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Tympanometry Protocols Used In Early Intervention Services In the United States: A Pilot Survey of Early Intervention and Pediatric Audiologists
Wendy D. Hanks, Ph.D.Molly A. Kinder, M.S.
Gallaudet University
The Purpose
What tympanometry protocols are being used?
Is the 1000 Hz probe tone in use? Audiologist’s 1000 Hz probe tone
knowledge?
Our Respondents Sent survey via
email on: EHDI listserve Educational Audiology
Association listserve AAA “SoundOff”
listserve
153 audiologists responded
The Survey Began with demographics
13% male; 87% female 35 states, Washington D.C., and the
Commonwealth of the Marina Islands represented
Demographics – Highest Degree
M.A.M.S.M.C.D.Au.DPh.D.Other
Demographics – Practice Setting
0
10
20
30
40
50
60
1
Type of Clinical Setting
Nu
mb
er o
f A
ud
iolo
gis
ts
Hospital
Physician's Office
Private Practice
Private Speech andHearing ClinicPublic Schools
University
Other
Experience with Pediatrics
Years of Experience Working with the Pediatric Population
0 5 10 15 20 25 30 35 40 45 50
0-5 years
6-10 years
11-15 years
16-20 years
21 or more years
Yea
rs o
f ex
per
ian
ce
Number of Audiologists
Experience with 0-3 Year Olds
Number of Years of Experience Working w ith 0-3 year olds
0 5 10 15 20 25 30 35 40 45
0-5 years
6-10 years
11-15 years
16-20 years
21 or more years
Yea
rs o
f E
xper
ien
ce
Number of Audiologists
Experience – How Many Children Per Week?
Children of a Certain Age Group Tested Per Week
0
20
40
60
80
100
120
0 childrenper w eek
1-10children
per w eek
11-20children
per w eek
21-30children
per w eek
31 ormore
childrenper w eek
Number of Children Per Week
Nu
mb
er o
f A
ud
iog
ists
0-6 months
7-12 months
13-36 months
37+ months
Equipment Used…
0 10 20 30 40 50 60
Teledyne TA7A
Amplaind 720
Earscan
American Electromedics AE
Maico (Race Car)
Welch Allen (all brands)
Interacousitcs Brand
Madsen Zodiac
Madsen Otoflex Models
GSI 28/37/38
GSI 33
GSI Tympstar (both versions)
Tym
pan
om
eter
Bra
nd
Total Number of Tympanometers
Probe Tones by Age
0
20
40
60
80
100
120
226 Hz 678 Hz 800 Hz 1000 Hz
0-6 months
7-12 months
13-36 months
37 months andolder
1000 Hz Tympanometry
0 10 20 30 40 50 60 70
Screening
Diagnostic
Number of Audiologists
Parameters - Pump Speed
0
5
10
15
20
25
30
35
40
45
226 Hz 678 Hz 800 Hz 1000 Hz
600/ 200 daPa/ s200 daPa/ s50 daPa/ sAFAPOther
Parameters – Sweep Pressure Direction
0102030405060708090
100
226 Hz 678 Hz 800 Hz 1000 Hz
Negative to PositivePositive to Negative
Parameters - Starting Pressure
0
10
20
30
40
50
60
70
80
90
226 Hz 678 Hz 800 Hz 1000 Hz
300 daPa200 daPa-200 daPa-400 daPaEquipment Default
Parameters – Stopping Pressure
0
10
20
30
40
50
60
70
226 Hz 678 Hz 800 Hz 1000 Hz
100 daPa
-200 daPa
-300 daPa
-400 daPa
Equipment Default
Right after thepeak
Parameters – Use of Tympanometric Width
05
101520253035404550
226 Hz 678 Hz 800 Hz 1000 Hz
On OffDon't Use
Parameters – Type of Display Used
0
10
20
30
40
50
60
70
80
90
226 Hz 678 Hz 800 Hz 1000 Hz
Compensated(Baseline On)Uncompensated(Baseline Off)
Parameters – Type of Immittance Used
0
10
20
30
40
50
60
70
226 Hz 678 Hz 800 Hz 1000 Hz
YBGB/ G
Parameters used to Determine if Tympanogram is Normal
0102030405060708090
100
226 Hz 678 Hz 800 Hz 1000 Hz
Ear canal volume
Tympanometricpeak pressure
Static acousticimmittance(compliance)Tympanic width orgradient
Norms Used
05
101520253035404550
226 Hz 678 Hz 800 Hz 1000Hz
ASHA ScreeningGuidlinesKei et al. 2003
Jerger Types
Margolis & Heller1986Margolis et al. 2003
Nozza et al. 1992
Nozza et al. 1994
Roush et al. 1995
Current Studies and Data In 2003, two studies published with
normative data for 1000 Hz tympanometry Kei et al., 2003
SAA compensated at +200 daPa Refer if SAA less than .39 ml
Margolis et al., 2003 SAA compensated at -400 da Pa Refer if SAA less than .6 ml
1000 Hz Tympanometry Knowledge
1000 Hz Probe Tone Knowledge
0
10
20
30
40
50
60
CEU Cou
rse(
s)
Jour
nal Arti
cle(s
)
Unive
rsity
Cou
rsew
ork
Develo
ping
own
clinic
al nor
ms
Oth
er a
udio
logist
/stu
dy g
roup
Oth
er
Method of Education
To
tal #
of
Au
dio
log
ists
1000 Hz Probe Tone Use
0
10
20
30
40
50
60
70
Number of Audiologists
1
Circumstances
Initial newborn hearingscreening (along withOAEs and/or ABR)Second newborn hearingscreening (along withOAEs and/or ABR)Other screenings
Diagnostic evaluation(initial)
Follow-up evaluations
Do not use 1000 HzTympanometry
Other (please specify)
Is 1000 Hz Tympanometry Useful With Children 0-6 Months?
0
10
20
30
40
50
60
70
80
90
100
Yes No Do not use 1000 Hztympanometry
Response
Nu
mb
er o
f A
ud
iolo
gis
ts
Additional Information26 of 153 respondents 1000 Hz tympanometry
is crucial/important in the testing of young children (6)
Do not have the capability of 1000 Hz probe tone (7)
Interpretation of 1000 Hz can be difficult (4)
The protocol for using immittance was described (3)
1000 Hz data is needed (2)
Use 1000 Hz as a cross check only (1)
226 Hz can be used reliably with the infants population (1)
“Could not answer all the technical questions (1)
"I work part-time and don't see many children (1).
Conclusions – Further study of this
topic is needed More training on the
appropriate use of tympanometry is needed
1000 Hz tympanometry normative data should be used consistently