (anvil) Pressure amplification
Stapes (stirrup) Attenuation reflex
Ligaments (protection, low
Muscles frequency masking)

Oval Auditory Auditory

Cochlea
Window Nerve Cortex
T HE MIDDLE EAR & COCHLEA
T HE M IDDLE E AR

Func?on  
  Deliver  acous?c  energy  
           (air)  from  
the  tympanic  membrane  
into  the  
liquid  medium  of  the  
inner  ear  (cochlea)  
  clucth  
  Stapedius  Reflex  
 M IDDLE E AR
 
Func?on:  
 Osicular  coupling  

 Acous?c  coupling  

 Input  impedance  
stapes-­‐cochlea    
 Middle  ear  aera?on  

  http://epl.meei.harvard.edu/~keh/cd846/Lecture02.pdf
Geisler 1998
 M IDDLE E AR

 Middle ear aeration

ossicular and acoustic
coupling
Merchant et al. 1997
http://epl.meei.harvard.edu/~keh/cd846/Lecture02.pdf
 Pathology  /Middle  Ear  defect:  
   Eustachius  Tube  disorder  

 Barotrauma  

 O??s  media  

 Otosklerosis,  Timpanosklerosis  

 Hemo?mpanum  

   hearing  bone  disloca?on  

 A UDIOMETRI I MPEDANS
 Tympanometri  

 Eustachius  Tube  func?on  

 Stapedius  Reflex  
  Normally,  the  air  pressure  in  the  ear  canal  is  
the  same  as  ambient  pressure.    
  under  normal  condi?ons,  the  air  pressure  in  
the  middle  ear  is  approximately  the  same  as  
ambient  pressure  since  the  eustachian  tube  
opens  periodically  to  ven?late  the  middle  ear  
and  to  equalize  pressure.    
  In  a  healthy  individual,  the  maximum  sound  is  
transmiSed  through  the  middle  ear  when  the  
ambient  air  pressure  in  the  ear  canal  is  equal  
to  the  pressure  in  the  middle  ear.    
 T YMPANOMETRY
  Tympanometry    
  used  to  test  the  condi?on  of  the  middle  ear  objec?ve  
test  of  middle-­‐ear  func?on  
  To  test  mobility  of  the  eardrum  (tympanic  membrane)  
and    
  the  conduc?on  bones  by  crea?ng  varia?ons  of  air  
pressure  in  the  ear  canal.  
  It  is  not  a  hearing  test,  but  rather  a  measure  of  
energy  transmission  through  the  middle  ear.    
  The  test  should  not  be  used  to  assess  the  
sensi?vity  of  hearing  and  the  results  of  this  test  
should  always  be  viewed  in  conjunc?on  with  pure  
tone  audiometry.  
 T YMPANOMETRY

  is  a  valuable  component  of  the  audiometric  

evalua?on.    
  In  evalua?ng  hearing  loss,  it  permits  a  
dis?nc?on  between  sensorinueural  and  
conduc?ve  hearing  loss,  when  evalua?on  is  
not  apparent  via  Weber  and  Rinne  tes?ng.    
  Furthermore,  in  a  primary  care  seWng,  
tympanometry  can  be  helpful  in  making  the  
diagnosis  of  o??s  media  by  demonstra?ng  
the  presence  of  a  middle  ear  effusion.  
 TYMPANOMETRI

  Tympanometri  the  mobility  of  the  tympanic  

membrane  is  measured  while  the  membrane  is  
exposed  to  a  (sinusoidal)  tone  of  frequency    
  In  the  ear,  the  tympanic  membrane  is  mechanically  
coupled  with  the  middle  ear  ossicles  to  the  oval  
window  -­‐the  interface  between  middle  and  inner  
ear.    
  It  is  this  en?re  system  (membrane,  middle  ear,  oval  
window)  that  is  forced  into  oscilla?on.    
  The  oscilla?on  is  detected  by  a  microphone.  (A  
more  detailed  descrip?on  is  given  in  
"Tympanometry  in  just  seconds".)    
 TYMPANOMETRI

  A  linear  theory  used  to  evaluate  the  signal  from  the  

microphone  is  presented  here.    
  The  response  of  a  linear  system  when  driven  by    
1.  a  periodic  oscilla?on  can  be  expressed  in  terms  of  the  
resistance  with  which  the  system  responds  to  the  
excita?on  (called  "impedance")  or    
2.  in  terms  of  the  ease  with  which  it  is  set  into  mo?on  
(called  "admiSance").    

