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Acoustic Immittance Measures: Basic and Advanced Practice

Davis, Tara M. Ph.D., CCC-A

doi: 10.1097/AUD.0000000000000245
Resource Review

One book, Acoustic Immittance Measures: Basic and Advanced Practice by Lisa L. Hunter and Navid Shahnaz, is reviewed in this issue. Tara Davis describes the text as an essential book for instructors, clinicians, and Au.D. students as it clearly describes contemporary scientific principles of middle ear immittance tests and techniques.

Department of Speech-Language Pathology and Audiology, University of South Alabama, Mobile, AL 36688, USA



Acoustic immittance tests, typically performed and supervised by audiologists, play a vital role in the detection and diagnosis of middle ear pathologies. Although tympanometry screenings are easily accomplished by a technician, the underlying principles of acoustics and middle ear physiology that dictate interpretation of results are complex. As a professor who regularly teaches the principles and procedures of acoustic immittance tests, I have greatly appreciated Acoustic Immittance Measures: Basic and Advanced Practice as a textbook which provides updated normative data, highlights of the latest immittance technology, and a clinically driven discussion on recent advances in wideband acoustic immittance. In addition to addressing new middle ear analysis techniques and technology, this book addresses other changes in evidence-based practice in recent years, such as modern protocols of middle ear assessment in infants using higher probe tone frequencies. Before the release of this book in 2014, students were referred to the 1997 textbook by Wiley and Fowler, Acoustic Immittance Measures in Clinical Audiology: A Primer or book chapters in other audiology textbooks.

As a recent addition to the Core Clinical Concepts in Audiology (CCC) series, the target audiences of this book are instructors, Doctor of Audiology (Au.D.) students, and practicing audiologists. From an instructor point of view, I appreciate this book and others in its series that specifically address clinical methodology and skills for beginning Au.D. students. Students and clinicians alike will find the book to be economical, practical, and an inclusive guide on acoustic immittance tests. Although the book is geared toward clinical learning, the authors successfully balance clinical applications with the scientific principles and research studies that provide the foundation of the clinical tests.

The book is divided into nine chapters, four of which contain study questions and/or lab exercises. Specific chapter topics include a history on acoustic immittance and contemporary acoustic immittance instruments, a basic review of outer and middle ear anatomy and physiology, scientific principles underlying acoustic immittance, single-frequency tympanometry, multifrequency tympanometry, acoustic-stapedius reflex measurements, principles governing wideband reflectance, immittance test considerations for infants and children, and clinical applications of immittance tests to middle ear disorders. Lab exercises are provided for 226 Hz tympanometry, multifrequency tympanometry, and acoustic reflexes/reflex decay.

The authors also include several helpful tables and figures. Tables of updated normative values are provided for tympanometry in normal infants, children, and adults, Eustachian Tube Function Tests in adults, and acoustic reflex thresholds in infants and adults. One table that I found particularly helpful (Table 4-1) not only summarizes the effects of middle ear pathologies on traditional tympanometric measures, it also lists the mass and stiffness effects of these pathologies on the middle ear system. Included in the final chapter on middle ear disorders are clinical cases that incorporate pictures of various tympanic membrane pathologies, audiograms, 226-Hz tympanograms, and multifrequency tympanograms. One suggestion for a future edition of the book is to enhance the resolution of the figures, such as using color images of the tympanic membrane instead of black and white to facilitate an easier identification of the described pathologies.

Overall, the authors have written an essential book for instructors, clinicians, and Au.D. students on current methodologies and concepts in acoustic immittance tests. I would highly recommend it as a resource that clearly articulates contemporary scientific principles of middle ear immittance tests and techniques.

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