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DNB ENT Theory Question 2011, 2018 as seen on Dnbmentors.com

Link - https://dnbmentors.com/kb/impedance-audiometry-dnb-ent-2011-2018/

Discuss the principle of Impedance Audiometry. Describe different types of curves of

impedance audiometry and its importance in clinical practice. Briefly describe the stapedial
reflex pathway. What are the applications of Impedance Audiometry in otological practice?

Question: Discuss the principle of Impedance Audiometry??

Basic Principle:
Th basic principle of impedance audiometry (IA) is that of measuring the amount of current
require to maintain a specified SPL in cavity. The system works on the principle that in a hand
walled cavity has calibrated tone applied to it. The SPL developed inside the cavity depends
on the volume of that cavity. If the cavity volume is larger, the intensity of the tone most be
large to obtain the given SPL within the cavity. If the cavity size is smaller, the intensity of the

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tone required to obtain the same SPL will be smaller.

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Working of Impendence system (Figure):
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All the impedance system has three units.

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1. To produce acoustic signal

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2. To induce and vary the air pressure

3. To analyse or measure the pick-up reflected sound energy in the form of SPL or
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acoustic immittance or electrical current equivalent

All the pressure system or the manometers have the facility to induce air pressure from
positive to negative pressure ranges changing from +200dapa to -300 or -400 dapa pressure.
Few systems have extendable pressure manometer up to -600 dapa.
The standard probe tone signal generated through immittance system is 226Hz. A low
frequency probe tone of 85dB or 90dBSPL. Some system even has additional probe tone
frequencies. Such as 660Hz, 800Hz, and 1000Hz of 75, 77, and 78dBSPL. (Madsen Zodiac,1980
Immittance system consists of 226Hz probe tone and Maico MI34 tympanometer. GSI 33
system has extra high frequency probe tones).
The third unit of basic impedance audiometer consist of a sensitive microphone to pick up the
SPL reflected back and convert into equivalent electrical signal through the rectifier and feed
it to analysing system which makes synchronized comparison of applied electrical signal and

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the reflected electrical signal through a balanced meter system. The difference between these
two SPL (cc, ml or microliters of c3) are constantly displayed by the compliance meter system.
The reflexes eliciting system i.e ipsilateral is generated by the same signal generator and
delivered through the same probe opening in majority of equipment but in few, separate
fourth opening within the probe is reported. A contralateral reflex signal generation is
through separate audiometer oscillator circuit.
According to Rintelman (1999), the working pattern of immittance system is as follows: -
A tube is used to couple an air pump and manometer to the probe to pressurize the ear canal.
A miniature speaker deliver the probe tone to the ear. A microphone picks up the acoustic
signal in the ear canal and converts it into an electrical signal is used to measure acoustic
immittance. A sinusoidal electrical signal is generated, amplified and delivered to the
miniature loudspeaker housed in the probe. The microphone picks up the probe tone in the
ear canal and converts it to an electrical signal. In AGC circuit keeps the probe tone at a

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constant sound pressure by controlling the gain of probe tone amplifier. The voltage that is

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required to keep the probe tone at a fixed level is proportional to the immittance of the ear.

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The electrical signal that drives the probe tone transducers also deliver through a comparator
along with the amplified output of the Mic. The comparator provides a measurement of
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magnitude of probe tone signal and the phase of the Mic signal. Once the system is calibrated
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the magnitude and the phase are converted into immittance or admittance unit. Current
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instruments employ microprocesses that perform same functions by digital signal processing.
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Static Acoustic Immittance or Static Acoustic Compliance:

It is a single digit number indicating the compliance under resting position expressed in terms
of equivalent volume. SAI refers to difference between total acoustic immittance measured
at atmospheric pressure or at peak pressure on tympanogram and the acoustic immittance
obtained at +200 or -400dapa pressure.

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