IMPEDENCE AUDIOMETRY
P AMALDEV NAMBIAR
83
IMPEDENCE AUDIOMETRY
Impedance audiometry measures the resistance (impedance)
of the middle ear system to sound.
• It’s an objective test
• To evaluate the middle ear.
• Useful particularly in children
Consists of
(a)Tympanometry
(b)Acoustic reflex measurements
TYMPANOMETRY
Principle
- When sound strikes tympanic membrane, some of the sound
energy is absorbed and the rest is reflected.
A stiffer tympanic membrane would reflect more of sound
energy .
By changing the pressures in a sealed external auditory canal and then
measuring the reflected sound energy, it is possible to find the
compliance or stiffness of the tympano-ossicular system
Compliance in audiometry refers to the measure of the middle ear's
ability to transmit sound energy. It is an important aspect of
audiological assessment, particularly in tympanometry, which is a
diagnostic test used to evaluate middle ear function.
It is typically measured in cubic centimeters (cm³) or milliliters (mL),
and it represents the amount of movement or displacement of the
eardrum in response to the applied pressure.
A normal compliance value indicates that the middle ear is
functioning properly, while abnormal compliance values may
indicate middle ear problems, such as otosclerosis, eustachian tube
dysfunction, or a perforated eardrum.
INDICATIONS
◦ Ossicular chain discontinuity.
◦ Ossicular fixation (m/c: Foot plate of stapes → otosclerosis)
◦ Serous otitis media (som) / middle ear effusion (block of
eustachian tube → Fluid collection).
PROCEDURE
metry, a small probe is inserted into the ear canal, and a varying air press
ures the movement of the eardrum and the reflexes of the middle ear mus
changes.
TYMPANOMETRY
MANOEUVERS
• Valsalva Maneuver
• Politzer Test
• Toynbee Maneuver
• Frenzel Maneuver
• Eustachian tube Catheterization
IMPEDENCE AUDIOMETRY
NISHCHAL GOWDA C R
82
ACOUSTIC REFLEX
• The acoustic reflex (also known as the stapedius reflex) is
an involuntary response in the middle ear that helps protect
the inner ear from loud sounds. It involves the contraction
of the stapedius and tensor tympani muscles in response to
high-intensity sounds. This contraction stiffens the ossicular
chain in the middle ear, reducing the transmission of sound
energy to the inner ear.:
• 1. Trigger: Sounds above 70–100 dB SPL typically activate
the reflex.
2. Muscles Involved:
Stapedius muscle: Pulls the stapes slightly away from the oval window.
Tensor tympani muscle: In some cases, contracts to pull the malleus inwar
• 3. Purpose:
• Protects the cochlea from potential damage caused by loud
sounds.
• Helps reduce low-frequency background noise, improving
the detection of high-frequency sounds.
PATHWAY
• 1. A loud sound enters the ear and is transmitted to the
cochlea.
• 2. The auditory nerve (cranial nerve VIII) sends signals to
the cochlear nucleus in the brainstem.
• 3. Signals are relayed to the superior olivary complex.
• 4. Motor signals are sent via the facial nerve (cranial nerve
VII) to the stapedius muscle and, in some cases, via the
mandibular branch of the trigeminal nerve (cranial nerve V)
to the tensor tympani muscle.
PATHWAY
Ipsilateral: CN VIII ® ventral cochlear nucleus ® CN VII nucleus ®
ipsilateral stapedius muscle.
Contralateral: CN VIII ® ventral cochlear nucleus ® contralateral
medial superior olivary nucleus ® contralateral CN VII nucleus ®
contralateral stapedius muscle
USES
(i) To test the hearing in infants and young children. It is an objective method.
(ii) To find malingerers. A person who feigns total deafness and does not give
any response on pure tone audiometry but shows a positive stapedial reflex is
a malingerer.
(iii) To detect cochlear pathology. Presence of stapedial reflex at lower
intensities, e.g. 40–60 dB than the
usual 70 dB indicates recruitment and thus a cochlear type of hearing loss.
(iv) To detect VIIIth nerve lesion. If a sustained tone of 500 or 1000 Hz,
delivered 10 dB above acoustic reflex threshold, for a period of 10 s, brings the
reflex amplitude to 50%, it shows abnormal adaptation and is indicative of
VIIIth nerve lesion (stapedial reflex decay).
(v) Lesions of facial nerve. Absence of stapedial reflex when hearing is normal
indicates lesion of the facial nerve, proximal to the nerve to stapedius. The
reflex can also be used to find prognosis of facial paralysis as the appearance
of reflex, after it was absent, indicates return of function and a favourable
prognosis.
(vi) Lesion of brainstem. If ipsilateral reflex is present but the contralateral
reflex is absent, lesion is in the area of crossed pathways in the brainstem.
THANK YOU
