PTA & Tympanometry

Dr.Firas Baheej 
Consultant Otolaryngologist
Medical City Teaching Complex
OBJECTIVES:
to through a light on:
1- Pure tone audiogram

2- Tympanogram
Pure tone audiogram (PTA)

 Is the cornerstone of clinical auditory

assessment
 Used to determine the hearing threshold (the
minimum sound level at which a spesific
response can be obtained
The decible (dB)

 Bel is the log to the base 10 of the ratio of the

sound intensity being measured to a
reference intensity which is constant, and is
measured in W/m2.
 Decibel (dB) is 10 times this ratio.
 Sound intensity(Ix) in dB=10 log10 Ix/Io
where Io= 10 -12 w/m2
Method

 The patient is seated in a soundproofed room

 The procedure is explained to the patient
 Earphones are used for air conduction
 The patient is asked to signal by pressing a
hand-held button as soon as the tone is
heared
 Pure tones are produced by a calibrated
audiometer and are first presented to better
ear
 Tones are first presented at an intensity above
the suspected threshold of the patient
 The intensity is reduced in 10 dB steps until no
sound is heard
 The signal is then increased in 5 dB steps until
half of the tones are heard
 This continues in the following order: 1000, 2000,
4000, 8000, 500 and 250 Hz
 The timing and duration of signal presentation
should be varied and no visual clues should be
offered
Soundproofed room
Headphone
Bone-conducting transducer
 The second ear is then tested in identical
fashion
 Then the procedure is repeated to test bone
conduction by using bone conductor
Audiogram
 Audiogram results
1-Sensorinueral hearing impairment: both air and
bone conduction thresholds are increased to the
same level
2-Conductive hearing impairment: bone threshold
remains normal but air conduction threshold
increased
3-Mixed hearing impairment: both air and bone
conduction threshold increases but the
increment in air conduction threshold is more
than the bone conduction threshold
Degrees of deafness
Audiogram results
Normal audiogram
Conductive deafness
Tympanometry)objective test(

 The test probe consists of a sound producer, a

sound receiver and a device for altering the
pressure within the external auditory
meatus(EAM)
 The probe has a soft plastic tip to allow an air-
tight seal in the EAM
 A test tone is made (220Hz, 65 dB) into the EDM,
of which some will be absorbed(admitted) by
middle ear system(drum and ossicles) and some
reflected
 The reflected sound energy is measured by the
probe microphon
 The compliance ( the amount of sound absorbed
by the middle-ear system ) can be determined
either by measuring the reflected sound level in
the ear canal or more commonly by measuring
the amount of energy required to keep the sound
level constant at varying canal pressures
 The compliance will be maximal when the ear
canal pressure is = to middle ear pressure
 The compliance is measured continuously
while the pressure in the EAM is
automatically varied from +200 to – 400
mmH2O
 Graphical result of tympanometry is classified
into 5 types
1- type A (normal)

 Maximal compliance occurs when the

pressure in the EAM is between +50_ -100
mm H2O
 A normal maximal compliance value is
between 2 and 4 ml
2- Type As (shallow)

 The same as type A but the maximal

compliance value is less than 2 mm H2O
 Indicates stiffness of middl-ear system as in
tympanosclerosis and otosclerosis
3- Type Ad (dislocation)

 The same as type A but the maximal

compliance is more than 4 mmH2O (high or
unrecordable peak of compliance
 Indicates excess mobility of the middle-ear
system as in ossicular discontinuity
4- Type B ( flat)

 Horizontal compliance (no peak) implying

persistently low compliance
 Indicates middle ear fluid, also occur in
tympanic membrane perforation and
adhesive otitis media
5- Type C

 The peak compliance occurs when the

pressure in the EAM is less than – 100 mm
H2O
 Indicates a significant low pressure in the
middle-ear system
 Occurs in eustachian tube dysfunction
 Dicided into C1 when the peak is between
-100 and -199 mm H2O, and C2 when the
beak occurs at less than -200 mm H2O