Background: It is acknowledged that size and site of tympanic membrane perforation is proportional to degree of hearing loss but there are many studies which suggests otherwise. Persistent ear discharge is also supposed to deteriorate hearing level with passage of time. This study is carried out to find out the relation between size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Objectives: The objective of this study is to study the effect of size and site of tympanic membrane perforation and duration of ear discharge on hearing loss. Materials and methods: This is a cross-sectional prospective study conducted at Kathmandu Medical College, department of ear nose and throat from January till July 2009. One hundred patients aged between 8 to 60 years with pars-tensa perforations were included in the study. Detail clinical examination and history was carried out followed by hearing evaluation by audiometry was done in all cases. All the data is collected, statistical analysis is done using SPSS program and documented for study. Results: One hundred patients with 119 perforated tympanic membrane, age ranged between 8 to 60 years, 44 males and 56 females were studied. Bilateral tympanic membrane perforation were seen in 19 patients, right sided perforation in 39 and left sided in 42 patients respectively. Large central perforation involving all four quadrants was the most common otologic findings seen in 72 ears (60.50%) whereas perforation in posterosuperior quadrant was the least common finding seen in 3 patients (2.52%). Significant relation is observed between site of perforation and degree of hearing loss; posterior placed perforations seem to have larger hearing loss. Ninety-five perforations (79.83%) showed more loss in low frequencies with larger air bone gap at low frequencies. The longer the duration of ear discharge, the more the hearing loss. Conclusion: The larger the perforation, the greater the decibel loss in sound perception. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss. Key words: chronic suppurative otitis media; tympanic membrane perforation; hearing loss DOI: 10.3126/kumj.v7i4.2761 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 397-401

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Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type

Tympanoplasty is one of the ever evolving surgical procedures mainly aimed at restoring the hearing loss and eradication of middle ear disease. We have made an attempt to assess the hearing improvement of various types and techniques of tympanoplasty. A prospective observational study was done on 50 cases of CSOM, of which 45 cases were tubotympanic type, and 5 cases were attico-antral. Patients of only pure conductive component with good cochlear reserve and good Eustachian tube function were considered for the study. This study aims at assessing the hearing improvement with various types of tympanoplasty.

Pre-Operative and Post-Operative Assessment of Hearing following Tympanoplasty

There are not many studies on the effect of the site and size of the perforation on the hearing loss. This study is set to investigate the relationship between the size and site of perforation and hearing loss. This study was carried out between September 2011 to September 2013, at a tertiary care centre during which 100 cases of chronic otitis media tubotympanic type having central perforation were selected. All patients underwent, tympanoplasty using temporalis fascia/cartilage graft, underlay technique with or without simple mastoidectomy/modified radical mastoidectomy and followed up for 3 months and evaluated for graft uptake and hearing improvement with respect to size and site of TM perforation. To measure the size of perforation intra-operatively, thin transparency sheet was used, on which a graph paper of 1 × 1 mm2 size was printed. Significant relationship was observed between size and site of tympanic membrane perforation with hearing loss. Perforations which were involving all four quadrants (AS + AI + PS + PI) are having maximum residual perforations after the surgery. In relation with size, subtotal perforation were having more residual perforations postoperatively, followed by medium sized perforations. An inherent relationship noted between ossicular involvement and hearing loss, maximum average hearing loss was observed in those cases, where all three ossicles (malleus, incus & stapes) were involved, also more hearing loss was noted in posterior perforations.

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Study of outcome of tympanoplasties in relation to size and site of tympanic membrane perforation.

Introduction: Tympanoplasty is a standard procedure to repair tympanic membrane perforation. The aim of this study is to evaluate the results of tympanoplasty (hearing improvement and tympanic membrane closure rate) in patients suffering from chronic perforation of the tympanic membrane by considering the prognostic factors. Materials and Methods: In a prospective study, based on the results of tympanoplasty with temporal graft fascia in 60 patients in the ENT department of the Medical Science University of Tabriz, we evaluated prognostic factors, such as age, sex, smoking, size, and site of perforation, for the outcome of this surgery. Results: The rate of surgical success- integration of the graft- was 93.3%. Improvement of hearing, as demonstrated through audiometry, occurred in 93% of cases. We did not find any factors to be statistically significant to affect surgical outcome. Conclusion: Even by considering the influence of different factors on the results of a tympanoplasty operation, according to the statistical results of this study, there is not a significant difference in the results of the operation, neither in the health of the tympanic membrane after surgery nor in hearing development.

http://ijorl.mums.ac.ir/article_6551_7ca10b1142149663b8866bef49f53047.pdf

Evaluation of Factors Affecting the Surgical Outcome in Tympanoplasty.

