IMPEDANCE AUDIOMETRY in otorhinolaryngology.pptx

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1. Dr. Kavisha Shah ENT Resident Dr. M.K.Shah Medical College and Research Centre,Ahmedabad .

2. USE TEST TYMPANOMETRY EUSTACHIAN TUBE FUNCTION STAPEDIAL REFLEX

3. SOUND WAVE SOUND WAVE AIR AIR SOLID A B SORBED SOUND

4. SOU N D AIR SOLID IMPED A NCE ST I FF NESS MASS FRICTIO N

5. AIR COCHLEA SOUND MIDDLE EAR IMPEDANCE MATCHING DEVICE COCHLE A EAC T M

6. CHANGE IN PRESSURE --- CHANGE IN TM STIFFNESS ---SOUND ENERGY REFLECTED BACK DEPENDS ON STIFFNESS OF TM OR PRESSURE CHANGE PROBE TONE AMPLIFIER S O U N D TYMPANIC MEMBRANE REFLECT ED SOUND MANOME T E R P R E S S U R E

7. T H E R E FORE TYM P A N OMET R Y M A Y BE DEFINED AS MEASUREMENT OF CHANGE IN IMPEDANCE OF MIDDLE EAR CAVITY AT THE TM PLANE IN RELATION TO CHANGE IN PRESSURE IN EAC. TYM P A N O G R A M Y IMPEDANCE OR STIFFNESS X AIR PRESSURE

8. I M P E D A N C E NONE OF THE PARAMETERS MEASURED INDIVIDUALLY S T IFF N E S S MASS FRICTION SO AS A RESULT ACOUSTIC ADMITTANCE IS MEASURED ADMITTANCE IS RECIPROCAL OF IMPEDANCE IMPEDANCE OPPOSITION TO FLOW OF ENERGY ADMITTANCE EASE WITH WHICH THE FLOW OF ENERGY OCCURS

9. LOW FREQUENCY PROBE TONE USED IMPEDANCE AUDIOMETERS STILL AUDIOMETERS DO NOT MEASURE ADMITTANCE DIRECTLY COMPLIANCE EASE OF MOVEMENT OR SPRINGINESS OF MIDDLE EAR SYSTEM IS ALSO RECIPROCAL OF STIFFNESS

10. HENCE IF COMPLIANCE IS MEASURED USING LOW FREQUENCY TONE IMPEDANCE OF MIDDLE EAR SYSTEM MOST OF THE IMPEDANCE AUDIOMETERS MEASURE COMPLIANCE

11. C1 – COMPLIANCE VALUE AT +200mm water C2 – COMPLIANCE VALUE AT (MAXIMUM) CX – STATIC COMPLIANCE (C2- C1=CX)

12. PRESSURE AT WHICH COMPLIANCE VALUE IS MAXIMUM IS CALLED AS MIDDLE EAR PRESSURE IE PRESSURE OF AIR IN MIDDLE EAR CAVITY.

13. T H E COMPLIANCE V ALUE A T + 20 m M w a ter I S T H E VOLUME OF EAC .

14. TYM P ANOMET R Y MEASUREMENT OF STATIC COMPLIANCE MEASUREMENT OF MIDDLE EAR PRESSURE

15. cc/ ml if COMPLIANCE Millimho if SUSPECTANCE IF A 220 Hz PROBE– 1MILLIMHO OF SUSPECTANCE = 1 CC/ML OF COMPLIANCE ABSOLUTE RELATIVE TYMPANOGRAM COMPENSATED

16. ABSOLUTE BASELINE IS COMPLIANCE AT +200 SHADED AREA IS VOLUME OF EAC ALSO CALLED NON COMPENSATED TYPE RELATIVE BASELINE IS AT ORDINATE BRACKET PORTION IS COMPLIANCE COMPENSATED BASELINE IS AT ORDINATE BRACKET PORTION IS COMPLIANCE SHADED AREA BESIDE THE TYMPANOGRAM IS VOLUME OF EAC

