Determinants of hearing loss severity in tympanic membrane perforations in a sub-Saharan African setting

AbstractBackgroundFactors specific to sub-Saharan Africa could have an impact on tympanic membrane perforation characteristics. Obtaining precise information on these characteristics and determinants of hearing loss severity would enable better management.ObjectiveTo determine the relationship between characteristics of tympanic membrane perforation and subsequent hearing impairment.MethodsA cross-sectional study of consenting patients presenting with tympanic membrane perforation was conducted. They were examined using otoendoscopy with a digital camera to obtain precise measurements, followed by pure tone audiometry.ResultsEighty-six cases of tympanic membrane perforation were included. Mean tympanic membrane perforation proportion was 34.1 ± 18.4 per cent. Medium-sized tympanic membrane perforations were predominant (47.7 per cent). Median tympanic membrane perforation duration was 20 years. Tympanic membrane perforation size was found to be a predictor of hearing loss severity (odds ratio = 2.5, 95 per cent confidence interval = 1.02–6.13,p= 0.04).ConclusionTympanic membrane perforation size was a predictor of hearing loss severity in our setting. Site, duration and aetiology seem to have no impact on hearing loss severity.

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Hearing loss in tympanic membrane perforations: an analytic study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183693 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1233 ◽

Cited By ~ 2

Author(s):

Kartik Herkal ◽

Karthikeyan Ramasamy ◽

Sunil Kumar Saxena ◽

Sivaraman Ganesan ◽

Arun Alexander

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone Audiometry ◽

Cross Sectional Study ◽

Tympanic Membrane Perforation ◽

Sectional Study ◽

Cross Sectional ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

R Value

Background: Tympanic membrane perforations are common cause of hearing loss. There are very few systematic studies that have evaluated the size and location of a perforation to the degree of hearing loss, this study correlates the size and location of tympanic membrane perforation to the pattern of hearing loss.Methods: The study design was based on cross sectional study. Ninety-six ears of dry tympanic membrane perforation of CSOM mucosal type were selected. Photographs of the tympanic membrane perforations were taken and size measured using the “Image J” software. The area of perforation was compared to hearing loss measured by pure tone audiometry. Results: Ninety-six patients, aged 15-60 years with perforated eardrums were studied. Size of tympanic membrane perforation showed moderate level of correlation with hearing loss (Pearson r value=0.463). The various locations of perforations were: posterior (23 ears with Mean hearing loss 28.6±7.7 dB), anterior (31 ears with Mean hearing loss 26.5±7.8dB), subtotal (42 ears with Mean hearing loss 34.2±8.2 dB).Conclusions: The hearing loss is frequency dependent, with maximum hearing loss at lower frequencies. Irrespective of size of perforation the hearing loss was the least for frequency of 2000Hz. Magnitude of hearing loss increases with increase in size of tympanic membrane perforation. Perforation posterior to handle of malleus resulted in more hearing loss than perforations involving anterior to the handle of malleus.

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Frequency Dependence Hearing Loss Evaluation in Perforated Tympanic Membrane

International Archives of Otorhinolaryngology ◽

10.1055/s-0037-1598597 ◽

2017 ◽

Vol 21 (04) ◽

pp. 336-342 ◽

Cited By ~ 3

Author(s):

Mohammed Dawood

Keyword(s):

Hearing Loss ◽

Frequency Dependence ◽

Tympanic Membrane ◽

Cross Sectional Study ◽

Tympanic Membrane Perforation ◽

Hearing Level ◽

Cross Sectional ◽

Maximum Loss ◽

Tympanic Membrane Perforations ◽

Membrane Perforation

Introduction Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. Objective The objective of this study is to evaluate and analyze the frequency dependence hearing loss in tympanic membrane perforation based on the size and the site of perforation. Methods For the study, I selected 71 patients' (89) ears for the cross-sectional study with tympanic membrane perforations; I examined the size and the site of perforations under the microscope and classified them into small, moderate, large, and subtotal perforations, and into anterior central, posterior central, malleolor central, and big central perforations. I measured mean level of speech frequencies hearing loss, and its relation with the site and the size of the perforation analyzed. Results The mean hearing loss at different sizes of the perforation at all speech frequencies was 37.4 dB, with ABG of 26.6 dB, and its maximum loss was detected in subtotal perforation of 42.3 dB, with ABG of 33.7 dB, at 500 Hz frequency, while in relation to the sites, it was 38.2 dB, with ABG of 26.8 dB, and its maximum loss was detected in big central site perforation of 42.1 dB, with ABG of 33.6 dB, at 500 Hz frequency. Conclusions The hearing loss was proportionally related with the sizes of the perforations, and the posterior site had greater impact on the hearing than anterior site perforations. This was also applied to the frequency dependence hearing level, as was detected to be worse at lower frequencies as 500 Hz, than those of 1000–2000 Hz.

