Traumatic tympanic membrane perforation: an overview in a tertiary care centre-Khammam

Background: Aim of the study was to distinguish traumatic tympanic membrane perforation (TTMP) by distribution, etiology and clinical presentation and to assess the prognosis and outcome of treatment and establish masterly inactivity as main treatment modality.Methods: A prospective observational study was performed on 60 cases of traumatic tympanic membrane perforation in the outpatient department of otorhinolaryngology, Mamatha medical college and general hospital, Khammam from October 2019 to March 2021. All the patients came to ENT OPD with the history of trauma to the ear and hearing loss were examined and after obtaining proper history, all the patients underwent ENT clinical examination, oto-endoscopic and audiological evaluation by pure tone audiometry. All the patients diagnosed with traumatic tympanic membrane perforation after obtaining informed written consent were included in the study. All the patients were followed at regular intervals and observations were recorded.Results: All patients were evaluated based on oto-endoscopic examination. Age ranges from 20-50 years, mean age of 33.6 years and with a male to female ratio of 1:1.4. Commonest etiology was physical assault (61.66%) followed by self-inflicted injury accounting 20%. Tinnitus (90%) was the common presenting complaint and the perforation spontaneously healing is about 90% patients.Conclusions: Traumatic perforation of tympanic membrane is under-reported otologic defect which has a good prognosis if treated at right time with a need to educate people on the consequences and about unskilled removal of wax/foreign body, early identification and apt diagnosis and management.

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Aftermath of traumatic tympanic membrane perforation: Our findings at a tertiary care hospital in Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.3.3923 ◽

2021 ◽

Vol 37 (3) ◽

Author(s):

Fazali Wahid ◽

Muhammad Saleem ◽

Raza Muhammad ◽

Muhammad Riaz Khan

Keyword(s):

Sample Size ◽

Tympanic Membrane ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

Common Finding ◽

Care Hospital ◽

Female Ratio ◽

Membrane Perforation

Objectives: To determine the outcome of traumatic tympanic membrane perforation in a teaching hospital at Peshawar, Pakistan. Methods: This prospective observational study was performed in the Department of ENT and Head and Neck Surgery, MTI/LRH, Peshawar, Pakistan from January 2016 to December 2019 after approved from Institutional Research and Ethical Board. All consented patients fulfilling inclusion criteria were enrolled. Sample size was calculated 114 using online sample size calculator (OpenEpi). Every patient was evaluated properly, subsequently otoscopy and PTA was performed. Required information was recorded and analyzed using SPSS (version 25). Results: Out of 114 patients 81 (71.1%) were males and 33(28.9%) were female with male: female ratio of 2.5:1. Patient’s age ranged from 6- 55 years with mean ± SD age of 26.41 ± 9.7 years. Majority of Patients, 46.5%( 53) were in 2nd decade. Amongst the causes slap outnumbered (80, 70.2%), and left ear was involved predominately (67, 58.7%) affecting mainly anterio-inferior quadrant (50, 43.9%). Small size perforation was most common finding (64, 56.1%). Majority of patients (72, 63.2%) presented in a week time and single perforation was the commonest (107, 93.%). Most of traumatic TM perforation got healed spontaneously (97, 85.1%). Conclusion: It is concluded that spontaneous healing of traumatic membrane perforation occurs in more than 90% cases provided the ear is kept dry and not accompanied by unfavorable conditions. doi: https://doi.org/10.12669/pjms.37.3.3923 How to cite this:Wahid FI, Saleem M, Muhammad R, Khan MR. Aftermath of traumatic tympanic membrane perforation: Our findings at a tertiary care hospital in Pakistan. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3923 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Traumatic perforations of tympanic membrane: a study of sixty patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194950 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1684

Author(s):

Anchal Gupta ◽

Padam Singh Jamwal

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone Audiometry ◽

Good Prognosis ◽

Management Approach ◽

Physical Assault ◽

Female Ratio ◽

Tympanic Membrane Perforations ◽

Common Etiology ◽

Systemic Antibiotics

Background: Traumatic perforation of the tympanic membrane can lead to hearing loss. This study was undertaken to study the etiology of traumatic tympanic membrane perforations.Methods: This hospital based retrospective observational study was conducted in the department of ENT, SMGS Hospital, Jammu from January 2018 to January 2019. A detailed clinical and otoscopic examination was done and symptoms noted. Tuning fork tests and pure tone audiometry was done in all the patients. Tympanic membrane perforations were visualized using otoscope or examination under microscope was done. A conservative management approach was adopted, except for those with bloody or watery discharge who received oral/systemic antibiotics to prevent infections. Results: 60 patients were included in the study. Maximum patients were in the age group of 21-40 years accounting for 56.7% patients. The male to female ratio was 1.4:1. The most common complaint was tinnitus (90%), followed by pain in ear (81.6%), hearing loss (56.7%), aural fullness (45%), ear bleed (16.7%) and vertigo (5%). The most common etiology was physical assault by slaps and blows to ear (40%), followed by instrumentation (syringing and foreign body removal). In 40 (66.67%), left ear was involved whereas in 20 (33.33%) right ear was involved. 51 (85%) patients showed spontaneous healing within 3 months whereas 9 (15%) showed no healing and these 15% patients underwent tympanoplasty at the end of 3 months.Conclusions: Traumatic tympanic membrane perforations have a very good prognosis if they are treated at a right time.

