Assessments of the size of tympanic membrane perforations: a comparison of clinical estimations with video-otoscopic calculations (original) (raw)
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Journal of Nepal Medical Association, 2022
Introduction: Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated ...
Quantitative analysis of tympanic membrane perforation: a simple and reliable method
The Journal of Laryngology & Otology, 2008
Background:Accurate assessment of the features of tympanic membrane perforation, especially size, site, duration and aetiology, is important, as it enables optimum management.Aim and objectives:To describe a simple, cheap and effective method of quantitatively analysing tympanic membrane perforations.Materials and methods:The system described comprises a video-otoscope (capable of generating still and video images of the tympanic membrane), adapted via a universal serial bus box to a computer screen, with images analysed using the Image J geometrical analysis software package. The reproducibility of results and their correlation with conventional otoscopic methods of estimation were tested statistically with the paired t-test and correlational tests, using the Statistical Package for the Social Sciences version 11 software.Results:The following equation was generated: P/T × 100 per cent = percentage perforation, where P is the area (in pixels2) of the tympanic membrane perforation a...
Pattern of tympanic membrane perforation in a tertiary hospital in Nigeria
2018
Background/Objectives: Tympanic membrane perforation is a common otological disorder with associated hearing impairment. This study aimed at determining the clinicoepidemiological pattern, etiological factors, clinical presentation, and management of tympanic membrane perforation in a tertiary hospital in Nigeria. Materials and Methods: This was a prospective, hospital-based study of patients with the clinical finding of perforated tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). Interviewer-assisted questionnaire was administered to obtain the detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0. Results: A total of 529 patients had tympanic membrane perforation, of which 368 (69.6%) were males and 161 (30.4%) were females with a male-to-female ratio of 2:1. The prevalence of tympanic membrane perforation in this study was 7.8%. The most common present...
Assessment of hearing loss in tympanic membrane perforation
Background Tympanic membrane perforation is a common problem and causes hearing disability, and many factors can affect the degree of hearing loss. Objective The aim of this study was to assess the degree of hearing loss in relation with the size and site of tympanic membrane perforation. Patients and methods This prospective study was conducted at Al-Yarmouk Teaching Hospital during the period from February 2015 to February 2016 on 75 patients (93 ears) with tympanic membrane perforations. The size and site of perforations were evaluated under the microscope and classified according to the size (small, moderate, and large), and the site (anteroinferior, anterosuperior, posteroinferior, and posterosuperior quadrants). Hearing loss was measured in each case with pure-tone audiometry and its relation with these parameters was analyzed. Results There was an increase in hearing loss with the increase in the size of perforation. Perforation locations had an impact on hearing loss; this was statistically significant, especially in the posteroinferior quadrant if compared with other quadrants, as P value was 0.037. Conclusion The size and site of tympanic membrane perforation had a significant effect on the magnitude of hearing loss.
Audiometric assessment of adolescents and adults with tympanic membrane perforation in Benin City
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2018
The tympanic membrane is a thin elliptical shaped pearly grey membrane. It is placed obliquely at the boundary between the external auditory canal and the middle ear, and as a result, its postero-superior part is more lateral than its antero-inferior part. 8 The total area of the tympanic membrane is about 85 mm 2 , out of which almost 2/3 rd (55 mm 2) is the vibrating area. 9 It is divided into two parts; the pars tensa and pars flaccida. The pars tensa forms the larger part of the tympanic membrane.
Objective: To analyze the hearing loss in tympanic membrane perforation based on shape, site and size of the perforation. Study design: Prospective hospital based study design Setting: ENT OPD at NSCB Medical College & Hospital (tertiary referral centre) Materials and methods: Patients reporting to ENT OPD with unilateral or bilateral CSOM Safe type were selected between March 2015 and August 2016. The inclusion criteria were of dry central perforation, pure conductive hearing loss and intact ossicular chain. These patients were subjected to Tuning fork tests and pure tone audiometry before and after patch paper test. Results: 54 patients were selected with unilateral or bilateral ear involvement making a total of 70 cases. Maximum patients belonged to low socioeconomic strata and rural areas and were of young adult age group. On the basis of shape, the circular shaped perforations had greater hearing loss (50% having moderate hearing loss) than oval and reniform (62.5% having mild hearing loss) perforations. Hearing loss was more with perforations with both anterior and posterior quadrants involvement (48% having moderate hearing loss). All cases improved in hearing post patch test with irrespective of type of shape, site or size of the perforation. Conclusion: All the three criteria of shape, site and size of perforation have significant relation with hearing loss. All had similar improvement post patch with these three variables. Paper patch test is a simple and reliable indicator of hearing loss improvement in central perforations with intact ossicular chain and can be used as a criterion for selection of patients for type I tympanoplasty.
Tympanic membrane perforation in the province of: A retrospective study
Medicine Science | International Medical Journal, 2018
In the current study, a retrospective scan was made of patients presenting at our clinic over the last 10 years and those diagnosed with tympanic membrane perforation were evaluated in 2 separate groups as patients with Chronic suppurative otitis media (CSOM) and Traumatic tympanic membrane perforations (TTMP). In this study patients with tympanic membrane perforation were evaluated through a retrospective examination of patients presenting at the Ear, Nose and Throat Clinic between May 2006 and May 2016. The tympanic membrane perforations were examined in two separate groups; CSOM and TTMP. When these patients were grouped according to the diagnosis criteria, the CSOM group comprised 8,335 (1.13%) patients and the TTMP group 422 (0.06%) patients. These two groups were compared in respect of the items stated age, gender, laterality. When the considerable number of patients is taken into consideration, although the results do not completely show a prevalence rate, they can give preliminary information.
The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB.Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.
Functional Correlations of Tympanic Membrane Perforation Size
Otology & Neurotology, 2012
Objective: The correlation between tympanic membrane perforations and hearing loss was studied. Study Design: Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed. Setting: Tertiary referral center. Patients: One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included. Interventions: All patients underwent primary myringoplasty. Main Outcome Measures: Preoperative conductive hearing loss due to eardrum perforations. Results: Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p G 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an Winverted V shapeW of the air-bone gap is a consistent finding. If the air-bone gap exceeds the Winverted V-shapeW pattern, additional pathology behind the eardrum must be assumed and addressed. Conclusion: We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An Binverted V-shape[ pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the airbone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed. Key Words: Conductive hearing lossVFrequency of hearing lossVLocationVResonance frequencyVRelation between air-bone gap and perforation sizeVTympanic membrane perforationVUmbo involvement.