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Audiometric assessment of adolescents and adults with tympanic membrane perforation in Benin City

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182699 ◽

2018 ◽

Vol 4 (4) ◽

pp. 901 ◽

Cited By ~ 2

Author(s):

Johnson Ediale ◽

Paul R. O. C. Adobamen ◽

Titus S. Ibekwe

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone Audiometry ◽

Cross Sectional Study ◽

Tympanic Membrane Perforation ◽

Adult Patients ◽

Hearing Level ◽

Cross Sectional ◽

Benin City ◽

Membrane Perforation

Background: The degree of hearing loss is directly proportional to the size of tympanic membrane (TM) perforation. However, there is dearth of information on correlation between severity of hearing loss and location of perforation on the tympanic membrane. The objective of the study was to determine the hearing level of adolescent and adult patients with tympanic membrane perforation.Methods: A cross sectional study at the ENT Clinic, University of Benin Teaching Hospital (U.B.T.H), Benin City. Consecutive patients with TM perforations were examined with ‘‘Firefly video-otoscope’’, and subsequently had pure tone audiometry. The contralateral intact TMs in individuals with unilateral TM perforation and the ears of students and staff of Institute of Health Technology UBTH were used as control. Data was analyzed using statistical package for social sciences (SPSS) version 20 and Image J software. P≤0.05 was considered statistically significant. Results: Two hundred ears from 148 patients with TM perforation in either or both ears were studied. Conductive hearing loss (CHL) had the highest prevalence; 64.3% and 55.9% in the right and left ears respectively. Slight CHL; 67.5% was more common. However, the severity of hearing loss increased with the size and also varied with the location of TM perforation.Conclusions: The hearing level among adolescent and adult patients with TM perforation showed a significant association with the size and the location of the perforation on the TM.

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Correlation of Site and Size of Tympanic Membrane Perforation and Middle Ear Air Space Volume with Magnitude of Hearing Loss

Annals of Otology and Neurotology ◽

10.1055/s-0039-1693095 ◽

2019 ◽

Vol 02 (01) ◽

pp. 10-15

Author(s):

Ramandeep Singh Virk ◽

Krishan Kudawla ◽

Sandeep Bansal ◽

Ramya Rathod ◽

Samarendra Behera

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Middle Ear ◽

Tympanic Membrane Perforation ◽

Tympanic Membrane Perforations ◽

Air Space ◽

Membrane Perforation ◽

Volume Group ◽

Space Volume ◽

Lower Frequencies

Abstract Introduction The effects of tympanic membrane perforations on middle ear sound transmission are not well characterized, largely because ears with perforations typically have additional pathological changes. It has been established that the larger the perforation, the greater is the hearing loss (HL). Aim This study aimed to correlate the location and size of tympanic membrane perforation and middle ear air space volume with the magnitude of HL in patients with tubotympanic or inactive mucosal type of chronic otitis media (COM). Materials and Methods A prospective clinical study of patients with tympanic membrane perforations due to COM and without any other ear disease and who attended the Otolaryngology services at our institute between July 2010 and December 2011 was conducted. A total of 300 ears were evaluated by performing otoendoscopy, followed by photo documentation and audiological investigations (pure-tone audiometry and tympanometry). Tympanic membrane perforations were categorized based on their size and location, and the mean air-bone (AB) gap between the various types of perforations was compared and statistically analyzed with significance level of p < 0.05. Results Out of 300 ears, maximum number of ears (n = 124, 41.3%) had large-sized perforations (> 30 mm2) that had a maximum mean AB gap of 26.43 dB, and minimum number of ears (n = 60, 20%) had small-sized perforations (0–9 mm2) that had minimum mean AB gap of 9.12 dB. The remaining were medium-sized perforations that had mean AB gap of 16.13 dB. Depending on the location, maximum were central perforations (n = 198, 66%) and minimum were anterosuperior (AS) perforations (n = 9, 3%). Based on the middle ear volume on tympanometry, maximum ears were of low-volume group (n = 246, 92%) that had larger mean AB gap of 19.96 dB HL when compared with the high-volume group (n = 24, 8%) with 11.80 dB HL. AB gap was maximum at lower frequencies and decreased with increase in frequencies except at 4,000 Hz, that is, 56.9 dB HL at 250 Hz, 42.6 at 500 Hz, 41.5 at 1,000 Hz, 32.4 at 2,000 Hz, and 49.5 at 4,000 Hz. Conclusion HL increases as the area of tympanic membrane perforation increases. There is an inverse relationship between HL and middle ear air space volume. Comparing the small-sized perforations at different sites with the middle ear volume being low, it was found that posterosuperior (PS) perforations had 4 to 7 dB greater HL than AS and anteroinferior (AI). However, the relationship was statistically insignificant. The phase cancellation effect of round window causing greater HL in posteroinferior (PI) perforations does not exist in small- and medium-sized perforations. HL is greater at lower frequencies and less at higher frequencies.

