Continuity Clinic Curriculum

Lucile Packard Childrens Hospital

How to Interpret the Tympanogram
How to Interpret the Tympanogram
Case: Miss Flowers brings her 8 year old daughter, Sunny into your clinic due to
concerns for recurrent ear infections and a sensation of dull sound. You recall
Sunny has had several ear infections in the past year but you have not been able to
evaluate Sunnys ears while healthy. Miss Flowers asks if you can do any testing
now that Sunny does not have an active infection to see if she still has fluid in her
ears.
Learning Objectives:
1. Identify reasons why tympanometry would be useful
2. Review common tympanogram curves and their related clinical diseases
Interpreting the Tympanogram

Confirms or rules out problems with the ear drum and middle ear space
o Objective/quantitative
Two general types
o Typical tympanometry evaluates ear canal volume, max peak
pressure, peak compliance
o High frequency tympanometry used for infants <6 months as low
frequency tones are not reliable due to highly compliant ear canals
AAP states tympanometry optional for diagnosis of AOM or OME pneumatic
otoscopy is the best single test
Success rate 74-94%
How to use: probe placed snuggly in external ear canal sound generated
transmits acoustic energy into canal while vacuum pump introduces positive
and negative pressures into ear canal microphone detects returning sound
energy
Data it provides
o Estimated volume of ear canal
Evaluates stenotic canal (small volume) or perforation or
patent ear tube (large volume)
Normal volumes can vary and are age dependent, but typically
range from 0.3mL to 0.9mL
o Maximum compliance/mobility of middle ear system
When air pressures are equal on both sides
Vertical peak of tracing
o Pressure at which middle ear has greatest mobility
Estimates middle ear pressure, ideal/normal is zero
Point on horizontal axis where vertical peak is highest
o Width of tympanogram curve
Tracing classification
o Type A: normal, max complicance peak around 0 daPa (ranges from 99 to +50 daPa)

Continuity Clinic Curriculum

Lucile Packard Childrens Hospital
How to Interpret the Tympanogram
Type As: reduced compliance
Type Ad: increased compliance

Image courtesy of AAFP 2004 article

o Type B: flat, clearly abnormal

49-99% positive predictive value for otitis media with effusion
(must use with history and physical exam findings)
Immobile TM
Can be seen with middle ear effusion (normal canal volumes)
or TM perforation or patent ear tubes (large canal volumes)
Can be seen with impacted cerumen (canal volume small to
normal)

Continuity Clinic Curriculum

Lucile Packard Childrens Hospital
How to Interpret the Tympanogram

Image courtesy of AAFP 2004 article

o Type C: significant negative pressure in the middle ear, possibly

indicative of pathology
Max compliance peak shifted to the left beyond -100 mm H2O
Seen just prior to or during resolution of otitis media with
effusion, Eustachian tube dysfunction, or inability to aerate the
middle ear space efficiently

Continuity Clinic Curriculum

Lucile Packard Childrens Hospital
How to Interpret the Tympanogram

Image courtesy of Peds in Review 1998

Image courtesy of Peds in Review 1998

Peer Reviewed by Melissa Tribble, Au.D. 2011

References/Resources:

Continuity Clinic Curriculum

Lucile Packard Childrens Hospital
How to Interpret the Tympanogram

AAFP 2004 article on Typmanometry:

http://www.aafp.org/afp/2004/1101/p1713.html
Peds in Review 1998:
http://pedsinreview.aappublications.org.laneproxy.stanford.edu/cgi/content/fu
ll/19/5/155?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=audiogram&se
archid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT