Gains:
- Ability to associate tympanogram types (A, B, C) and acoustic reflex findings with middle ear physiology and verify the artificial intelligence draft with clinical findings
- Ability to give artificial intelligence the tympanometry result in context and produce a preliminary interpretation draft integrated with the audiogram
- Ability to distinguish diagnostic limits of immittance tests and red flags requiring medical referral (ENT)
The audiogram shows "how much" hearing is happening; But in order to understand where the hearing loss occurs, it is necessary to know how the middle ear works. Immittance tests (tests that measure the resistance and transmission of the middle ear to sound energy) fill this gap. In this unit, we will cover the two most common immittance tests — tympanometry and acoustic reflex — and show you how to safely use AI to interpret them. The main principle remains unchanged: AI produces a draft of interpretation; Tympanogram alone does not make a diagnosis, it is combined with clinical examination and history, the decision is up to the specialist.
What is tympanometry and what does it measure?
Tympanometry measures how much movement (adaptation) the eardrum (tympanic membrane) and middle ear system respond to sound while changing the pressure in the ear canal in a controlled manner. The result appears as a curve (tympanogram) and the position of the vertex, its height and the canal volume are evaluated. Classically, three main types are identified:
Type A: The peak is in the normal pressure region and normal altitude. The middle ear is typically functioning normally. There are subtypes: As (shallow crest — may suggest conditions such as stiffness/otosclerosis), Ad (extremely deep crest — may suggest ossicular chain laxity or highly mobile eardrum).
Type B: Flat, peakless curve. Interpreted in conjunction with canal volume: flat curve with normal volume suggests fluid or immobility in the middle ear (e.g. otitis media with effusion); flat curve with high volume suggests perforated eardrum or open ventilation tube; A flat curve with low volume suggests probe obstruction or channel obstruction.
Type C: The peak has shifted to the negative pressure region. It suggests low middle ear pressure (e.g. eustachian tube dysfunction).
Attention: The same "Type B" curve means completely different things depending on the channel volume. If you do not give the channel volume to the artificial intelligence, the interpretation will be incomplete and misleading. Never read tympanogram type separately from volume.
acoustic reflex
The acoustic reflex is the automatic contraction of the stapes muscle in the middle ear when a sufficiently loud sound is introduced into the ear. This reflex provides information about the integrity of certain parts of the auditory pathway and reflex arc. The presence, absence and threshold of the reflex are significant; For example, the absence of a reflex in certain patterns may suggest a conduction-type problem or another condition. However, acoustic reflex interpretations are complex and do not provide a diagnosis alone; It is evaluated together with audiogram, tympanometry and clinical findings.
Integrate tests
The power in audiology is not in a single test, but in the consistency of the tests with each other. The table below summarizes typical patterns; However, these are guidelines and each case is evaluated individually.
tympanogram
Possible middle ear condition
Frequent accompanying finding
Next step
Type A
normal middle ear
There may be a sensorineural pattern
Combine with audiogram
Type B (normal volume)
fluid/immobility
Transmission type range
Otoscopy + ENT evaluation
Type B (high volume)
Membrane hole/open tube
Variable
Otoscopy + ENT
Type C
negative pressure
Light transmission component
Follow-up / According to ENT
Step by step: immittance comment support with artificial intelligence
- Give all the components. Provide anonymous tympanogram type, peak pressure, canal volume and acoustic reflex findings.
- Connect with audiogram. Add the same patient's audiogram summary so the AI can sketch consistency.
- Limit the role. Say, "Don't make a diagnosis; from the findings I give you can sketch a possible middle ear condition, don't use precise language."
- Ask for red flags. Have patterns that may require ENT referral (e.g. unilateral Type B, suspicion of membrane perforation) marked separately.
- Confirm by clinical examination. Do not accept tympanogram alone as a result without otoscopy findings, history and examination.
- Move to expert/physician approval. Provide ENT evaluation in cases requiring medical guidance.
Weak prompt / Strong prompt
Weak prompt:
Tympanogram came back flat, what does the patient have?
No canal volume, no acoustic reflex, no audiogram context; He asks for a definitive diagnosis of "what is going on?" AI is forced to make predictions with incomplete data.
