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Bifid Tympanogram Peak

Robert H. Margolis, PhD

May 29, 2006


Question

What does it mean when there are two peaks, or a bifid peak on a tympanogram? The results are still within normal range.

Answer

Sounds like a straightforward question but the complete answer lies in the physics of the middle ear. When this was first observed in the 60's and 70's, the focus was on relating this pattern to a middle ear condition, such as ossicular discontinuity. The best answer, provided by a group of physicists at the University of Antwerp, is the Vanhuyse Model (pronounced van-EYES-uh). The model shows that at low frequencies admittance tympanograms from normal adult ears should never be double peaked and at higher frequencies (around 1 kHz and above) they should all be double-peaked. The frequency at which the admittance tympanogram becomes double peaked is roughly equivalent to the resonant frequency of the middle ear. Because our standard 226-Hz probe frequency is remote from the resonant frequency, a double peak at that frequency is never normal (unless you're a newborn infant). When it occurs in anyone older that a few months of age it's an indication of a mass-dominated ear, which can be caused by a decrease in stiffness (thin eardrum or ossicular discontinuity) or an increase in mass (loading of the eardrum or ossicular chain by abnormal tissue like cholesteatoma, granulation, fibrosis, or thick fluid). In the former case, the double-peaked tympanogram is tall and narrow; in the latter case it is broad and flattened. For a more complete discussion see Chapter 17 in Audiology: Diagnosis, Roeser et al (eds) Thieme Medical Publishers, 2000.

Robert H. Margolis, Ph.D., is professor of Audiology in the Department of Otolaryngology at the University of Minnesota.


robert h margolis

Robert H. Margolis, PhD

Robert H. Margolis earned bachelor's and master's degrees from Kent State University (1968, 1969) and a Ph.D. degree from the University of Iowa (1974). After a post-doctoral research fellowship at the University of Wisconsin, he joined the faculty of the UCLA Medical School in 1975. In 1980, he was appointed associate professor of communication sciences and disorders and director of the Gebbie Hearing Clinic at Syracuse University. In 1988 he became professor and director of audiology at the University of Minnesota Medical School. In 2000 he established AUDIOLOGY INCORPORATED to develop improved hearing tests. Dr. Margolis has over 120 publications in scientific and clinical journals and textbooks. His research has focused on development of methods for evaluating disorders of hearing. He has been awarded research grants from the Deafness Research Foundation, NATO Division of Scientific Affairs, and the National Institutes of Health. He has served as president of the Minnesota Academy of Audiology, the International Hearing Foundation, and the Minneapolis-University Rotary Club. He has been awarded the Honors of the Association by the Minnesota Academy of Audiology, the Humanitarian Award by the American Academy of Audiology, the Editor's Award by the Journal of the American Academy of Audiology, the Rotarian of the Year Award by the Minneapolis-University Rotary Club, the Larry Mauldin Award for Excellence in Education in Audiology, an Honorary Membership by the Vitacura Rotary Club (Santiago, Chile), and the James Jerger Career Research Award by the American Academy of Audiology.


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