The influence of tympanic membrane perforation site on the hearing level of conductive hearing loss in chronic suppurative otitis media (original) (raw)
Related papers
2022
Chronic suppurative otitis media is a severe health condition that affects people worldwide. Perforation in the tympanic membrane reduces the surface area of the membrane available for sound transmission. It's important to identify and treat tympanic membrane perforation as soon as possible, since untreated tympanic membrane perforation contributes to chronic disruptive changes in the middle ear, resulting in further hearing loss, which is a major physical and psychological issue that affects people's lives. The study has been conducted to compare the relationship between the location and size of perforation of the tympanic membrane in chronic suppurative otitis media with the magnitude of hearing loss. The cross-sectional prospective study was conducted among 67 patients who visited the Otorhinolaryngology department for myringoplasty. The study period was from January to April 2021, the age group of patients was between 8 and 43 years old. The number of female participants was 35 (52.2%) and males-32(47.8%) respectively. Average age ±SD was 21.93±9.47 years. Fifty (74.6%) patients had right ear perforation and seventeen (25.4%) with left ear perforation/ It was not statistically significant (χ 2 =22.891; p-value=0.290). Most of the patients were with subtotal of (all quadrants) 30 (44.77%), 2-3 quadrants, and one quadrant perforation were 23 (34.32%) and 14 (20.89%) respectively. Most of the patients, i.e.37 (55.22%), had hearing loss between 26-40dB. There was a significant connection between the perforation size and degree of hearing, (χ 2 =22.891; p-value <0.0001). In one quadrant perforation, greatest hearing loss was on the post inferior quadrant 29.97±4.32 dB. For 2-3 quadrants perforation the hearing loss was greatest in postero-superior combined with postero-inferior perforation 37.42±9,59dB. The most significant hearing loss was in subtotal perforation mean ±SD was 42.13±7.07dB. Hearing loss increases in proportion to the extent of the perforation, post inferior quadrant alone and combined with the post-super were observed with the greatest hearing loss according to the findings of this study.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2017
Chronic suppurative otitis media is a serious health problem worldwide. It has been a general view that the hearing loss increases with the size of the perforation, more so if it is in the postero-inferior quadrant. The present study is an effort to test the validity of above concepts. With Institutional ethical committee clearance, an observational study was carried at SMS medical college, Jaipur. A total of 90 cases were studied. All cases between the age group 15-50 years with dry tympanic membrane perforations were divided into 3 groups Group I (0-9 mm 2), Group II (9-30 mm 2), Group III ([30 mm 2) with 30 in each group based on size of perforation. Hearing loss was calculated as average of hearing loss at 500, 1000, 2000 Hz. Similarly the site of perforation was grouped as perforation involving anterior quadrant, posterior quadrant and multiple quadrant as Group A, Group B, Group C respectively. At the end of study, data was compiled systematically and analyzed using Post Hoc test. The age group ranges between 15 and 50 years with mean age of 25.6 years. Hearing loss was found to be directly proportional to the size of perforation in our study. (p = 0.000, highly significant). We also observed that hearing loss was more in posterior and multiple perforations than in anterior perforations. (p = 0.000, highly significant). Overall this study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2017
Background: Study performed to evaluate relationship between surface area of tympanic membrane perforation and degree of hearing loss and the effect of perforation site on that relationship in patients with chronic otitis media. Methods: Seventy-five perforated tympanic membranes from 63 patients aged between 14-45 years with inactive mucosal chronic otitis media included in this study. Rigid endoscope (0 degree) used to take an image for each perforation that analyzed by Autodesk Design Review 2013 program. Degree of hearing loss assessed by pure tone audiometry. Surface area of perforation classified into four groups according to its percentage. Perforation site categorized into three groups regarding its relation to handle of malleus. Data analysis carried out with SPSS program version 17. Results: We studied 34 females and 29 males with different surface area and site of perforations. It observed that with increment of surface area of tympanic membrane perforation, the degree of conductive hearing loss increases (P value=0.000). This relationship expressed in a logarithmic equation. The mean hearing loss of posterior perforation was 1.7±0.5 dB for each 1% of perforation but in anterior perforation was 1.5±0.6 dB for each 1% of perforation (p value 0.185). Conclusions: In chronic otitis media, there is a quantitative logarithmic relationship between surface area of tympanic membrane perforation and degree of conductive hearing loss. The site of perforation does not play a significant role in determining degree of conductive hearing loss.
Correlating the site of tympanic membrane perforation with Hearing loss
BMC Ear, Nose and Throat Disorders, 2009
Background: It is recognized that the size of tympanic membrane(TM) perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss.
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.
Observations on Tympanic Membrane Perforations (Safe Type) and Hearing Loss
Indian Journal of Otolaryngology and Head & Neck Surgery, 2016
The most commonly observed clinical findings in otological practice is discharging ear in which perforation of the tympanic membrane is the commonest, yet the patients hardly ever seek advice for deafness as the presenting symptom. In patients with the symptoms of ear ache or ear discharge when relieved seldom present for follow up and are not very much concerned about the hearing loss present there. There is a different correlation between surface area of tympanic membrane and amplification of sound. Conductive hearing loss is seen in lower tones than higher tones. When the surface area of tympanic membrane is reduced in case of perforations there is decreased in amplification of sound waves. Hearing loss is less in smaller perforations than in larger ones and more for lower tones than for higher tones. A perforation has more serious effect on hearing when it is located in the vicinity of the attachment of malleus. Perforations situated in the postero-inferior quadrant will cause more hearing loss than in other quadrants. The aim of the study is to know the exact location and exact size of perforation and to make a comparative study on the amount of hearing loss produced respectively-in cases of central perforations. Data of 100 patients was collected and studied from May 2015 to April 2016. Hearing loss is related to site and size of perforation with postero-inferior quadrant perforations caising more degree of hearing loss. It varies between 2 and 25 dB more at lower 2 frequencies. Hearing loss is related to size and site of perforation. Small perforation in the postero-inferior quadrant cause more hearing loss than a perforation of same size in other quadrants. Similarly the size of perforation also affects the amount of hearing loss.
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.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2021
This paper aims to assess correlation of site, size and duration of tympanic membrane perforation with hearing loss using pure tone audiogram and surgical outcome in terms of above parameters. The present study was conducted on 100 patients in Department of ENT and HNS, SMGS Hospital, Government Medical College Jammu during a time period of November 2018 to October 2019. All the patients with age 15-60 years who presented with tympanic membrane (pars tensa) perforation were included in the study. According to the size of perforation, mean pure tone threshold in group I was 20.87 ± 3.86 dB, in group II was 26.45 ± 6.08 dB and in group III was 32.6 ± 5.56 dB. The difference in hearing threshold between all the three groups was significant statistically. In terms of site, group E had maximum hearing threshold (34.67 ± 4.20 dB), followed by group B (32.71 ± 5.88 dB). Group A had the lowest hearing threshold of 24.99 ± 6.21 dB. The difference between hearing thresholds of group B perforations and group A perforations was statistically significant (p \ 0.05). However, the difference between group E and group B was insignificant. This study has shown significant correlation between the size and the site of the perforation to the degree of hearing loss. The bigger the perforation, the greater the hearing loss. The central perforations were associated with more hearing loss than posterior perforations, thus refuting the hypothesis that site and size of a tympanic membrane perforation does not affect the degree of conductive hearing loss. This study did not show any correlation between duration of disease and degree of hearing loss. Surgical and audiometric results obtained in this study can be accepted as satisfactory and as expected by the literature.
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.