Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2012
Functional correlations of tympanic membrane perforation size.
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Lerut Bob, Pfammatter Alain, Moons Johnny, Linder Thomas
Аннотация
OBJECTIVE: The correlation between tympanic membrane perforations and hearing loss was studied.
STUDY DESIGN: Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed.
SETTING: Tertiary referral center.
PATIENTS: One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included.
INTERVENTIONS: All patients underwent primary myringoplasty.
MAIN OUTCOME MEASURES: Preoperative conductive hearing loss due to eardrum perforations.
RESULTS: Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p < 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an 'inverted V shape' of the air-bone gap is a consistent finding. If the air-bone gap exceeds the 'inverted V-shape' pattern, additional pathology behind the eardrum must be assumed and addressed.
CONCLUSION: We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An "inverted V-shape" pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the air-bone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed.
STUDY DESIGN: Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed.
SETTING: Tertiary referral center.
PATIENTS: One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included.
INTERVENTIONS: All patients underwent primary myringoplasty.
MAIN OUTCOME MEASURES: Preoperative conductive hearing loss due to eardrum perforations.
RESULTS: Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p < 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an 'inverted V shape' of the air-bone gap is a consistent finding. If the air-bone gap exceeds the 'inverted V-shape' pattern, additional pathology behind the eardrum must be assumed and addressed.
CONCLUSION: We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An "inverted V-shape" pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the air-bone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed.