What are the contraindications of tympanometry?

Contraindications of Tympanometry

The primary contraindication to tympanometry is recent ear surgery or trauma, as specified by the American Academy of Otolaryngology-Head and Neck Surgery guidelines. 1

Absolute Contraindications

• Recent ear surgery or trauma is the only explicitly stated contraindication in current clinical practice guidelines for tympanometry 1
• This restriction exists to avoid disrupting healing tissues or causing complications at surgical sites 1

Relative Contraindications and Clinical Considerations

While not absolute contraindications, certain situations require modified technique or interpretation:

Age-Related Technical Limitations

• Infants younger than 6 months require specialized equipment with a 1,000 Hz probe tone rather than the standard 226 Hz probe, as the standard frequency is insensitive to middle ear effusion due to naturally stiffer tympanic membranes in this age group 2, 3
• Tympanometry is not reliable in infants younger than 7 months when using standard 226 Hz probe tones because of highly compliant ear canals 4
• The procedure itself is not contraindicated in young infants, but requires appropriate equipment and expertise for accurate interpretation 2

Conditions Affecting Interpretation

• Tympanic membrane perforation will produce abnormal results (high equivalent ear canal volume on type B tracing) but is not a contraindication to performing the test; in fact, tympanometry can help differentiate perforation from middle ear effusion 1
• Cerumen impaction causing complete canal obstruction will prevent accurate measurement and should be cleared before testing 2
• External auditory canal edema or discharge may prevent adequate probe placement and seal, requiring aural toilet before tympanometry can be performed 1

Common Clinical Pitfalls

• Do not use tympanometry as the sole diagnostic tool - it cannot distinguish between acute otitis media and otitis media with effusion and requires clinical correlation with history and otoscopic findings 2
• Equipment calibration is essential - annual calibration and proper maintenance are necessary to avoid misinterpretation of findings 1
• Avoid performing tympanometry immediately post-operatively in patients who have had tympanoplasty, myringotomy, or other ear surgery until adequate healing has occurred 1

Practical Implementation

The recommended diagnostic sequence is:

• Perform pneumatic otoscopy first as the primary diagnostic method 1
• Use tympanometry when the diagnosis is uncertain after pneumatic otoscopy or when objective documentation of middle ear status is needed 1
• Defer tympanometry only in cases of recent ear surgery or trauma 1