Published: 2019-12-23

A prospective study of the hearing gain achieved in relation to the site and size of tympanic membrane perforation after type 1 tympanoplasty with temporalis fascia graft

Gopinathan N. Pillai, Anjana Mary Reynolds, Nazneen Parammal Ayyappankandi, Cyril C. Ninan


Background: Chronic otitis media (COM) mucosal type is characterised by recurrent ear discharge and hearing loss secondary to tympanic membrane perforation. Type 1 tympanoplasty is the surgical option for its closure. The objective of this study is to record the site and size of tympanic membrane perforation, quantify the hearing loss with pure tone audiogram and to assess the hearing gain achieved following type 1 tympanoplasty with temporalis fascia graft.

Methods: This prospective study comprises 120 patients of the age group of 15 to 60 years with COM who attended the otorhinolaryngology department, from June 2015 to May 2018. Site and size of perforation were assessed by the number of quadrants involved. Hearing loss was quantified by pure tone audiometry (PTA) pre-op and 3, 6 and 12 months post-op. The pure tone average with the air-bone gap (ABG) at 12 months is used for the assessment.  

Results: In this study, mean pure tone average pre-operatively for small, medium, large and subtotal perforations were 26 dB, 32 dB,35 dB, 42 dB respectively and 14.37 dB, 23 dB, 23.66 dB, and 32.5 dB post operatively after one year. On statistical analysis by ANOVA test, postoperative hearing gain was statistically significant.

Conclusions: The study shows that hearing loss was proportional to the size of perforation. Air-bone closure following type 1 tympanoplasty was more for subtotal perforation and for perforations involving both anterior and posterior quadrants.



Air-bone gap, Chronic otitis media, Conductive hearing loss, Pure tone audiogram, Type 1 tympanoplasty, Temporalis fascia graft

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Merchant SN, Rosowski JJ. Acoustics and Mechanics of the middle ear. In: Gulya AJ, Lloyd B. Minor, Dennis S. Poe. Glasscock Shambaugh. Surgery of the ear. 6th edn. Connecticut: People's Medical Publishing House;2010.59-61.

Wasson JD, Papadimitriou CE, Pau H. Myringoplasty impact of perforation size on closure and audiological improvement. J Laryngol Otol. 2009;123(9):973-7.

Lerut B, Pfammatter A, Moons J, Linder T. Functional correlation of tympanic membrane perforation size. Otol Neurotol. 2012;33:379-86.

Kumar N, Chilke D, Puttewar MP. Clinical Profile of tubotympanic CSOM and its management with special reference to site and size Tympanic membrane Perforation, Eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol. 2012;64:5-12.

Gudepu P, Kesavan B, Kanchumurthy A. Comparative study of hearing loss with site and size of perforation. J Evidence Based Med Healthcare. 2016;3(41):2035-40.

Dasgupta S, Maslin M. Physiology of hearing. In: Watkinson JC, Clarke RW. Scott-Brown's Otorhinolaryngology Head and Neck Surgery.8th edn. CRC Press: Taylor and Francis Group; 2018.578-9.(1):10.

Voss SE, Mehta RP, Rosowski JJ, Neil OE, Merchant SN. Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol. 2006;27(2):136-43.

Oluwole M. Assessment of the size of the tympanic membrane perforation: a comparison of clinical estimation with video otoscopic calculation. University of Ibadan; 2008.

Titus SI, Onyekwere GN, Taiwo GI. Correlating the site of tympanic membrane perforation with hearing loss. BMC Ear Nose Throat Disord. 2009;9:1-33.

Pannu KK, Chadha S, Kumar D, Preeti. Evaluation of hearing loss in tympanic membrane perforations. Indian J Otolaryngol Head Neck Surg. 2011;63(3);208-13.

Nahata V, Patil C, Patil R, Gattani G, Disawal A, Roy A. Tympanic membrane perforation; Its correlation with hearing loss and frequency affected-An analytical study. Indian J Otol. 2014;20:10-5.

Nayak PD, Solanki G, Chand D, Samor V, Gupta G, Sharma S. Study on impact of perforation size of tympanic membrane on hearing loss and audiological outcome after closure in patients with chronic otits media. Int J Med Res Prof. 2017;3(1);245-9.