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A Correlative Study Between Size of Tympanic Membrane Perforation, Pure Tone Audiometry and Intraoperative Findings in Tympanoplasty

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2018.v26i1.155 ◽

2018 ◽

Vol 26 (1) ◽

pp. 43-47

Author(s):

Santosh U P ◽

Sridurga J ◽

Aravind D R

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Pure Tone ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Membrane Perforation ◽

Operative Findings

Introduction Chronic otitis media (COM) is a most common and prevalent disease of the middle ear. COM has been defined as a longstanding inflammatory condition of middle ear and mastoid, associated with perforation of the tympanic membrane. Tympanoplasties are common surgeries performed for chronic otitis media in inactive mucosal type. Any otological surgery may involve a menace/ hazard of hearing loss post operatively. In this study, an attempt was made to correlate, size of tympanic membrane perforation, pure tone audiometry and intra-operative findings in tympanoplasties, results were analysed and conclusion drawn. Materials and Methods Forty patients attending ENT OPD with chronic otitis media (COM), inactive mucosal type, with conductive hearing loss undergoing tympanoplasties who were willing to participate in the study were selected. Ear was examined pre-operatively to assess the size of perforation and then, pure tone audiometry (PTA) was done to assess the type of hearing loss and its severity. During tympanoplasty, middle ear was inspected for ossicular status and any other pathology was noted. Later, the size of tympanic membrane perforation, pure tone audiometry and intra operative findings were correlated with each other and analysed. Result In small and medium sized perforation, PTA and intraoperative findings correlated with each other. Whereas, in large and subtotal perforation, there was no correlation. Conclusion In small and medium sized perforation, middle ear inspection may not be necessary. Whereas, in large and subtotal perforation it is necessary.

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Tympanic membrane perforation: correlation of hearing loss with its site and size

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180016 ◽

2018 ◽

Vol 4 (2) ◽

pp. 397 ◽

Cited By ~ 1

Author(s):

Arvinder Singh Sood ◽

Pooja Pal ◽

Amit Kumar

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Linear Correlation ◽

Tympanic Membrane Perforation ◽

P Value ◽

Cross Sectional ◽

Group Iii ◽

Group I ◽

Membrane Perforation ◽

Group Ii

Background: The objectives of the study were correlation of hearing loss with size and site of tympanic membrane perforation. Methods: A cross-sectional prospective study of 100 patients of both sex and age between 11-60 years with perforated tympanic membrane was conducted in the department of Otorhinolaryngology (ENT). Size and site of TM perforation was assessed using otoscope and otomicroscope. Size of perforation was measured with 1 mm thin wire loop and vernier caliper. Patients were divided into three groups according to size; Group I (0-9 mm), Group II (9-30 mm), Group III (>30 mm). The tympanic membrane was divided into five segments anterosuperior, posterosuperior, anteroinferior, posteroinferior and central for the localization of the site of perforation. Data thus collected was statistically analysed. Results: Patients with Group I perforation had an average hearing loss of 31.42±7.15 decibel. Group II had an average hearing loss of 39.42±8.97 decibel. Group III had an average hearing loss of 48.91±7.38 decibel. Maximum hearing loss was noted in patients with central perforation with an average hearing loss of 39.34±9.47 decibel. Average hearing loss was found higher in posterior perforations than anterior quadrant perforations. This difference was however not statistically significant with ‘p’ value of ‘0.689’. Conclusions: Linear correlation was found between size of tympanic membrane perforation and degree of hearing loss. No linear correlation between site of tympanic membrane perforation and hearing loss was found. We found no correlation between duration of disease and size of tympanic membrane perforation with degree of hearing loss.

