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## Explain the Theory of Immittance Audiometry

Acoustic noise is measured by inserting a piece called a probe ball into the ear. This space in the ear is enough to create a hermetic seal. This advice includes several things. First, a sound receiver/generator, which is a speaker that will play sound in the ear. The sound generator generates a specified frequency at a specified intensity, and the speaker converts the output of the sound generator to produce a sound wave that is then sent to the ear canal. The second is the microphone and sound level meter that will monitor the sound inside the ear canal. Third, a pressure pump and a manometer, the pressure pump directs changes in air pressure to the ear canal, and the manometer shows the amount of air pressure sent to the ear canal.

The discontinuity in measurement, compliance is the movement of the tympanic membrane. This is done by stimulating the ear with pure sound and constant intensity. Then the sound pressure level is measured. This measurement is then used to determine the impedance (how much energy flows through the system) of the middle ear and tympanic membrane and everything connected to it. Hearing loss comes from several sources of mechanical and acoustic stiffness, mass and resistance. The stiffness element comes from the air volumes in the outer ear and middle ear spaces, the tympanic membrane, tendons and ligaments of the chest. A mass comes from the ossicles, ear drum and perilymph. Resistance is determined by the perilymph. The impedance of an object depends on the frequency. The formula for determining impedance is the square root of R2 + (2p f M – S / 2p f )2 where R = Resistance, M = Mass, S = Stiffness, f = frequency.

A few things to keep in mind are that mass is an important factor for high frequencies and stiffness is an important factor at low frequencies for system response. Resistance is largely determined by the ligaments attached to the ossicles and mass is determined by the weight of the cartilage and tympanic membrane. Stiffness is primarily indicated by the pressure of the fluid from the root on the foot.

Tympanometry and Acoustic Reflexology fall under the category of acoustic loudness. Tympanometry is the term for evaluating the movement of the tympanic membrane. This is usually a graphical representation of the change in tympanic membrane compliance as the ear canal pressure changes from negative to positive. As the pressure increases from zero to its maximum negativity or its maximum positive position. In the graph, the point where the pressure in the ear canal is equal to the pressure in the impedance of the middle ear cavity is at its lowest value, in other words, the compliance is at its highest value. A graphical display called a tympanogram can be of several types. In clinical use these graphs are divided into different Jerger types for diagnosis. A Type A tympanogram is characterized by pressure + 50mm H20. This is classified as normal. A Type B tympanogram is not indicated by the apex and is fluctuating. This is often in serous or chronic otitis media. A Type C tympanogram is characterized by a peak representing negative pressure in the middle ear. This is usually due to Eustachian tube dysfunction. An abnormal typanogram can be defined if the peak is too high or too wide.

The acoustic reflex is when a loud enough sound (70 dB HL) is presented to both ears that it causes contraction of the stapedius muscle in both ears. This reflexive muscle contraction tightens the conduction mechanism via the stapedius tendon, and changes the ear’s pitch. Acoustic reflux is easily measured because the displacement is picked up by the top of the probe and displayed on the displacement device meter. How this works is that the afferent nerve travels from the ear to the ipsilateral cochlear nucleus. The neurons then travel to the olivary complexes on both sides of the brain. The two superior olive complexes on their sides send signals to the nuclei of the facial nerve. And then finally the efferent motor limbs of the auditory reflex innervate the right and left facial nerves, which allow the stapedius muscles to contract in both ears.

The consequences of acoustic reflux are complex but simple to understand. A pathological ear is defined as an ear that has a problem. This may be a dead ear or conductive or sensorineural hearing loss. If the ear is normal, the stapedius muscle will pull in both ears. When stimulation is presented to the pathological ear and the ear has only conductive hearing loss, reflux will be evident after the conductive hearing loss has overcome and the ear has received 70 dB HL. Then reflux will show in both ears. In a dead cat, the stimulus will never cause reflux. In sensorineural hearing loss that is profound, the reflex will not be seen in the pathological ear. Similarly to the rest of the hearing, the reflux will not be present in the pathological ear. These results are best seen in the slides. It is very difficult to explain them in words.

It is also important to note that in reporting the results of the Acoustic Reflux test, the terms ipsilateral and contralateral should only be used with direct reference to the ear and ear of the stimulus.

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