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Although the math is all very interesting, it does not result in an especially useful understanding of what tympanometry really represents from a clinical standpoint. There is some overlap with AR (acoustic reflex) testing and tympanometry, and the AR technique is often used when one wants to look at pressure over time. Although there is much more to it than this, tympanometry essentially involves measuring how much sound is reflected back while pressure is swept through the ear canal. When the eardrum is at it's neutral position (least stiff) less sound is reflected back from the ear drum. Low compliance -- fluid in middle ear or perforation, or clogged tympanometer tip (with cerumen generally).
In essence one looks at the peak compliance (which should be at 0), the shape of the compliance curve (too low -- stiff, too high - -floppy), and the ear volume (too high -- perforation).
When there is a positive or negative pressure behind the ear drum, the peak of the tympanogram is displaced to one side or the other. When the eardrum is stiff due to scarring, there is less change in the trace with the pressure sweep and the tympanogram looks flat. This is all oversimplified, and there are also strange patterns that can arise due to odd physics of the ear drum that are not worth delving into.
In general, flat tymps will be due to perforation, stiffness, or a technical error (clogged tip).


Finally, tympanometry can be used to detect abnormal contractions of the stapedius and tensor tympani muscles.
The tympanogram is a very simple automated procedure that can be done by nearly anyone after about 5 minutes of training.
A technician-physician team is one possible combination where the physician assesses the ears and interprets the test, while the technician administers the test. The only 'benefit' is that you can have the windows open slightly & the wind isn't a problem. Plus, on the motorway, travelling at speed, then they stop that horrible high pitched squeel & ear popping sound when the windows are just about to close.
A tympanometer measures the acoustic immittance in the external auditory meatus as a function of air pressure within the external auditory meatus. While immensely more complicated than needed for clinical work, it is very useful to establish vocabulary (AHSA, 2014). A test tone (usually 220 hz for adults and 1000 hz for children) is presented while pressure is swept through -400 to +300 dpa (deca-pascals). If the eardrum is under no positive or negative pressure, it will have it's maximum compliance at 0. Thus the sweep of pressure locates the ear pressure that is associated with the eardrum being neutral.


Possibilities include damage to the TM (most commonly), or a disarticulated ossicular chain.
These are typically used at the bedside as a quick method of determining if there is a perforation of the ear drum or a middle ear infection. The amount of sound that is reflected back from the eardrum is quantified and plotted on an inverse sweep.
On the other hand, if it is under negative or positive pressure, the peak will move to the left or right. Perforations are spotted by noticing that the tymp is flat AND the ear canal volume is excessive (ECV). The person doing the tymp should be able to look into ears with an otoscope, and note whether or not there is wax or a perforation. The person doing the tymp should also realize that the machine will not work if it is clogged by wax.



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