Tympanometry Protocols Used In Early Intervention Services In the United States: A Pilot Survey of Early Intervention and Pediatric Audiologists Wendy.

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