Relationship between tympanic membrane perforation and conductive hearing loss in patients with chronic otitis media

Amjed H. Ali, Isam M. Alshareda


Background: Study performed to evaluate relationship between surface area of tympanic membrane perforation and degree of hearing loss and the effect of perforation site on that relationship in patients with chronic otitis media.

Methods: Seventy-five perforated tympanic membranes from 63 patients aged between 14-45 years with inactive mucosal chronic otitis media included in this study. Rigid endoscope (0 degree) used to take an image for each perforation that analyzed by Autodesk Design Review 2013 program. Degree of hearing loss assessed by pure tone audiometry. Surface area of perforation classified into four groups according to its percentage. Perforation site categorized into three groups regarding its relation to handle of malleus. Data analysis carried out with SPSS program version 17.  

Results: We studied 34 females and 29 males with different surface area and site of perforations. It observed that with increment of surface area of tympanic membrane perforation, the degree of conductive hearing loss increases (P value=0.000). This relationship expressed in a logarithmic equation. The mean hearing loss of posterior perforation was 1.7±0.5 dB for each 1% of perforation but in anterior perforation was 1.5±0.6 dB for each 1% of perforation (p value 0.185).

Conclusions: In chronic otitis media, there is a quantitative logarithmic relationship between surface area of tympanic membrane perforation and degree of conductive hearing loss. The site of perforation does not play a significant role in determining degree of conductive hearing loss.


Site of tympanic membrane perforation, Size of tympanic membrane perforation, Degree of hearing loss in CSOM, Measurement of size of perforation

Full Text:



Nahata V, Patil CY, Patil RK. Tympanic membrane perforation: Its correlation with hearing loss and frequency affected - An analytical study. Indian J Otol. 2014;20(1):10-5.

Maharjan M, Kafli P, Bista M. Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. Kathmandu University Med J. 2009;7(4):397-401.

Pannu KK, Chadha S, Kumar D. Evaluation of Hearing Loss in Tympanic Membrane Perforation. Indian J Otolaryngol Head Neck Surg. 2011;63(3):208–13.

Nepal A, Bhandary S, Mishra SC. Assessment of quantitative hearing loss in relation to the morphology of central tympanic membrane perforations. Nepal Med Coll J. 2007;9(4):239-44.

Browning GG, Merchant SN, Kelly G. Conditions of the middle ear. In: Gleeson M, eds. Scott-Brown's Otorhinolaryngology Head and Neck Surgery. Seventh edition. London: Edward Arnold; 2008: 3388-3430.

Mehta RP, Rosowski JJ, Voss SE. Determinants of Hearing Loss in Perforations of the Tympanic Membrane. Otol Neurotol. 2006;27(2):136-43.

Bhusal CL, Guragian RPS, Shrivastav RP. Correlation of hearing impairment with site of tympanic membrane perforation. Journal Institute Med. 2005;27(2):.

Ibekwe TS, Nwaorgu OG, Ijaduola TG. Correlating the site of tympanic membrane perforation with Hearing loss. BMC Ear, Nose Throat Dis. 2009;9:1.

Ribeiro FA, Gaudino VR, Pinheiro CD, Marcal GJ. Objective comparison between perforation and hearing loss. Brazilian Journal of Otorhinolaryngology. 2014;80(5):386-9.

Gulya AJ. Anatomy of the Temporal Bone and Skull Base. In: Gulya AJ, Minor LB, Poe DS, eds. Glasscock-Shambaugh Surgery of the Ear. Sixth edition. USA: People's Medical Publishing House; 2010: 57-65.