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001962 ◽

2018 ◽

Vol 132 (11) ◽

pp. 1013-1017

Author(s):

E Choffor-Nchinda ◽

F Djomou ◽

R-C Meva'a Biouele ◽

D Mindja ◽

A Bola ◽

...

Keyword(s):

Hearing Loss ◽

Tympanic Membrane ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Sub Saharan Africa ◽

Cross Sectional ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Sub Saharan ◽

Loss Severity

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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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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Tympanoplasty Type-I using tragal perichondrium graft: Our experience

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.421 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Fazali Wahid ◽

Sajid Rashid Nagra

Keyword(s):

Tertiary Care ◽

Case Series ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

P Value ◽

Type I ◽

Care Hospital ◽

Female Ratio ◽

Case Series Study

Objective: To determine the efficacy of tragal perichondrium graft used in tympanoplasty Type-I at a tertiary care hospital. Methods: This descriptive case-series study was performed at the department of E.N.T, Head and Neck Surgery, Medical Teaching Institution/Lady Reading Hospital (MTI/LRH), Peshawar, Pakistan from June 2017 to May 2018. After approved from IREB, a well informed consent was taken. Pure Tone Audiometry (PTA) was performed before surgery and post-operatively at three and six months interval. The mean ± SD Air-Bone Gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). Chi-square (X2) test of significance was used taking confidence interval at 95%. The p-value ≤0.05 was considered significant. Results: Total patients were 36; male 21 (58.3%), female 15(41.7%) with male: female ratio of 1.4:1. Mean ± SD age was 27.14 ± 7.49 years (Range 15 – 50Years). Tympanic membrane perforation was commonly found on right side 22 (61.1%), predominantly involving anterioinferior site 19 (52.8%) and medium sized perforation outnumbered 22 (61.1%). Mean pre-operative air-conduction of 49.72 dB was significantly reduced to 18.27 dB with pvalue of <0.05. Similarly the pre-operative mean air bone gap on PTA of 45.63 ± 8.35dB was also reduced to statistically significant level of 7.41 ± 3.51 dB on post-operative PTA with p-value of <.05. Graft was taken up well in 34 cases (94.4%). Conclusion: Tragal perichondrial graft is an effective grafting material used for tympanoplasty due to its possessing qualities. doi: https://doi.org/10.12669/pjms.35.4.421 How to cite this:Wahid FI, Nagra SR. Tympanoplasty type I using tragal perichondrium graft: Our experience. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.421 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparative study of outcomes of type-1 tympanoplasty with and without anterior tucking

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201277 ◽

2020 ◽

Vol 6 (4) ◽

pp. 657

Author(s):

Kiran Gangadar S. ◽

G. Priyadarshini

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Type 1 Tympanoplasty ◽

Membrane Perforation ◽

Group 2

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

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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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Evaluasi Pendengaran Pasien Pascatindakan Miringoplasti Berdasarkan Gambaran Audiometri Nada Murni di Rumah Sakit Dr. Hasan Sadikin Bandung

Journal Of Medicine & Health ◽

10.28932/jmh.v3i1.3171 ◽

2021 ◽

Vol 3 (1) ◽

pp. 9-15

Author(s):

Anggie Mutmainnah ◽

Arif Dermawan ◽

Lina Lasminingrum

Keyword(s):

Tympanic Membrane ◽

Middle Ear ◽

Hearing Threshold ◽

Pure Tone Audiometry ◽

Descriptive Study ◽

Tympanic Membrane Perforation ◽

Hearing Improvement ◽

Membrane Perforation ◽

Ear Infections ◽

Age Range

Tympanic membrane perforation is one of the causes of hearing loss and can causerecurrent middle ear infections. Myringoplasty is a procedure for reconstruction of the tympanicmembrane perforation by using a ring in the ear with a complete hearing bone chain, goodmotion, and no pathological tissue in the middle ear. Myringoplasty aims to improve hearingfunction and prevent recurrent infections of the middle ear and inner ear. This study aimed tofind out the hearing characteristics of patients after myringoplasty based on an image of pure tone audiometry in the THT-KL Poli RSHS Bandung period January - December 2016. This is aretrospective descriptive study of patients undergoing myringoplasty. There were 285 new casesof tympanic membrane perforation with an age range of 15-55 years; 153 men (53.7%), 132women (46.3%), 109 (50.27%) patients had an increase in the hearing threshold of 10.1 dB - 20dB, reaching a normal hearing threshold of 249 (87, 4%) patients, and closure of perforationwere 254 (89.1%) patients. In a conclusion, there was a good hearing improvement aftermyringoplasty on tympanic membrane perforation without other abnormalities. Keywords: Myringoplasty, perforation of the tympanic membrane, increased hearing threshold.

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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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