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