17. IMP POINT– CLINICAL CONDITION OF TM TO BE ALWAYS NOTED STUDY BY A.S. FELDMAN– HEALED TM INVALIDATES COMPLIANCE AS ONE OF THE TESTS OF TYMPANOMETRY NORMAL RANGE COMPLIANCE 0. 35 TO 1.40 > < 2.50mL .28 mL ABN O R MAL L Y HIGH ABNORMALLY LOW

18. LARGE TM OSSICULAR DISC O NTIN U ITY SC A RE D /HEALED TM POST S T AP E DE C T OMY EAR OTITIS MEDIA WITH EFFUSION OS S ICUL A R FIXATION T Y M P ANO S CLE R O SIS OTOSCLEROSIS TUMOUR OF MIDDLE EAR

19. EXPRESSED IN mm WATER / DEKA PASCAL (daPa) 1mm WATER = 1.20 DEKA PASCAL RANGE = +50 TO -50 mm WATER MEP NEGATIVE WHEN P < -100 mm WATER PAED AGE GROUP-- +25 TO -100mm WATER

20. NORMAL MEP SCARRED TM OSICULLAR FIXATION OSICULLAR DISCONTUINITY STAPEDIAL OTOSCLEROSIS NEGATIVE MEP ET DYSFUNCTION SECRETORY OTITIS MEDIA/EFFUSION

21. ABSENCE OF PEAK PERFORATED TM ADHESIVE OTITIS MEDIA ARTIFACT PATENT GROM M ET IN TM CERUMEN POSITIVE MEP EAR L Y ACUTE OTITIS MEDIA

22. PHYSIOLOGICAL SWALLOWING CHILD CRYING VALSALVA HOLD BREATH IN EXPIRATION IN E A R L Y AOM PUS FORMED IN MEC AND ET DYSFUNCTION DECREASE VOLUME + INCREASE PRESSURE OF MEC POSITIVE PRESSURE PEAK

23. TYMPANOGRAMS J. JERGER A B A.S. FELDMAN

24. SHARP MAXIMUM AT mm WATER NORMAL EAR AND SOME CASES OF OTOSCLEROSIS

25. NORMAL MIDDLE EAR PRESSURE WITH HIGH COMPLIANCE SEEN IN OSSICULAR CHAIN DISCONTUINITY OR SCARRING OF TM NOTCHED PEAK OR DOUBLE MAX AT mm USUALLY SEEN WITH A HIGH FREQUENCY PROBE IN OSSICULAR DISCONTUINITY

26. NORMAL MIDDLE EAR PRESSURE WITH LOW COMPLIANCE OTOSCLEROSIS AND THICKENED TM

27. FLAT TYMPANOGRAM LITTLE OR NO COMPLIANCE AND NO SHARP PEAK SEEN IN ADHESIVE OTITIS MEDIA, OTITIS MEDIA WITH EFFUSION, PERFORATION OF TM

28. NEGATIVE MIDDLE EAR PRESSURE WITH NORMAL COMPLIANCE ET DYSFUNCTION WITHOUT EFFUSION

29. NEGATIVE MIDDLE EAR PRESSURE WITH LOW COMPLIANCE ET DYSFUNCTION WITH OTITIS MEDIA WITH EFFUSION

30. PEAK PRESSURE COMPLIANCE OR AMPLITUDE TYPE OF CONFIGURATION OF TYMPANOGRAM

31. 1.NORMAL TYMPANO GRAM GOOD COMPLIANCE AND PEAK PRESSURE AT mm WATER CORRESPONDS TO JAGER TYPE A

32. 2.NORMAL MIDDLE EAR PRESSURE WITH HIGH COMPLIANCE IF 226HZ PROBE USED THEN EITHER OSSICULAR CHAIN DISCONTUINITY OR SCARRING OF TM BUT IF A 660 OR 800 HZ PROBE USED THEN A NOTCHED PEAK OR DOUBLE MAX AT mm USUALLY SEEN IN OSSICULAR DISCONTUINITY

33. 3.NORMAL MIDDLE EAR PRESSURE WITH LOW COMPLIANCE OTOSCLEROSIS OR OSSICULAR FIXATION AND THICKENED TM

34. 4. FLAT TYMPANOGRAM LITTLE OR NO COMPLIANCE AND NO SHARP PEAK SEEN IN ADHESIVE OTITIS MEDIA, OTITIS MEDIA WITH EFFUSION, PERFORATION OF TM . CORRESPONDS TO JAGER TYPE B.

