Relationship between tympanic membrane perforation and conductive hearing loss in patients with chronic otitis media

Abstract

INTRODUCTIONThere is high incidence of conductive hearing loss caused by perforations of tympanic membrane in chronic otitis media. The results of studies regarding the effect of the size and the site of perforations on the degree of hearing loss conflicting.Some studies show a correlation between degree of hearing loss and the size of tympanic membrane perforation that larger perforation causes larger hearing loss.1-4 The weak point of these studies is the crude estimation of the size of tympanic membrane perforation. In our study, we use a program enable us to calculate the surface area of perforation precisely and designing a logarithmic equation between degree of hearing loss and surface area of perforation.The results of articles were conflicting about the effect of perforation site on the degree of hearing loss. The present studies depend on comparing the mean of the degree of hearing loss of different site of perforation ABSTRACT 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.

Degree of Hearing Loss in Association with Site of Tympanic Membrane Perforation: A Systematic Review

“…Moreover, all the perforations were dry. 21 Posterior Normal Hearing 1(Ali et al 2019) 22 Anterior Normal Hearing 1(Ali et al 2019) 22 Multiple Moderate 1(Gupta et al 2019) 28 Total Mild 1(Gupta et al 2019) 28 Though it was found that most of the studies established mild degree hearing loss with most of the sites of perforations but looking at the individual intensities in decibels, posterior perforations had greater hearing loss than anterior ones. The studies that discussed central perforations depicted that central one had greater hearing loss than anterior and posterior perforations.…”

Middle ear status – structure, function and pathology: A scoping review on middle ear status of COVID-19 positive patients

“…Fidan et al ( 2020 ) reported hyperaemia and bulging of the tympanic membrane, while in a case series by Dharmarajan et al ( 2021 ), four participants presented with retracted tympanic membrane and two had dull tympanic membranes. While the third study (Wanna et al, 2020 ) did not specifically report on the anatomical structure of the tympanic membrane, this case study reported that a participant presented with purulent otorrhea, which may be indicative of tympanic membrane perforation (Ali & Alshareda, 2017 ).…”

The influence of tympanic membrane perforation site on the hearing level of conductive hearing loss in chronic suppurative otitis media

“…The effect of increasing the surface area ratio of the tympanic membrane to the oval window increases sound pressure by about 27 decibels while the movement of the ossicle lever contributes about 3 dB. 14 Ali et al 20 reported that a conductive hearing impairment in the tympanic membrane perforation could be resulted from two processes. There is ossicular coping that caused a pressure difference between the tympanic membrane surfaces on the inside and outside which would cause a decrease in phase between oval and round windows, and the surface of the tympanic membrane was subjected to interference with the transmission of sound waves from the external auditory canal-ossicles-cochlea.…”