Tympanometry in San Francisco, CA
If your provider has recommended a tympanometry test, or if you have been experiencing ear fullness, pressure, muffled hearing or recurring ear infections, SH Otolaryngology can help you understand what is happening in the middle ear.
Tympanometry is a quick, objective test that measures how your eardrum responds to gentle air pressure changes. It helps your care team evaluate whether the middle ear is working normally, whether fluid or pressure may be present, and whether additional hearing testing or medical follow-up is needed.
At SH Otolaryngology, our highly trained team performs tympanometry as part of a comprehensive approach to ear and hearing health for patients of all ages in San Francisco.
Why Middle Ear Testing Matters
Hearing does not depend on the inner ear alone. Before sound reaches the inner ear, it must travel through the outer ear, move the eardrum and pass through the tiny bones of the middle ear. If the eardrum cannot move normally because of fluid, pressure, blockage, scarring or another middle-ear issue, sounds may seem muffled even if the inner ear is healthy.
Tympanometry helps identify mechanical problems that may not be obvious from symptoms alone. It can be especially useful when someone says that they can hear but that speech sounds plugged, distant, dull or unclear. It can also help explain why a child may seem inattentive, ask for repetition, turn up the volume, or have speech and listening concerns after frequent ear infections.
A tympanometry test may help answer questions such as:
- Is the eardrum moving the way it should?
- Is there negative pressure behind the eardrum?
- Could middle ear fluid be affecting hearing?
- Is an ear tube open and functioning?
- Could a perforated eardrum, wax blockage or abnormal ear canal volume be influencing results?
- Should the next step be monitoring, a diagnostic audiogram, medical treatment or referral to an ENT physician?
What Is Tympanometry?
Tympanometry is a non-invasive test that evaluates middle ear function. During the test, a small soft probe is placed at the opening of the ear canal. The device sends a gentle tone into the ear while changing air pressure slightly. As the pressure changes, the tympanometer measures how much the eardrum moves.
The result is recorded on a graph called a tympanogram. The shape of the tympanogram gives your audiologist information about eardrum mobility, middle ear pressure and the volume of the ear canal.
What Does Tympanometry Test For?
Tympanometry helps diagnose and monitor a range of middle ear conditions, including:
- Fluid in the middle ear (otitis media with effusion / “glue ear”) — the most common cause of abnormal tympanometry results
- Middle ear infections (acute otitis media) — especially in children
- Eustachian tube dysfunction — when the tube that equalizes pressure between your middle ear and the back of your throat isn’t functioning properly
- Eardrum perforation — a hole or tear in the tympanic membrane
- Impacted earwax — blockage in the ear canal affecting eardrum movement
- Scarring of the tympanic membrane — from previous infections or trauma
- Otosclerosis — abnormal bone growth that stiffens middle ear movement
- Status of tympanostomy tubes — checking whether ear tubes are open or blocked
It is also used by audiologists before recommending hearing aids, as middle ear health directly affects how well a hearing aid will perform.
Tympanometry is not the same as a hearing test. It does not measure the softest sounds you can hear, how clearly you understand speech, or whether you need hearing aids. Instead, it measures how the eardrum and middle ear are functioning.
For that reason, tympanometry is often performed with a diagnostic audiogram, speech testing, otoscopy and other audiology tests. Together, these results give a more complete picture than any single test alone.
Tympanometry vs. a Hearing Test or Ear Exam
Patients often hear several terms used during an ear or hearing evaluation. Each one answers a different question.
| Test or Exam | What It Evaluates | What It Helps Determine |
| Otoscopy | Visual exam of the ear canal and eardrum | Wax buildup, visible infection, drainage, eardrum appearance, ear tubes or perforation |
| Tympanometry | How the eardrum moves in response to pressure | Middle ear fluid, pressure, eardrum mobility, tube function or possible perforation |
| Diagnostic audiogram | Hearing thresholds and speech understanding | Type, degree and pattern of hearing loss |
| Speech testing | How clearly speech is heard and understood | Speech reception threshold and word recognition ability |
| Acoustic reflex testing | Reflexive middle ear muscle response to sound | Additional information about the middle ear, auditory pathway and certain hearing patterns |
Tympanometry is one part of the evaluation. Your audiologist will interpret it alongside your symptoms, medical history and other test results.