35. 5.NEGATIVE MIDDLE EAR PRESSURE WITH LOW COMPLIANCE ET DYSFUNCTION WITH OTITIS MEDIA WITH EFFUSION CORRESPONDS TO JAGER TYPE CS

36. 6. POSITIVE MIDDLE EAR PRESSURE NORMAL COMPLIANCE RARELY SEEN IN E A R L Y AOM IN EAR L Y AOM PUS FOR M ED IN MEC AND ET DYSFUNCTION DECREASE VOLUME + INCREASE PRESSURE OF MEC POSITIVE PRESSURE PEAK

37. 7.NEGATIVE MIDDLE EAR PRESSURE WITH NORMAL COMPLIANCE ET DYSFUNCTION WITHOUT EFFUSION

38. MIDDL E EA R P A T H O L OGY T W O T Y P ES STATIC COMPLIANCE REPRESENTIVE OF THE MORE LATERAL PATHOLOGY EAC T M M E C C OC H LEA

39. 1.STAPEDIAL FIXATION AND COMMON COLD -- MEP WITH LOW COMPLIANCE EXPECTED BUT -- MEP WITH LOW COMPLIANCE OTITIS MEDIA WITH EFFUSION

40. STAPEDIAL FIXATION AND SCARRED / HEALED TM NORMAL MEP WITH HIGH COMPLIANCE BUT NORMAL MEP WITH HIGH COMPLIANCE OSSICULAR DISCONTINUITY

41. THICKENED TM , TYMPANOSCLEROTIC PATCH NORMAL MEP WITH LOW COMPLIANCE NORMAL MEP WITH LOW COMPLIANCE STAPEDIAL OTOSCLEROSIS

42. SMALL PERFORATION OF TM FLAT TYPE TYMPANOGRAM WITH NOR M AL VOLUME FLAT TYPE TYMPANOGRAM WITH NOR M AL VOLUME ADHESIVE OTITIS MEDIA, OTITIS MEDIA WITH EFFUSION

43. OSSICULAR DISCONTINUITY WITH THIKENED TM NORMAL MEP WITH LOW COMPLIANCE NORMAL MEP WITH LOW COMPLIANCE STAPEDIAL OTOSCLEROSIS

44. MAINTAINANCE E Q U A L I T Y P RE S S U R E MIDDLE OF OF AIR B E T W EEN THE EAR AND AMBIENT ATMOSPHERE FUNCTION OF EU S T A CHIAN TUBE DRAINAGE OF MUCUS FROM EAR TO THE NASOPHARYNX

45. AIR IN MIDDLE EAR CAVITY CONSTANTLY BEING ABSORBED STEADY FALL IN MIDDLE EAR PRESSURE CONTRACTION OF TENSOR PALATINI AND LEVATOR PALTINI MUSCLE DURING SWALLOWING INTERMITTENT OPENING OF ET AIR PASSING THROUGH IT INTO MEC PRESSURE IN MEC BROUGHT BACK TO NORMAL

46. FOR TESTING WE SEE WHETHER V AL S A L V A S W AL L O WI N G DECREASE MEP INCREASE MEP

47. TWO TYPES OF TEST ARE AVAILABLE WI L L I AMS TOYNBEES PERFORATED TM IN T A CT TM

48. MEP MEASURED RESTING PRESSURE SWALLOING WITH NOSE MOUTH CLOSED VALSALVA

49. NORMAL P A R TI A L L Y IM P A IRED GROSSLY IMPAIRED RESTING P RESSURE mm WATER S W AL L OING WITH NOSE MOUTH CLOSED NEGATIVE NEAGATIVE NO CHANGE NO CHANGE VALSALVA POSITIVE NO CH A NGE POSITIVE NO CHANGE

