Published: 2020-04-21

Role of pure tone audiometry in assessing ossicular status in patients with mucosal type of chronic otitis media

Deepthy Das, Gurumani Sriraman, Valli Rajasekaran


Background: Chronic suppurative otitis media (CSOM) is the disease of the middle ear cleft, which presents as hearing loss and ear discharge. This study aimed to assess the role of pure tone audiometry (PTA) in analysing the ossicular erosion in mucosal type of CSOM subjects.

Methods: The current cross-sectional study was conducted among 60 people with mucosal CSOM.  Preoperative hearing was assessed by PTA. The surgeries were done and intra operative ossicular status were recorded. IBM SPSS 20 software was used for the analysis. Student t-test was used to correlate ossicular status and PTA findings.  

Results: Among 60 subjects, 12 (20%) patients had eroded incus and 53 (88.3%) had normal stapes. The malleus was preserved in all patients. The result of our study showed that an average ABG of 58 dB at 500 Hz, 47 dB at 1 kHz, 41 dB at 2 kHz and 41 dB at 4 kHz in patients with   ossicular erosion. ABG for 500 Hz and 1 kHz were statistically significant for eroded incus. ABG for 500 Hz, 1 kHz, 2 kHz and 4 kHz were all statistically significant for eroded stapes.

Conclusions: There is a significant difference between the PTA findings at different frequencies between intact and eroded ossicular chain. Pre-operative ABG helps us to assess the status of incus and stapes.


Chronic otitis media, Ossicular discontinuity, Promontory, Pure tone average, Tubotympani

Full Text:



Jahn AF. Chronic otitis media: diagnosis and treatment. Med Clin N Am. 1991;75(6):1277-91.

Acuin J. Chronic suppurative otitis media: burden of illness and management options. In Chronic suppurative otitis media: burden of illness and management options. WHO. 2004: 83.

Rao VV, Shilpa MJ, Bhat M. Pattern of hearing loss in tubotympanic type of chronic suppurative otitis media. Int J Otorhinolaryngol Head Neck Surg. 2018;4(5):1267.

Kabdwal N, Varshney S, Bist SS, Bhagat S, Mishra S, Agarwal V. Pre- and post-operative evaluation of hearing in chronic suppurative otitis media. Indian J Otol. 2013;19(4):164.

Das AK, Jumani K, Kashyap RC. Subdural empyema: A rare complication of chronic otitis media. Med J Armed Forces India. 2005;61(3):281.

Gupta A, Agarwal SR. A study of prevalence of cholesteatoma in complications of suppurative otitis media. Indian J Otolaryngol Head Neck Surg. 1998;50(2):140-6.

Proctor B. The development of the middle ear spaces and their surgical significance. J Laryngol Otol. 1964;78(7):631-45.

Sade J, Berco E, Buyanover D, Brown M. Ossicular damage in chronic middle ear inflammation. Acta Otolaryngologica. 1981;92(1-6):273-83.

Katz J, Chasin M, English KM, Hood LJ, Tillery KL, editors. Handbook of clinical audiology. Baltimore: Williams and Wilkins; 1978.

Fausti SA, Wilmington DJ, Helt PV, Helt WJ, Martin KD. Hearing health and care: the need for improved hearing loss prevention and hearing conservation practices. J Rehab Res Develop. 2005;42.

Patil DU, Burse KS, Kulkarni SV, Sancheti V, Bharadwaj C. Correlation of the pure tone audiometry findings with intraoperative findings in patients with chronic suppurative otitis media. MVP J Med Sci. 2015;2(1):4-14.

Srinivas C, Kulkarni NH, Bhardwaj NS, Kottaram PJ, Kumar SH, Mahesh V. Factors influencing ossicular status in mucosal chronic otitis media: an observational study. Indian J Otol. 2014;20(1):16.

Shariff ME. Analysis of hearing loss by pure tone audiometry in patients with chronic suppurative otitis media. National J Physiol Pharm Pharmacol. 2019;9(6):515-8.

Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg. 2010;62(4):421-6.

Yazdi KA, Saedi B, Fayezizadeh M, Seifmanesh H. Association between audiometric profile and intraoperative findings in patients with chronic suppurative otitis media. Iranian J Otorhinolaryngol. 2011;23(2):37-42.

Ahmed SA, Hameed A, Khaleel ME, Munir M. Analytical study of ossicular chain in middle ear cholesteatoma. Annals King Edward Med Univ. 2009;15(3):134.

Muftah S, Mackenzie I, Faragher B, Brabin B. Prevalence of chronic suppurative otitis media (CSOM) and associated hearing impairment among school-aged children in Yemen. Oman Med J. 2015;30(5):358.