Powerful prompt:
Your role: immittance comment draft assistant. Making a diagnosis; Use "possible" language, write missing data [no data]. Right ear: tympanogram Type B, canal volume within normal range, no peak. Acoustic reflex: not detected. Audiogram summary: air-bone gap is present, bone conduction is close to normal. Task: write whether these findings are consistent with each other and sketch the possible middle ear condition; Mark the point where ENT referral may be required. State that the decision is up to the specialist/physician.
The strong prompt gives all the ingredients, ties it to the audiogram, prohibits precise language, and asks for the medical referral point.
three mini cases
Case 1 — Consistent pattern. In a 6-year-old child, the right ear is Type B (normal volume), air-bone gap is 30 dB, and bone conduction is normal. The expert feeds the findings to the AI; YZ outlines "consistent with conductive-type component and possible middle ear fluid; otoscopy and ENT evaluation recommended." Effusion is seen on otoscopy, the child is referred to ENT. The tests confirmed each other, speeding up the writing of the AI draft.
Case 2 — Volume trap. An expert sees a Type B curve but asks the AI without giving the channel volume. The AI says "possible middle ear fluid." The expert notices that the channel volume is high; This time the table turns in the direction of the eardrum hole or open tube. The expert adds the volume to the prompt and corrects the draft. Lesson: tympanogram without volume is half information.
Case 3 — Red flag. An adult patient has unilateral Type B and an unexplained sensorineural component in that ear. The expert reviews the draft with a “red flag” filter. YZ reminds that unilateral asymmetrical findings may require further medical evaluation. The specialist refers the patient to the ENT; AI became a reminder, the decision remained with the expert.
Copiable prompt templates
IMMITENCE INTEGRATION TEMPLATEevaluate the following summary of tympanogram type + canal volume + acoustic reflex + audiogram together. Are the findings consistent with each other? Write a sketch of a possible middle ear situation using "possible" language. Data: [findings]
CANAL VOLUME CHECK TEMPLATEThe tympanogram I provided is Type B. Canal volume: [value]. What could be the possible meanings of the smooth curve with this volume? Don't comment without giving the volume. Give the result as a list, the decision is up to the expert.
RED FLAG SCREENING TEMPLATEIs there a pattern in the following immittance + audiogram findings that may require ENT/physician referral (e.g. unilateral asymmetry, suspected membrane perforation, unexplained finding)? Tick and write why you recommend redirecting. Data: [findings]
AUDIOGRAM-IMMITENCE CROSS-CHECK TEMPLATEIf the audiogram shows a conduction-type component, is the tympanogram consistent with it? If discrepancy, which repeat test/clinical step is recommended? Data: [audiogram summary + tympanogram]
Common mistakes
- Bypassing channel volume. Interpreting Type B independent of volume; mixing the membrane hole with liquid.
- Mistaking tympanogram alone for diagnosis. Declaring results without otoscopy, history and audiogram.
- Overinterpreting the acoustic reflex. Making a definitive diagnosis from a single reflex finding.
- Missing the red flag. Overcoming unilateral asymmetric findings without requiring medical guidance.
- Ignoring conflict between tests. Skipping repeat/clinical evaluation if audiogram and tympanogram are discordant.
In summary
Tympanometry evaluates the functioning of the middle ear, and acoustic reflex evaluates the integrity of the auditory pathway. Tympanogram type (A, B, C) is necessarily read together with the canal volume and combined with the audiogram, otoscopy and history. AI can outline a coherent interpretation from these findings and remind red flags that require ENT referral; but diagnosis, medical guidance and final decision belong to the audiologist and physician.
Application task
Set up an anonymous, made-up case: a tympanogram type + canal volume + acoustic reflex finding + brief audiogram summary. Get an outline with the "immittance integration" template, then apply the "red flag screening" template. Then ask the same Type B curve again by deliberately changing the channel volume (for example, from normal to high) and observe how the interpretation changes. This embodies why volume is indispensable.
checklist
- [ ] I gave the tympanogram type along with the canal volume.
- [ ] I added the acoustic reflex finding and the audiogram summary.
- [ ] I asked the AI for a draft comment in the language "possible".
- [ ] I had the red flag/ENT guidance points marked separately.
- [ ] I confirmed with otoscopy and clinical context.
- [ ] I have conveyed the situations requiring medical guidance to the approval of the specialist/physician.