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A STUDY ON CORRELATION OF SIZE AND SITE OF TYMPANIC MEMBRANE PERFORATION WITH DEGREE OF CONDUCTIVE HEARING LOSS IN CHRONIC OTITIS MEDIA

UP STATE JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY ◽

10.36611/upjohns/volume9/issue1/4 ◽

2021 ◽

Vol VOLUME 9 (ISSUE 1) ◽

pp. 19-23

Author(s):

M Lavanya

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Conductive Hearing Loss ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforation ◽

Tympanic Membrane Perforations ◽

Posterior Quadrant ◽

Membrane Perforation ◽

Duration Of Disease ◽

Conductive Hearing

Background: Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and conductive hearing loss. Materials and Methods: In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. Based on the inclusion and exclusion criteria a total of 100 patients were included in this study. All the patients clinical data was analyzed statistically using paired t-test. Results:Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearingloss. Conclusions: The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation. Keywords: Tympanic membrane, Conductive hearing loss, Perforation, hearing loss, posterior quadrant, ear.

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Traumatic perforation: determinants of conductive hearing loss

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20172583 ◽

2017 ◽

Vol 3 (3) ◽

pp. 592

Author(s):

Ravi K. S. ◽

Ravishankar S. N.

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Conductive Hearing Loss ◽

Previous History ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Tertiary Center ◽

Membrane Perforation ◽

History Of ◽

Conductive Hearing

Background: Traumatic perforations of the tympanic membrane are very common in day to day life and it may be due to direct or indirect source. The aim of this study is to evaluate the various factors which determine the degree of hearing loss in patients with traumatic perforation of tympanic membrane. Methods: A retrospective review was performed in 50 patients seen at the ENT department in our rural tertiary center over a period of two years between January 2015 to December 2016. The patients with history of ear trauma from various causes and with absolutely no previous history of any ear disease were included in our study. The data retrieved included parameters such as age, sex, side, cause of injury and presenting complaints such as hearing loss, earache, tinnitus, and vertigo. A detailed clinical and otoscopic examination was done to determine the size and location of the perforation. Hearing was assessed using pure tone audiometry (PTA) to determine the degree of hearing loss and to correlate with frequency, size and location of perforation. Results: A total of 50 patients with traumatic perforations of the tympanic membrane were enrolled for the study, comprising of 32 males and 18 females patients. Age of the patients ranged from12 to 65 years of age. The results showed that the most common mode of trauma was RTA (46%). Audiometry shows that the larger the tympanic membrane perforation, the larger the air–bone gap. Hearing loss was highest at the lowest frequencies and generally decreased as the frequency increased. The results also showed that there was no difference in air bone gap with relation to location of perforation (anterior vs. posterior). Conclusions: The conductive hearing loss resulting from a tympanic membrane perforation is frequency dependent, with the largest losses occurring at the lowest sound frequencies, hearing loss increases as size of the perforation increases and no relation with location of perforation.

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Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183695 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1246

Author(s):

Dimple Sahni ◽

Bikramjit Singh ◽

K. S. Uppal ◽

Sanjeev Bhagat ◽

Dinesh Sharma ◽

...

Keyword(s):

Tympanic Membrane ◽

Sodium Hyaluronate ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Medium Size ◽

P Value ◽

Beneficial Effects ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Traumatic Origin

Background: Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations. The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.Methods: 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months. Results: 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.Conclusions: Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.

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Correlation of tympanic membrane perforations with hearing loss

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193857 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1213

Author(s):

Mirza Aneesa ◽

Samreen Siraj ◽

Arshid Ali

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Conductive Hearing Loss ◽

Tympanic Membrane Perforation ◽

Tympanic Membrane Perforations ◽

Posterior Quadrant ◽

Membrane Perforation ◽

Duration Of Disease ◽

Conductive Hearing ◽

Paired T Test

Background: Tympanic membrane perforations are common cause of hearing loss. This study was designed to analyze the relation between tympanic membrane perforation and hearing loss.Methods: In this prospective study, patients with dry tympanic membrane perforations of safe type were included. The patients were divided into groups in according to size, site and duration of perforation. Results: 49 patients with 70 dry tympanic membrane perforations were studied. Data was analyzed statistically using paired t-test. Hearing loss increased as the size of perforation increased. Posterior quadrant perforations were associated with more hearing loss as compared to anterior quadrant perforations. Also duration of disease was in linear relation with mean hearing loss.Conclusions:The degree of conductive hearing loss as a result of tympanic membrane perforation would be expected with the size, site and duration of perforation.

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