50. NORMAL RESTING PRESSURE mm WATER SWALLOING WITH NOSE MOUTH CLOSED NEGATIVE VALSALVA POSITIVE

51. P A R TI A L L Y IM P A IRED SWALLOING WITH NOSE MOUTH CLOSED NEAGATIVE NO CHANGE VALSALVA NO CHANGE NEAGATIVE

52. GROSSLY IMPAIRED SWALLOING WITH NOSE MOUTH CLOSED NO CHANGE VALSALVA NO CHANGE

53. AUDIOMETER ARTIFICIALLY INC OR DEC MEP RECORD CHANGE IN PRESSURE EACH TIME PT. SWALLOWS TEST CARRIED OUT FOR FIXED DURATION 40SEC TO MAX 160 SEC

54. MEP CHANGED EITHER TO +250 OR -250 P T . ASKED T O S W ALLOW CHANGE IN MEP EITHER DEC OR INC NOTED IN A STEP LADDER PATTERN

55. MEP WHEN TUBE CLOSED SUDDEN OPENING OF TUBE DEC IN MEP AGAIN PASSIVE CLOSURE OF TUBE MEP BECOMES STEADY AG A IN P T . ASKED T O S W ALOW CHANGE IN MEP HENCE A STEP LADDER PATTERN GRAPH OBTAINED

56. OPENING OF TUBE DEC IN MEP PASSIVE CLOSURE OF TUBE MEP BECOMES STEADY

57. NORMAL PRESSURE NEUTRALISES BY 3 TO 4 SWALLOWS PARTIALLY IMPAIRED SOME PRESSURE PERSISTS EVEN AFTER MORE THAN 5 SWALLOWS GROSSLY IMPAIRED NOT NEUTRALISED AT ALL BY R EPEATED SWALLOWING

58. NORMAL PRESSURE NEUTRALISES BY 3 TO 4 SWALLOWS

59. PARTIALLY IMPAIRED SOME PRESSURE PERSISTS EVEN AFTER MORE THAN 5 SWALLOWS

60. GROSSLY IMPAIRED NOT NEUTRALISED A T AL L B Y R E P E A TED SWALLOWING

61. MIDDLE EAR CAVITY STAPEDIUS TENSOR TYMPANI 7 TH NERVE 5 TH NERVE EFFECT OF CONTRACTION OF STAPEDIUS MUSCLE MORE PRONOUNCED THAN THAT OF TENSOR TYMPANI ACOUSTIC REFLEX TESTED BY CONTRACTION OF STAPEDIUS MUSCLE

62. CONTRACTION OF TENSOR TYMPANI TESTED SEPARATELY STIMULATION OF TRIGEMINAL NERVE AND DOING AUDIOMETRY STARTLE TYPE REFLEX FATIGUEBLE IN NATURE UNSTABLE LONG LATENCY PERIOD DONE IN PT. WITH SEVERE DEAFNESS IN WHOM ACOUSTIC REFLEX CANT BE PERFORMED BUT MIDDLE EAR STATUS HAS TO BE KNOWN

63. DIAGRAMMATIC REPRESENTATION OF ACOUSTIC REFLEX S t imulu s of 8 5 db of 1 sec

64. NORMAL EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT ABSENT ABSENT

65. NORMAL EAR DEAF EAR NORMAL EAR NORMAL EAR

66. DEAF EAR DEAF EAR DEAF EAR NORMAL EAR

67. DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL ABSENT ABSENT ABSENT ABSENT BILATEAL MODERATE TO SEVERE CONDUCTIVE HEARING LOSS

68. DEAF EAR NORMAL EAR DEAF EAR DEAF EAR

69. NORMAL DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT ABSENT PRESENT

70. NORMAL EAR NORMAL EAR NORMAL EAR DEAF EAR

71. DEAF EAR NORMAL EAR

72. DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL ABSENT ABSENT ABSENT ABSENT DEAF EAR DEAF EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT PRESENT PRESENT PRESENT SEVERE NEURAL IN NATURE MODERATE DEGREE AND COCHLEAR IN NATURE

73. DEAF EAR DEAF EAR DEAF EAR NORMAL EAR

74. NORMAL EAR NORMAL EAR IPSILATERAL CONTRALATERAL IPSILATERAL CONTRALATERAL PRESENT ABSENT PRESENT ABSENT

75. CENTRAL LESION

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