Common Symptoms That May Lead to Tympanometry
Not every symptom is caused by a middle ear problem. Tympanometry helps narrow the possibilities and guide next steps.
Your provider may recommend tympanometry if you or your child experiences:
- Ear fullness, pressure or plugged ears
- Muffled hearing or sudden changes in hearing
- Frequent ear infections
- Ear pain or discomfort, especially with pressure changes
- Popping, crackling or clicking in the ears
- Trouble hearing after a cold, sinus infection or allergies
- Ringing or buzzing in the ears with a feeling of pressure
- Balance concerns associated with ear symptoms
- Speech, language or listening concerns in a child
- A history of ear tubes or eardrum perforation
- A recent failed hearing screening
What to Expect During a Tympanometry Test
Tympanometry is one of the fastest and most comfortable tests in audiology. Here’s what the procedure looks like step by step:
Step 1 — Otoscope Exam
Before any testing, your audiologist will look inside your ear canal using an otoscope — a lighted instrument — to check for earwax buildup, infection, or any visible issue that could interfere with the test or require attention first.
Step 2 — Probe Placement
A small, soft probe tip is gently inserted into your ear canal to create a seal. The probe contains three tiny ports: one that emits a low-pitched tone, one that varies the air pressure in your ear canal, and one that measures your eardrum’s response.
Step 3 — The Test
Once the probe is in place, you’ll hear a low-pitched tone and feel a mild sensation of pressure — similar to the feeling your ears get before they “pop” on an airplane. This is brief and painless. During this time, it’s important to sit still and avoid speaking, swallowing, or moving, as these actions change middle ear pressure and can affect results.
Step 4 — Results Recorded
The device records your eardrum’s movement and plots it on a graph called a tympanogram. The entire test typically takes one to two minutes per ear.
Step 5 — Results Review
Your audiologist will walk through your tympanogram with you, explain what the shape of the graph indicates, and discuss next steps — whether that’s follow-up testing, a referral to an ENT physician, monitoring over time, or no further action needed.
How to Read a Tympanogram
Your results are displayed on a graph — the tympanogram — that plots eardrum movement (compliance) against air pressure. The shape of the graph tells your audiologist what’s happening in your middle ear.
Audiologists classify tympanograms into three main types:
Type A — Normal: The graph shows a peak that rises and falls like a mountain. This indicates normal eardrum movement and normal middle ear pressure. No middle ear problem is indicated.
Type B — Flat: The graph shows little to no peak — a relatively flat line. This is the most common abnormal result and most often indicates fluid behind the eardrum. It can also indicate a eardrum perforation (which produces a very large ear canal volume reading) or significant earwax blockage.
Type C — Negative Pressure: The graph’s peak is shifted to the left, indicating abnormally negative pressure in the middle ear. This is most commonly associated with Eustachian tube dysfunction, where the pressure-equalizing tube is not functioning properly. The eardrum may be retracted as a result.
Your audiologist will interpret your results in the context of your full audiological evaluation and medical history, not the tympanogram alone.
Who Should Get a Tympanometry Test?
Tympanometry is appropriate for patients of all ages. Your provider may recommend it if you:
- Have a history of frequent ear infections
- Experience a feeling of fullness or pressure in one or both ears
- Have recently had a cold or upper respiratory infection with associated hearing changes
- Are a child with suspected fluid in the ears or speech/hearing development concerns
- Have been diagnosed with Eustachian tube dysfunction
- Have ear tubes (tympanostomy tubes) that need monitoring
- Are being evaluated for hearing aids
- Have had a perforated eardrum and are being monitored during healing
- Were referred for a comprehensive audiological evaluation
A note for parents: Tympanometry is especially important for young children. Children ages 3 to 5 are particularly susceptible to middle ear fluid and infections, which can cause conductive hearing loss during a critical period of speech and language development. The test is quick and safe, requiring no active participation from the child — just staying still for about two minutes.
What Happens If My Results Are Abnormal?
Abnormal tympanometry results don’t automatically mean something serious. Many causes are temporary and very treatable. However, your audiologist will discuss the results with you and determine appropriate next steps.
If your tympanogram suggests middle ear fluid, infection, or eustachian tube dysfunction, you may be referred to an ENT (ear, nose, and throat) physician for further evaluation and treatment.
