Recommended Procedure: Tympanometry

British Society of Audiology. (2013).

Berkshire (United Kingdom): British Society of Audiology, 2-20.

This guideline provides procedural recommendations for conducting a tympanometry assessment to evaluate middle ear function for patients across the lifespan. The guideline provides specific recommendations regarding equipment calibration and maintenance, subject preparation, testing, subject instructions, and documentation. Select recommendations are included; readers should access the full guideline for additional information.

British Society of Audiology

Tympanometry is contraindicated for patients with:<p></p><ul> <li>otorrhoea;</li> <li>acute otitis media, where the tympanic membrane is observed to be red and bulging;</li> <li>excessive wax, such that there is a risk that insertion of the probe tip may risk damaging the ear drum; and</li> <li>a recent ear surgery (within 2 months), unless formally approved by an ENT specialist.</li></ul>

For infants with a corrected age under 6 months, use a 1000-Hz probe tone. "Traces should usually be repeated, if possible, to check that the result is repeatable and not due to artifacts such as baby movement. It is especially important to retest any ear with an abnormal or difficult-to-interpret tympanogram" (p. 10).

Daily calibration into an appropriately-sized cavity is recommended for equipment (pp. 5-6).

For subjects with a corrected age over 6 months, use a 226 Hz probe tone and ensure an airtight seal.

Special considerations may need to be made for patients with the following conditions:<p></p><ul> <li>under general anaesthetic,</li> <li>with outer ear defects such as complete stenosis or atresia,</li> <li>with tenderness/soreness in the ear,</li> <li>with foreign bodies in the ear canal (e.g., grommets, insects, cotton), and</li> <li>with soft wax that may need to be removed prior to testing.</li></ul>

All unexpected test results must be repeated and should not be accepted without verifying that the result is replicable. 

Prior to examination the following should be completed:<p></p><ul> <li>The patient's audiological history should be collected, including any ear-related symptoms, current ear-related treatments, and surgery involving the ears.</li> <li>The subject should be seated comfortably and remain still.</li> <li>Any objects that may interfere with probe insertion should be removed.</li> <li>Otoscopic examination must be completed.</li> <li>Informed consent must be obtained and the tester must deem it safe to test.</li></ul>

For patients with acute otitis media, "where a red and bulging tympanic membrane is observed during otoscopy, tympanometry is contraindicated" (p. 7).