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

Abstract

BackgroundFactors 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.

Effects of location, size and shape of tympanic membrane perforations on hearing: analysis of 400 cases

“…1 On the other hand, there is a definite agreement regarding the size of the perforation: hearing loss will increase with the increasing size of a tympanic membrane perforation. [1][2][3] The volume of the middle ear and mastoid cell complex, involvement of manubrium mallei, and duration of perforations are other factors that may affect hearing. 1,4,5 The main goal of this study was to evaluate the effect of size, location and shape of the perforations on hearing by analysing pre-operative pure tone average (PTA) and air-bone gap (ABG) values of a large study group treated in a tertiary referral centre, which included over 400 cases.…”

Hearing loss increases with size but not site of tympanic membrane perforation in Aboriginal Australian children in remote locations

“…21 In a multivariate logistic regression analysis on 67 patients (86 perforations) aged 10 and over size of perforation proved to be the only significant predictor of HL severity. 23 The logistical challenges of data collection in our study population due to age, remoteness, and resources mean that the variables measured in the literature cited above could unfortunately not be measured in this study.…”

“…Several other studies also demonstrate increased HL with posterior perforations. Studies consistently utilize the manubrium mallei as the angled division between anterior and posterior 6–8,10,12,15,23 . However, the exact classification of location varies somewhat and is not often illustrated, making comparison difficult.…”

Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients

“…Perforation causes a decrease in ossicular coupling due to the inability to transmit pressure across the TM. A study set in the sub-Saharan African region showed a link between hearing loss and TM perforation, including the site of perforation [8]. There is also said to be a strong correlation between age and hearing function in such individuals, especially with conductive hearing loss, which was less severe in children than in patients over the age of 30 [9].…”