Introduction Tympanic membrane perforation is a relatively common problem that predisposes patients to varying degrees of conductive hearing loss. Objective The objective of this study is to evaluate and analyze the frequency dependence hearing loss in tympanic membrane perforation based on the size and the site of perforation. Methods For the study, I selected 71 patients' (89) ears for the cross-sectional study with tympanic membrane perforations; I examined the size and the site of perforations under the microscope and classified them into small, moderate, large, and subtotal perforations, and into anterior central, posterior central, malleolor central, and big central perforations. I measured mean level of speech frequencies hearing loss, and its relation with the site and the size of the perforation analyzed. Results The mean hearing loss at different sizes of the perforation at all speech frequencies was 37.4 dB, with ABG of 26.6 dB, and its maximum loss was detected in subtotal perforation of 42.3 dB, with ABG of 33.7 dB, at 500 Hz frequency, while in relation to the sites, it was 38.2 dB, with ABG of 26.8 dB, and its maximum loss was detected in big central site perforation of 42.1 dB, with ABG of 33.6 dB, at 500 Hz frequency. Conclusions The hearing loss was proportionally related with the sizes of the perforations, and the posterior site had greater impact on the hearing than anterior site perforations. This was also applied to the frequency dependence hearing level, as was detected to be worse at lower frequencies as 500 Hz, than those of 1000–2000 Hz.

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Frequency Dependence Hearing Loss Evaluation in Perforated Tympanic Membrane.

This cross-sectional study was conducted in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery in TU Teaching Hospital from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. This study showed that the hearing loss was found to be more at lower frequencies and less as the frequencies increased. Hearing loss is more marked at lower frequencies as compared to higher frequencies, irrespective any size or location of perforation of pars tensa.

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Frequency dependence of hearing loss with perforations.

Objective: This prospective study was done to assess the level of preoperative hearing impairment in different sites of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty Materials and Methods: A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology and Head and Neck Surgery from June 2003 to May 2004 Cases of CSOM tubo-tympanic type with dry central perforation, with conductive type of hearing loss were subjected to myringoplasty Preoperative audiometric evaluations were done Just prior to operation, examination under microscope was performed Exact site of perforation was noted During operation, those found to have ossicular discontinuity or fixation were excluded from this study Results: It was observed that the greatest hearing loss was found in big central (45dB) and posterior central (43dB); whereas least in those of anterior central (31dB) and central malleolar (34dB) perforations The average hearing loss at 500Hz, 1000Hz and 2000Hzwas 4640 dB, 3090 dB and 319 dB respectively This showed that the hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase Conclusion: This study shows that the posterior-central perforations cause more hearing loss than anterior-central ones The hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase Journal of Institute of Medicine Vol27(2) 2005

Correlation of hearing impairment with site of tympanic membrane perforation

Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery. Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2 days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth. Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260 (6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation, 4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/ 11 (81.8%) patients by 6 months. Conclusion Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months . Functional recovery was earlier when CTN was preserved than when sectioned. Keywords: CTN; middle ear surgery; taste disturbance DOI: http://dx.doi.org/10.3126/joim.v32i3.4955 Journal of Institute of Medicine , December, 2010; 32:3 18-23

Taste disturbances following middle ear surgery

Background: To compare the Conventional methods with Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty. Materials and Methods: Patients above 17 years of age with the diagnosis of Chronic Suppurative Otitis Media-tubotympanic type undergoing Myringoplasty at TU Teaching Hospital from January 2004 to July 2005 were included in the study. The pre and postoperative Pure Tone Audiometry (PTA) was performed and evaluated. The postoperative subjective hearing status of the patients was recorded as improved, same or worsened. Objectively, the postoperative hearing was assessed in terms of Air Bone Gap closure, Air Conduction Threshold improvement and Glasgow Benefit Plot. The objective methods were then compared with the postoperative subjective hearing status of the patients. Results: The association between the Air Bone gap closure and the postoperative subjective hearing status was not statistically significant. The association between the Air Conduction threshold improvement and the postoperative subjective hearing status was statistically significant. The association between the Glasgow Benefit Plot and the postoperative subjective hearing status was also statistically significant. Conclusion: The study showed that the Air Conduction threshold improvement and the Glasgow Benefit plot are better parameters for evaluating subjective hearing results after myringoplasty than the Air Bone gap closure. Key words: Glasgow Benefit Plot, myringoplasty, Pure Tone Audiometry (PTA) The full text of this paper is available at Journal of Institute of Medicine website

RP Shrivastav

Papers

Frequency dependence of hearing loss with perforations.

Correlation of hearing impairment with site of tympanic membrane perforation

Taste disturbances following middle ear surgery

Comparison between the conventional methods and Glasgow Benefit Plot in evaluating subjective hearing results after myringoplasty