The Effect of Tympanic Membrane Perforation Site, Size and Middle Ear Volume on Hearing Loss

Aslıer, Mustafa; Özay, Hüseyin; Gürkan, Selhan; Kırkım, Günay; Günerı, Enis Alpin

doi:10.5152/tao.2019.4015

Cited by 17 publications

(41 citation statements)

References 10 publications

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“…1,2,8,9 The common view is that hearing loss varies inversely with middle-ear volume (ABGs are larger in ears with smaller middle-ear volumes). 1,11,12 In these studies, either tympanometry or computer software is used to measure the middle-ear mastoid volume. But both of these techniques have limitations regarding accuracy.…”

Section: Discussionmentioning

confidence: 99%

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

Balci

İşlek²,

Bakiş

et al. 2021

J. Laryngol. Otol.

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Objective This study aimed to evaluate the effect of size, location and shape of tympanic membrane perforations on hearing levels of a large study group treated in a tertiary referral centre. Method Medical data of 458 patients with tympanic membrane perforations were evaluated. Results A total of 336 patients had normal middle-ear findings during the surgical procedures. There was a significant difference in terms of mean pure tone average and air–bone gap values between posterior-inferior and anterior-inferior perforations (p = 0.005 and p = 0.044, respectively). The mean air–bone gap value of kidney-shaped perforations was significantly higher. Posterior-superior and posterior perforations were significant indicators for ossicular chain defects (p < 0.001; odds ratio, 14.2 and p = 0.004; odds ratio, 3.4, respectively). Conclusion Perforations located in the posterior-inferior quadrant caused the greatest hearing loss. The difference between posterior-inferior and anterior-superior or inferior perforations was statistically significant. Posterior perforations had a significant relationship with ossicular chain pathologies. Kidney-shaped perforations caused higher pure tone average and air–bone gap values than annular, elliptical or pinpoint perforations.

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Section: Discussionmentioning

confidence: 99%

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

Balci

İşlek²,

Bakiş

et al. 2021

J. Laryngol. Otol.

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“…14,19 The results of experimental studies on human cadavers by Zahnert et al 19 showed that reducing the thickness of the cartilage graft may decrease acoustic transfer loss. A study by Aslıer et al 20 on 34 cases of type 1 tympanoplasty using cartilage grafts showed no differences in hearing thresholds, but graft material, graft thickness, cartilage surface area ratio and time passed after surgery may affect the course of sound energy absorbance. In the present study, a significant reduction was observed in air-bone gap at frequencies of 0.25, 1 and 2 kHz (5-7 dB) a year following surgery; hence, crushed cartilage may affect the course of acoustic transfer and may reduce air-bone gap.…”

Section: Discussionmentioning

confidence: 96%

Comparing audiometric parameters between crushed and intact cartilage tympanoplasty: a double-blinded, randomised, controlled trial study

et al. 2020

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ObjectiveTo investigate hearing and the take rate of crushed cartilage grafts in tympanoplasty.MethodsIn this double-blinded, randomised, controlled trial, 46 patients with tympanic membrane perforation were enrolled. A conchal cartilage graft was used for reconstruction in both intervention and control groups. In the intervention group, crushed cartilage was used. The success rate and hearing results were ascertained every four months over a one-year follow-up period.ResultsA total of 36 patients – 20 in the intervention group and 16 in the control group – completed one year of follow up. There were no statistically significant differences between the two groups in mean air–bone gap, bone conduction threshold, speech discrimination score or speech reception threshold.ConclusionThe reduction in living cells after crushed cartilage tympanoplasty may decrease the rigidity and the volume of the graft, but may not necessarily improve the hearing results.

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“…However, they showed no dependence of sound transmission on the location of a TM perforation. In contrast, other groups were able to determine the dependence of middle ear sound transmission on the location of a perforation in their experiments [ 23 , 24 ] and its effect on HL [ 25 , 26 ]. Voss et al [ 27 ] demonstrated that higher sound pressure at the oval window has no relevant effect on sound transmission.…”

Section: Discussionmentioning

confidence: 99%

The impact of tympanic membrane perforations on middle ear transfer function

Bevis

Sackmann

Effertz

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Injury or inflammation of the middle ear often results in the persistent tympanic membrane (TM) perforations, leading to conductive hearing loss (HL). However, in some cases the magnitude of HL exceeds that attributable by the TM perforation alone. The aim of the study is to better understand the effects of location and size of TM perforations on the sound transmission properties of the middle ear. Methods The middle ear transfer functions (METF) of six human temporal bones (TB) were compared before and after perforating the TM at different locations (anterior or posterior lower quadrant) and to different degrees (1 mm, ¼ of the TM, ½ of the TM, and full ablation). The sound-induced velocity of the stapes footplate was measured using single-point laser-Doppler-vibrometry (LDV). The METF were correlated with a Finite Element (FE) model of the middle ear, in which similar alterations were simulated. Results The measured and calculated METF showed frequency and perforation size dependent losses at all perforation locations. Starting at low frequencies, the loss expanded to higher frequencies with increased perforation size. In direct comparison, posterior TM perforations affected the transmission properties to a larger degree than anterior perforations. The asymmetry of the TM causes the malleus-incus complex to rotate and results in larger deflections in the posterior TM quadrants than in the anterior TM quadrants. Simulations in the FE model with a sealed cavity show that small perforations lead to a decrease in TM rigidity and thus to an increase in oscillation amplitude of the TM mainly above 1 kHz. Conclusion Size and location of TM perforations have a characteristic influence on the METF. The correlation of the experimental LDV measurements with an FE model contributes to a better understanding of the pathologic mechanisms of middle-ear diseases. If small perforations with significant HL are observed in daily clinical practice, additional middle ear pathologies should be considered. Further investigations on the loss of TM pretension due to perforations may be informative.

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The Effect of Tympanic Membrane Perforation Site, Size and Middle Ear Volume on Hearing Loss

Cited by 17 publications

References 10 publications

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

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

Comparing audiometric parameters between crushed and intact cartilage tympanoplasty: a double-blinded, randomised, controlled trial study

The impact of tympanic membrane perforations on middle ear transfer function

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