Tympanometry alone appears to be sufficient in the course of the usual practice (particularly pediatrics) where the most common usage is to determine the presence of middle ear fluid and the integrity of the tympanic membrane. Therefore, when acoustic reflex testing is performed with tympanometry, adequate justification for its utilization should be documented.

The following list of indications is used as a guide in determining the medical necessity for tympanometry and acoustic reflex testing when reported:

Indications for Tympanometry

• the tympanic membrane (eardrum) and middle ear space appear normal and audiometry shows evidence of a conductive hearing loss
• there is uncertainty about the presence of middle ear disease and the patient is uncooperative or too young for conventional audiometric testing
• to document the presence of middle ear fluid
• to evaluate patients complaining of pressure or fullness in the ear when audiometry is normal

• to evaluate sensorineural hearing loss when the degree of loss is different in each ear
• to localize the site of injury in cases of facial nerve paralysis
• when trying to estimate the hearing sensitivity in an individual or infant who does not cooperate for a standard audiometric evaluation

Any other indications reported for acoustic reflex testing should be given individual consideration.

Description

Tympanometry (code 92567) and acoustic reflex testing (code 92568) both provide valuable information when evaluating the middle ear. However, each test has its own specific function.

Tympanometry, which utilizes the application of pressure to the middle ear, is basically used for the evaluation of conductive hearing loss. This is a useful study for pediatricians, family practitioners, and otolaryngologists as it can be used as a screening device for determining middle ear disease and, is excellent for following children with a history of middle ear disease. It is the only method of measuring middle ear function in a patient who is unable to perform a formal audiometry test. Tympanometry is usually indicated without acoustic reflex testing.

Acoustic reflex testing, on the other hand, utilizes sound to test the reflex contractions of the stapedius muscle. This may be measured bilaterally, even when the sound is introduced only on one side. This test is used specifically for the evaluation of sensorineural hearing loss.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.