For children being monitored for recurring fluid, tympanometry may be repeated every few weeks over several months to track changes over time.
Tympanometry and Hearing Aid Evaluations
Middle ear problems can temporarily change hearing test results. For example, fluid or pressure can create a conductive hearing loss, making sounds seem softer because they are not traveling efficiently through the middle ear. If those issues resolve, hearing thresholds may change.
That is why tympanometry may be part of a hearing aid evaluation. Your audiologist wants to make sure recommendations are based on the most accurate, stable information possible. If a middle ear problem is detected, your provider may recommend medical evaluation or repeat testing before fitting hearing aids.
Why Choose SH Otolaryngology for Tympanometry?
We serve patients throughout San francisco.
Frequently Asked Questions About Tympanometry
Is tympanometry the same as a hearing test?
No. Tympanometry measures the mechanical function of the middle ear — specifically how your eardrum responds to pressure changes. It does not measure how well you hear. It is typically performed alongside a diagnostic audiogram, which does test hearing.
Does tympanometry hurt?
No. The test is completely non-invasive and painless. You may feel a brief sensation of pressure — similar to the ear-popping feeling when flying — but there is no discomfort and no risk of harm to your hearing.
How long does tympanometry take?
The test itself takes one to two minutes for both ears. Including the otoscope exam and results discussion, expect the full interaction to take about 10 to 15 minutes, though it is often part of a longer comprehensive audiology appointment.
Can children have tympanometry?
Yes — tympanometry is safe for all ages and is one of the most commonly performed tests in pediatric audiology. For young children, parents can help by explaining what will happen beforehand and encouraging the child to sit still during the brief test.
Is tympanometry covered by insurance?
Tympanometry is generally covered by most insurance plans, including Medicare, when ordered as part of a diagnostic evaluation. We recommend verifying your specific coverage with your insurance provider before your appointment.
What does it mean if my child has a Type B tympanogram?
A flat (Type B) tympanogram in a child most often indicates fluid behind the eardrum, which is very common and frequently associated with ear infections or seasonal congestion. Your audiologist and/or ENT physician will discuss whether monitoring, medication, or further intervention is appropriate based on your child’s full clinical picture.
What does a flat tympanogram mean?
A flat, or Type B, tympanogram means the eardrum is not showing a normal mobility peak. It may suggest middle ear fluid, a perforated eardrum, an open ear tube, wax blockage or a poor probe seal. Ear canal volume and the ear exam help determine the most likely reason.
What does a Type C tympanogram mean?
A Type C tympanogram shows negative middle ear pressure. This is often associated with eustachian tube dysfunction, which can happen after colds, allergies, sinus problems or altitude changes.
Can tympanometry diagnose an ear infection?
Tympanometry can show whether fluid or reduced eardrum movement is present, but it does not diagnose an ear infection by itself. A medical provider will also consider symptoms, otoscopy and other findings.
Can tympanometry detect fluid behind the eardrum?
Tympanometry can provide objective evidence that suggests fluid may be present, especially when the graph is flat and ear canal volume is normal. Your provider will confirm the interpretation with the full exam.
Why would my child need tympanometry after a failed hearing screening?
A child may fail a hearing screening because of temporary middle ear fluid, pressure, wax or permanent hearing loss. Tympanometry helps determine whether a middle ear issue may be contributing to the screening result.
Do I need a referral for tympanometry?
It depends on your insurance plan and the reason for testing. Some plans require a physician referral for diagnostic testing to be covered. SH Otolaryngology can help explain what information may be needed when you call.
Can tympanometry be performed if I have ear tubes?
Yes. Tympanometry is often used to help assess whether ear tubes are open and functioning. Tell your audiologist if you or your child has ear tubes before testing begins.
Can I have tympanometry if I have a perforated eardrum?
Your provider will decide based on your ear history, symptoms and otoscopy findings. Tympanometry may provide useful information in some cases, but testing may be modified or delayed if there is active drainage, pain or recent surgery.
Schedule a Tympanometry Test in San Francisco
If you’ve been referred for tympanometry or have concerns about your or your child’s middle ear health, our team is ready to help. Contact SH Otolaryngology today to schedule your appointment.