A Study of Correlation Between Tympanic Membrane Perforation Size With Hearing Loss in Patients With Inactive Mucosal Chronic Otitis Media

Abstract

Purpose: This study is directed towards establishing a correlation between the objective measurement of tympanic membrane (TM) perforation size with hearing loss in patients with inactive mucosal chronic otitis media (COM), and to compare the otoscopic findings of the TM perforation vis-a-vis the results obtained by image analysis of the endoscopic image of the perforation. Materials and methods: An observational, prospective and hospital based study was performed on 107 ears (78 patients) with inactive mucosal chronic otitis media. Objective measurement of the TM perforation size was done by capturing the images of the perforation on ImageJ analysis software. A correlation was established between the hearing loss and the perforation with respect to its size and location. The accuracy of the otoscopic finding of the perforation was established with respect to the endoscopic image of the perforation. Results: The extent of the hearing loss was seen to increase with increasing size of the TM perforation (r = 0.435, p < 0.0001). Posterior perforations had a 12% greater hearing loss than anterior perforations but this was significant only at the frequency of 500 Hz (p = 0.02). There was a positive correlation between the otoscopic estimation of the size of the perforation with the endoscopically obtained image. Conclusion: Hearing loss in chronic otitis media is directly proportional to the size of the TM perforation and posteriorly based perforations have worse audiometric thresholds at lower frequencies (500 Hz).

Do the size, site and activity of tympanic membrane perforations relate to hearing loss in Aboriginal and Torres Strait Islander children? An observational study.

“…We believe the absence of a significant increase in HL in both active and inactive perforations involving the 50-75% is due to the small number in the 50-75% group, making this a likely Type 1 error. An increase in HL with increased TM perforation size is consistent with the consensus of both theoretical and clinical studies in the literature 4,6,8,[10][11][12]16 . In a study of 78 patients (107 ears) with inactive mucosal COM, perforations were classified as a percentage of total surface area using image processing software 8 .…”

“…An increase in HL with increased TM perforation size is consistent with the consensus of both theoretical and clinical studies in the literature 4,6,8,[10][11][12]16 . In a study of 78 patients (107 ears) with inactive mucosal COM, perforations were classified as a percentage of total surface area using image processing software 8 . A strong correlation was found between HL and size of perforation 8 .…”

“…Our study found no difference in HL between frequencies across all perforation sizes and locations. This contradicts others that showed HL to be greater in the lower frequencies 4,6,8,11,21 . We hypothesise this may be due to the unique disease processes and lack of treatment in our patient group rather than the now discredited hypothesis of different anatomical factors between ATSI and Caucasian ears.…”

“…In a study of 78 patients (107 ears) with inactive mucosal COM, perforations were classified as a percentage of total surface area using image processing software 8 . A strong correlation was found between HL and size of perforation 8 . A study of 300 ears divided perforations into small, medium and large using digital measurements 11 .…”

“…It has been generally accepted that hearing loss (HL) is greater with an increase in size of the TM perforation 6 . However, perforation site and the effect on hearing is more controversial with contradictory evidence regarding this [6][7][8][9][10][11][12] . Whilst early work showed worse hearing with posteroinferior based perforations 13,14 , others have found posterosuperior defects to be worse 11,15 and more recent work demonstrated no difference between sites 4,6,7,12 .…”