CC BY-NC-ND 4.0 · Semin Hear 2023; 44(01): 005-016
DOI: 10.1055/s-0043-1764139
Review Article

The Rise and Fall of Aural Acoustic Immittance Assessment Tools

Navid Shahnaz*
1   School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
Hammam AlMakadma*
2   Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
Chris A. Sanford
3   Department of Communication Sciences and Disorders, College of Health, Idaho State University, Pocatello, Idaho
› Author Affiliations


Clinical assessment of middle ear function has undergone multiple transformations and developments since the first acoustic impedance measurements were made in human ears nearly a century ago. The decades following the development of the first acoustic impedance bridge by Metz in 1946 witnessed a series of technological advancements leading to the widespread use of single-frequency admittance tympanometry in the 1960s. In the 1970s, multi-frequency and multi-component tympanometry (MFT) emerged for clinical use, allowing for a better understanding of the middle ear acoustic-mechanical response at frequencies between 200 and 2,000 Hz. MFT has not gained widespread clinical adoption despite its advantages over single-frequency tympanometry. More recent technological developments enabled assessment for frequencies greater than 2,000 Hz, leading to the advent of wideband acoustic immittance measures with capabilities for comprehensive assessment of middle ear acoustic mechanics, and a great potential for use of acoustic immittance testing in various diagnostic practices. This article reviews important historical markers in the development and operation of middle ear assessment tools and analysis methods. Technical and clinical factors underlying the emergence and adoption of different acoustic immittance tests as a standard of clinical practice are described. In addition, we discuss the likelihood for widespread adoption of wideband acoustic immittance and wideband tympanometry in future clinical practice.

* N.S. and H.A. have jointly contributed as first co-authors.

Publication History

Article published online:
14 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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