CORRELATION BETWEEN TYMPANIC MEMBRANE PERFORATION AND HEARING LOSS

Lidija RISTOVSKA, Zora JACHOVA, Rade FILIPOVSKI, Nikica ATANASOVSKA

Abstract


Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. The perforation causes conductive hearing loss by reducing the surface area available for sound transmission to the ossicular chain.

Objective: The objective was to analyze the characteristics of tympanic membrane perforations in relation to hearing loss and to determine the type and degree of hearing loss.

Materials and methods: We analyzed audiometric, otoscopic findings and medical reports of 218 patients, 114 males (52.3%) and 104 females (47.7%), aged 9 to 75 years (mean age of 47.9 years), examined during the period of November 2012 to October 2015. For statistical data analysis we used Chi-square test with level of significance p<0.05.  

Results: Most of the patients had unilateral perforations (89%) with right ear predominance and involvement of two quadrants of pars tensa (37.2%). Mean air-bone gap was 23.9 dB. The largest air-bone gap was at frequency of 250 Hz. Most of the patients (73.1%) had mixed hearing loss (p=0.032), and average hearing thresholds from 21 to 40 dB.

Conclusion: Mean air-bone gap is largest at the lower frequencies, and decreases as frequency increases. Size of the perforation has effect on hearing loss. Mean air-bone gap increases with increasing size of the perforation. There is no big difference between the mean air-bone gap in posterior versus anterior perforations.


Keywords


hearing loss; perforation; tympanic membrane

Full Text:

PDF

References


Villar-Fernandez MA, Lopez-Escamez JA. Outlook for tissue engineering of the tympanic membrane. Audiol Res, 2015; 5(1): 117.

Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital, 2011; 31(6): 366-371.

Erkorkmaz Ü, Yılmaz MS, Güven M, Kaymaz R. Determination of factors that impact patient satisfaction following tympanoplasty. J Int Adv Otol 2014; 10(3): 264-269.

Stenfeldt K, Johansson C, Hellström S. The collagen structure of the tympanic membrane: collagen types I, II, and III in the healthy tympanic membrane, during healing of a perforation, and during infection. Arch Otolaryngol Head Neck Surg, 2006; 132(3): 293-298.

Isaacson JE, Vora NM. Diferential diagnosis and treatment of hearing loss. Am Fam Physician 2003; 68(6): 1125-1132.

Mehta RP, Rosowski JJ, Voss SE, O'Neil E, Merchant SN. Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol 2006; 27(2): 136-143.

Kumar N, Chilke D, Puttewar MP. Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation. Eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg 2012; 64(1): 5-12.

Park H, Hong SN, Kim HS et al. Determinants of conductive hearing loss in tympanic membrane perforation. Clin Exp Otorhinolaryngol 2015; 8(2): 92-96.

Debnath M, Khanna S. A comparative study of closure of tympanic membrane perforation between chemical cauterization and fat plug myringoplasty. International Journal of Otolaryngology and Head & Neck Surgery, 2013; 2(6): 248-252.

Saliba I, Froehlich P. Hyaluronic acid fat graft myringoplasty, An office based technique adapted to children. Arch Otolaryngol Head Neck Surg, 2011; 137(12): 1203-1209.

Hong P, Bance M, Gratzer PF. Repair of tympanic membrane perforation using novel adjuvant therapies: a contemporary review of experimental and tissue engineering studies. Int J Pediatr Otorhinolaryngol, 2013; 77(1): 3-12.

Rafique M, Farrukh MS, Shaikh AA. Assessment of hearing loss in tympanic membrane perforation at tertiary care hospitals. Journal of Liaquat University of Medical and Health Sciences, 2014; 13(1): 32-36.

Sharma K, Manjari M, Salaria N. Middle ear cleft in chronic otitis media: a clinicohistopatological study. Indian J Otolaryngol Head Neck Surg, 2013; 65(Suppl 3): S493-S497.

Fukuchi I, Cerchiari DP, Garcia E, Rezende CEB, Rapoport PB. Tympanoplasty: surgical results and comparison of the factors that may interfere in their success. Braz J Otorhinolaryngol 2006; 72(2): 267-271.

Schroeder A, Darrow DH. Management of the draining ear in children. Pediatr Ann 2004; 33(12): 843-853.

Olowookere SA, Ibekwe TS, Adeosun AA. Pattern of tympanic membrane perforation in Ibadan: a retrospective study. Ann Ib Postgrad Med 2008; 6(2): 31-33.

Singh B, Baka N, Kumar N, Purohit JP. Study of various grafts in closure of tympanic membrane perforation. Scholars Journal of Applied Medical Sciences 2015; 3(3G): 1509-1515.

Bhadouriya S, Srivastava M, Gaur S, Lavania A, Saxena R. A study of chemical cauterization of tympanic membrane perforations by using trichloroacetic acid. International Journal of Institutional Pharmacy and Life Sciences 2012; 2(2): 195-204.

