Transcript Tympanometry Protocols Used In Early

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

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What tympanometry protocols are being
used?
Is the 1000 Hz probe tone in use?
Audiologist’s 1000 Hz probe tone
knowledge?
Our Respondents
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Sent survey via email
on:




EHDI listserve
Educational Audiology
Association listserve
AAA “SoundOff” listserve
153 audiologists
responded
The Survey
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Began with demographics
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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.D
Ph.D.
Other
Demographics –
Practice Setting
60
Number of Audiologists
Hospital
50
Physician's Office
40
Private Practice
30
Private Speech and
Hearing Clinic
Public Schools
20
University
10
Other
0
1
Type of Clinical Setting
Experience with Pediatrics
Years of Experience Working with the Pediatric Population
Years of experiance
21 or more years
16-20 years
11-15 years
6-10 years
0-5 years
0
5
10
15
20
25
30
Num ber of Audiologists
35
40
45
50
Experience with 0-3 Year Olds
Num ber of Years of Experience Working w ith 0-3 year olds
Years of Experience
21 or more years
16-20 years
11-15 years
6-10 years
0-5 years
0
5
10
15
20
25
30
Num ber of Audiologists
35
40
45
Experience –
How Many Children Per Week?
Number of Audiogists
Children of a Certain Age Group Tested Per Week
120
100
80
0-6 months
7-12 months
60
13-36 months
40
20
37+ months
0
0 children
per w eek
1-10
11-20
21-30
children
children
children
per w eek per w eek per w eek
Num ber of Children Per Week
31 or
more
children
per w eek
Equipment Used…
GSI Tympstar (both versions)
GSI 33
Tympanometer Brand
GSI 28/37/38
Madsen Otoflex Models
Madsen Zodiac
Interacousitcs Brand
Welch Allen (all brands)
Maico (Race Car)
American Electromedics AE
Earscan
Amplaind 720
Teledyne TA7A
0
10
20
30
40
Total Num ber of Tym panom eters
50
60
Probe Tones by Age
120
100
0-6 months
80
7-12 months
60
13-36 months
40
37 months and
older
20
0
226 Hz
678 Hz
800 Hz
1000 Hz
1000 Hz Tympanometry
Diagnostic
Screening
0
10
20
30
40
Num ber of Audiologists
50
60
70
Parameters - Pump Speed
45
40
35
30
600/200 daPa/s
200 daPa/s
50 daPa/s
AFAP
Other
25
20
15
10
5
0
226 Hz
678 Hz
800 Hz
1000 Hz
Parameters –
Sweep Pressure Direction
100
90
80
70
60
50
40
30
20
10
0
Negative to Positive
Positive to Negative
226 Hz
678 Hz
800 Hz
1000 Hz
Parameters - Starting Pressure
90
80
70
60
300 daPa
200 daPa
-200 daPa
-400 daPa
Equipment Default
50
40
30
20
10
0
226 Hz
678 Hz
800 Hz 1000 Hz
Parameters –
Stopping Pressure
70
100 daPa
60
-200 daPa
50
40
-300 daPa
30
-400 daPa
20
Equipment Default
10
0
226 Hz
678 Hz 800 Hz 1000 Hz
Right after the
peak
Parameters –
Use of Tympanometric Width
50
45
40
35
30
25
20
15
10
5
0
On
Off
Don't Use
226 Hz
678 Hz
800 Hz
1000 Hz
Parameters –
Type of Display Used
90
80
70
60
Compensated
(Baseline On)
Uncompensated
(Baseline Off)
50
40
30
20
10
0
226 Hz
678 Hz
800 Hz 1000 Hz
Parameters –
Type of Immittance Used
70
60
50
Y
B
G
B/G
40
30
20
10
0
226 Hz
678 Hz
800 Hz
1000 Hz
Parameters used to Determine
if Tympanogram is Normal
100
90
80
70
60
50
40
30
20
10
0
Ear canal volume
Tympanometric
peak pressure
Static acoustic
immittance
(compliance)
Tympanic width or
gradient
226 Hz
678 Hz
800 Hz 1000 Hz
Norms Used
50
45
40
35
30
25
20
15
10
5
0
ASHA Screening
Guidlines
Kei et al. 2003
Jerger Types
Margolis & Heller
1986
Margolis et al. 2003
Nozza et al. 1992
Nozza et al. 1994
226 Hz 678 Hz 800 Hz
1000
Hz
Roush et al. 1995
Current Studies and Data
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In 2003, two studies published with
normative data for 1000 Hz tympanometry
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Kei et al., 2003
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SAA compensated at +200 daPa
Refer if SAA less than .39 ml
Margolis et al., 2003
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SAA compensated at -400 da Pa
Refer if SAA less than .6 ml
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Total # of Audiologists
1000 Hz Tympanometry
Knowledge
1000 Hz Probe Tone Knowledge
60
50
40
30
20
10
0
1000 Hz Probe Tone Use
Initial newborn hearing
screening (along with
OAEs and/or ABR)
Second newborn hearing
screening (along with
OAEs and/or ABR)
Other screenings
70
60
50
Number of
Audiologists
40
Diagnostic evaluation
(initial)
30
Follow-up evaluations
20
Do not use 1000 Hz
Tympanometry
10
0
1
Circumstances
Other (please specify)
Is 1000 Hz Tympanometry Useful
With Children 0-6 Months?
100
90
Number of Audiologists
80
70
60
50
40
30
20
10
0
Yes
No
Response
Do not use 1000 Hz
tympanometry
Additional Information
26 of 153 respondents
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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)
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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 –
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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