J Med Sci, Volume 54, Number 3, 2022 July: 256-263 256 *corresponding author: dyahayukd@gmail.com Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Volume 54, Number 3, 2022; 256-263 https://doi.org/10.19106/JMedSci005403202206 Submitted: 2021-12-01 Accepted : 2022-02-12 Keywords: chronic suppurative otitis media; tympanic membrane perforation; site of perforation; hearing threshold level; hearing loss The influence of tympanic membrane perforation site on the hearing level of conductive hearing loss in chronic suppurative otitis media Adhika Banu Wicaksono, Edhie Samodra, Melysa Fitriana, Feri Trihandoko, Anisa Haqul Khoiria, Dyah Ayu Kartika Dewanti* Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia ABSTRACT Chronic suppurative otitis media (CSOM) is an infection of the middle ear cavity both partially and totally. It is characterized by ear discharge through a tympanic membrane perforation for over a period of 2 to 6 weeks. Hearing loss is the most common complication of CSOM. One of the degrees of hearing loss in tympanic membrane perforation is depending on the site of perforation, but this premise is still debatable because of pros and contras by some researchers. This study aimed to assess the degree of hearing loss in relation to the site of tympanic membrane perforation. A cross-sectional prospective study design was performed involving 43 patients of safe type CSOM who came to the Department of Otolaryngology Head and Neck Surgery from the period January 2016 to November 2018. All subjects were divided into 4 groups based on the site of perforation. There was a perforation in the posteroinferior, the posterosuperior, the anteroinferior, and the anterosuperior. A statistical analysis using Anova along with multivariate analysis was conducted. Our result showed that the most common site of tympanic membrane perforation was at the anteroinferior (30 samples, 59.8%). The highest hearing threshold was seen at posteroinferior with a mean hearing level of 37.7±2.0 dB, anteroinferior with a mean hearing level of 31.7±0.7 dB, anterosuperior with a mean hearing level 30.7±1.4 dB, and posterosuperior mean hearing level 28.9±1.5 dB. The difference was found significant with p=0.004. Posteroinferior tympanic membrane perforation had a higher number of hearing loss compared to the other sites. In conclusion, the tympanic membrane perforation site has an important role in the hearing level of conductive hearing loss in CSOM. ABSTRAK Otitis media supuratif kronis (OMSK) adalah infeksi pada rongga telinga tengah baik sebagian maupun seluruhnya. OMSK ditandai dengan keluarnya cairan dari telinga melalui perforasi membran timpani selama lebih dari 2 sampai 6 minggu. Gangguan pendengaran adalah komplikasi OMSK yang paling umum. Derajat gangguan pendengaran tergantung pada lokasi perforasi membran timpani, tetapi dugaan ini masih diperdebatkan karena adanya pro dan kontra dari para peneliti. Penelitian ini bertujuan menilai derajat gangguan pendengaran dalam kaitannya dengan lokasi perforasi membran timpani. Rancangan penelitian prospektif potong lintang terhadap 43 pasien OMSK tipe aman yang datang ke poli THT-KL rawat jalan periode Januari 2016 sampai November 2018. Subjek penelitian dibagi menjadi empat kelompok berdasarkan letak perforasi yaitu posteroinferior, posterosuperior, anteroinferior, dan anterosuperior. Analisis statistik dilakukan menggunakan Anava disertai analisis perbedaan multivariat. Hasil penelitian menunjukkan bahwa tempat perforasi membran timpani yang paling umum adalah di anteroinferior (30 sampel, 59,8%). Ambang pendengaran tertinggi terlihat pada posteroinferior dengan tingkat pendengaran rata-rata 37,7±2,0 dB, anteroinferior dengan tingkat pendengaran rata-rata 31,7±0,7 dB, anterosuperior dengan tingkat pendengaran rata-rata 30,7±1,4 dB, dan tingkat pendengaran rata-rata posterosuperior 28,9±1,5 dB. Perbedaan ditemukan signifikan dengan p=0,004. Perforasi membran timpani posteroinferior memiliki jumlah gangguan pendengaran yang lebih tinggi dibandingkan dengan tempat lain. Dapat disimpulkan letak perforasi membran timpani memiliki peran penting terhadap derajat pendengaran tuli konduktif pada OMSK.