Selecting the right ear tip for tympanometry and acoustic reflex testing is critical for the measurement quality and utilising the time available with a patient efficiently.
Most commonly mushroom shaped ear tips are used for testing (Impedance, DPOAE, TEOAE and Automated ABR), but sometimes, an umbrella shaped tip can be used for quick impedance screening.
It takes practice to select the right ear tip for tympanometry or immittance testing, ensuring they are not too big or small. We’ve created a guide to provide some helpful tips on getting it just right.
Performing otoscopy
The first step is to examine the structures of the ear through otoscopy. It is important to look at the curvature of the outer canal as well as the size and shape to get an accurate measurement. Make sure the ear is clear of wax or other debris to avoid clogging the probe tip.
Types of ear tips
Once otoscopy has been completed, you can now choose the correct tip. This can be easier said than done as it can depend on a number of factors. For example, when measuring the ears of a child, you will only have a small window in which you have their attention.
The key is for the tip to be hermetic (airtight); large enough to block the canal but not so large that it could cause a break in the seal or stop the probe tube from sitting at the opening of the canal. This is why a probe tip is required that provides pressure fixation or changes for both measurements. It can be very easy to break the seal from patient movement. There are two types of tips: Umbrella and Mushroom:
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| Umbrella tip |
Mushroom tip |
| Umbrella tips are usually used with handheld screening devices. They are designed to seal the entrance of the canal and should not be inserted into the canal itself. |
Mushroom tips are usually the preferred choice amongst professionals performing diagnostic testing. These are designed to be inserted into the canal to form a seal. |
Proper placement of the umbrella tip
Placement should be right at the entrance of the ear canal with the opening completely occluded by the tip. Here are some examples:
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| Correct size and placement |
Incorrect size and placement |
| The probe tip is completely occluding the opening to the ear canal. |
The probe tip is too small, increasing the likelihood of the seal breaking in the ear (causing the measurement to stop and need to be repeated). |
Proper placement of the mushroom tip
The mushroom tip should fit right into the entrance of the ear canal. Remember, if you’re using a shoulder probe, the tip needs to stay in place on its own, so it can’t be too large.
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| Correct size and placement |
Incorrect size and placement |
| The probe tip is completely occluding the opening to the ear canal but can still sit in the canal without being held. |
The probe tip is too small and cannot occlude the canal. Even if the probe can stay in the canal it can not obtain a seal, preventing it from working. |
Factors that might effect a seal being formed
No matter how many tips or times you try, sometimes a seal simply can’t be obtained.
- Hair: The number one reason for an improper seal is hairy ear canals. Older patients tend to have more hair in their ear canal which can prevent a proper seal forming, even if trimmed
- Size of the canal: Occasionally an individual can have a very large ear canal and there might not be a large enough tip to seal it. Equally, if a patient has a very skinny canal opening, this can also make it difficult
- Placement of the tip: Taking note of how the canal is shaped is important when using a handheld probe. If there’s a large curve in the canal, keep this in mind when placing the tip. As in otoscopy, pulling on the earlobe can help straighten the canal
- Ear wax: If a patient has a lot of earwax, it can occlude the probe tip preventing measurement
- Minimal patient compliance: When a patient (usually a child) moves or talks a lot, this can make it very difficult to achieve a proper seal.
Types of probe
There are two probe options; a handheld option and one that you place on the shoulder:
Using a shoulder probe
With the shoulder probe it can be difficult to find the right size as it’s essential that the tip seals the canal, but also that it’s able to stay in place on its own. You can’t usually use umbrella tips with a shoulder probe (unless a professional is holding it) as they are unable to stay in place on their own.
Using a handheld probe
Handheld probes can be used with both types of tips. If doing diagnostic testing that includes tympanometry and reflexes, a mushroom tip is recommended.
Tympanometers
We provide industry-leading handheld and desktop tympanometers that give fast and accurate middle ear measurements for all age groups, including neonates.
With probes specifically designed for small ear canals, middle-ear measurements for children and neonates can be conducted with speed and accuracy. With an elegant and compact design, they are portable and ideal for use on the go, as well as in clinical environments where space is at a premium.
They also include a wide range of test functionality and multi-language options, meeting all possible testing requirements.
For more information on our range of screening and diagnostic tympanometers, please visit our tympanometers webpage, contact our customer support team on +44 (0)1865 880 846 or email.
Additional resources
Video: Choosing the right ear tip | Amplivox