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:

tympanometry-tip

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:

size-and-placement

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.

proper placement of the mushroom tip

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

Related posts

What is tympanometry compliance?

How to interpret a tympanogram

How to perform Otoscopy

How to perform acoustic reflex tests