  Both  expressions  of  the  response  are  presented  

here  next  to  each  other  in  a  table.    
  The  general  term  used  to  describe  how  energy  is  
transmiSed  through  the  middle  ear  is  admi=ance.    

  The  instrument  measures  the  reflected  sound  and  

expresses  it  as  an  admiSance  or  compliance,    

  ploWng  the  results  on  a  chart  known  as  a  tympanogram.  

 O PERATION
 A  tone  of  226Hz  is  generated  by  the  tympanometer  into  the  ear  canal      
 where  the  sound  strikes  the  tympanic  membrane  
 
 causing  vibra?on  of  the  middle  ear  
 
 results  in  the  conscious  percep?on  of  hearing.    
 
 Some  of  this  sound  is  reflected  back  and  picked  up  by  the  instrument    
 Most  middle  ear  problems  result  in  s?ffening  of  the  middle  ear,  
which  causes  more  of  the  sound  to  be  reflected  back.  
•  assesing middle ear function

•  illustrating the relationship between outer ear pressure with

resistance (impedance) on MT and middle ear
 H OW IT WORKS

the sound is transmitted to the loud speaker

inserting the tool to the ear canal

amount of sounds relfected by tympanic

air flowing membrane measured by the microphone

the result reflect in grafic form

measuring pressure on the ear canal
wall Tympanogram
H OW IT WORKS
 P ROCEDURE
  A]er  an  otoscopy  (examina?on  of  the  ear  with  an  
otoscope)  to  ensure  that  the  path  to  the  eardrum  is  
clear  and  that  there  is  no  perfora?on,    

  the  test  is  performed  by  inser?ng  the  tympanometer  

probe  in  the  ear  canal.    

  The  instrument  changes  the  pressure  in  the  ear    

  generates  a  pure  tone,  and  measures  the  eardrum  

responses  to  the  sound  at  different  pressures.  
 T HYMPANOGRAM SHOWS
  Complience   of   the   midle   ear   system   (   tympanic  
membrane  movement  )  
  Ear  canal  volume  
  Middle   ear   pressure     (normally,   it   is   equall   to  
atmosphere  pressure)  
  Differ  paSern  with  the    numerous  disorder  paSern  
 T YPE OF T YMPANOGRAM
  Type  A  tympanogram  is  considered  normal.  There  is  a  
normal  pressure  in  the  middle  ear  with  normal  mobility  
of  the  eardrum  and  the  conduc?on  bones.  
  Type  B  and  C  tympanograms  may  reveal    
  fluid  in  the  middle  ear  ,    
  perfora?on  of  the  tympanic  membrane,    
  scarring  of  the  tympanic  membrane,  
   lack  of  contact  between  the  conduc?on  bones  of  the  
middle  ear  or  a  tumor  in  the  middle  ear.  
  In  contrast  to  the  above  informa?on:  Typing  of  
tympanometric  data  should  NOT  be  used  as  a  
diagnos?c  indicator.  It  is  merely  a  descrip?on  of  shape.    
  There  is  no  CLEAR  dis?nc?on  between  type  A  (not  to  
men?on  A  sub-­‐S  and  A  sub-­‐D)  and  type  B  and/or  type  
C.  
  Only  measures  of    
  sta?c  acous?c  admiSance,  

   ear  canal  volume,  and    

  tympanometric  width/gradient  compared  to  gender,  
age,  and  race  specific  norma?ve  data  can  be  used  to  

  somewhat  accurately  diagnose  middle  ear  pathology  

along  with  the  use  of  other    
  audiometric  data  (e.g.  air  and  bone  conduc?on  
thresholds,  otoscopic  examina?on,  normal  word  
recogni?on  at  elevated  presenta?on  levels,  etc.).    
THANK YOU