Al-Juboori AN. Evaluation of spontaneous healing of traumatic tympanic membrane perforation. General Med 2014; 2(1): 129.

Dawood MR. Spontaneous healing of traumatic tympanic membrane perforation. Mustansiriya Medical Journal 2015; 14(1): 24-29.

Afolabi OA, Aremu SK, Alabi BS, Segun-Busary S. Traumatic tympanic membrane perforation: An aetiological profile. BMC Res Notes 2009; 2: 232.

Sarojamma DSR, Raj S, Satish HS. A clinical study of traumatic perforation of tympanic membrane. IOSR Journal of Dental and Medical Sciences 2014; 13(4): 24-28.

Abbas S, Arshad M, Ghani S. Tympanic membrane perforations secondary to blast trauma - an experience of 74 affected ears. Isra Medical Journal 2014; 6(4): 267-269.

Ritenour AE, Wickley A, Ritenour JS et al. Tym¬panic membrane perforation and hearing loss from blast overpressure in Operation Enduring Freedom and Operation Iraqi Freedom wounded. J Trauma 2008; 64(2 Suppl): S174-S178.

Johnston LC, Feldman HM, Paradise JL et al. Tym¬panic membrane abnormalities and hearing levels at the ages of 5 and 6 years in relation to persistent otitis media and tympanostomy tube insertion in the first 3 years of life: a prospective study incorporating a randomized clinical trial. Pediatrics 2004; 114(1): e58-e67.

Ibekwe TS, Nwaorgu OG, Ijaduola TG. Correlating the site of tympanic membrane perforation with hearing loss. BMC Ear Nose Throat Disord 2009; 9: 1.

Maharjan M, Kafle P, Bista M, Shrestha S, Toran KC. Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. Kathmandu Univ Med J (KUMJ) 2009; 7(4): 397-401.

Ansari MA, Khayani IAM, Farrukh MS, Kashmiri ZA, Farooq MU. Outcome of bilateral myringoplasty in dry central perforation - an appraisal. J Dow Univ Health Sci 2014; 8(1): 16-20.

Lerut B, Pfammatter A, Moons J, Linder T. Functional correlations of tympanic membrane perforation size. Otol Neurotol 2012; 33(3): 379-386.

Nahata V, Patil CY, Patil RK, Gattani G. Tympanic membrane perforations: Its correlation with hearing loss and frequency affected – An analytical study. Indian Journal of Otology 2014; 20(1): 10-15.

Elhaj AsHA, Abdalla MB, Abdalla HA. The effect of area and site of tympanic membrane perforations on hearing thresholds among Sudanese patients. Gezira Journal of Health Sciences 2008; 4(1): 1-12.

Bhusal CL, Guragain RPS, Shrivastav RP. Size of tympanic membrane perforation and hearing loss. JNMA J Nepal Med Assoc 2006; 45(161): 167-172.

Pannu KK, Chadha S, Kumar D, Preeti. Evaluation of hearing loss in tympanic membrane perforation. Indian J Otolaryngol Head Neck Surg 2011; 63(3): 208-213.

Santhi T, Rajan KV. A study of closure of tympanic membrane perforations by chemical cauterization. Indian J Otolaryngol Head Neck Surg 2012; 64(4): 389-392.

Islam MS, Islam R, Bhuiyan MAR, Rashid S, Datta PG. Pattern and degree of hearing loss in chronic suppurative otitis media. Bangladesh Journal of Otorhinolaryngology 2010; 16(2): 96-105.

Ribeiro FdeAQ, Gaudino VRR, Pinheiro CD, Marçal GJ, Mitre EI. Objective comparison between perforation and hearing loss. Braz J Otorhinolaryngol 2014; 80(5): 386-389.

Kasliwal N, Joshi S, Pareek SM. Determinants of sensorineural hearing loss in chronic middle-ear disease. Indian J Otolaryngol Head Neck Surg 2004; 56(4): 269-273.

Barman D, Dutta M, Mukherjee M, Sarkar A, Shit S, Sarkar A. Evaluation of cochlear function in safe type of chronic otitis media. Bengal Journal of Otolaryngology and Head Neck Surgery 2013; 21(1): 8-11.

Mohsin MA, Kumar MR, Reddy BGN, Ravikumar D. Sensorineural hearing loss in chronic suppurative otitis media of tubotympanic variety. National Journal of Otorhinolaryngology and Head & Neck Surgery 2013; 1(10): 3-4.

de Azevedo AF, Pinto DCG, de Souza NJA, Greco DB, Gonçalves DU. Sensorineural hearing loss in chronic suppurative otitis media with and without cholesteatoma. Braz J Otorhinolaryngol 2007; 73(5): 671-674.




DOI: http://dx.doi.org/10.19057/јser.2016.2

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Article Metrics Graph

No metrics found.

Refbacks

  • There are currently no refbacks.