International Journal of Otorhinolaryngology and Head and Neck Surgery | September-October 2018 | Vol 4 | Issue 5 Page 1233 International Journal of Otorhinolaryngology and Head and Neck Surgery Herkal K et al. Int J Otorhinolaryngol Head Neck Surg. 2018 Sep;4(5):1233-1239 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 Original Research Article Hearing loss in tympanic membrane perforations: an analytic study Kartik Herkal 1 , Karthikeyan Ramasamy 2 , Sunil Kumar Saxena 2 , Sivaraman Ganesan 2 , Arun Alexander 2 * INTRODUCTION Hearing loss is one of the major reasons for disability and social anxiety in a person’s life. Permanent perforation of tympanic membrane (TM) in chronic otitis media (CSOM) is the commonest cause for correctable hearing loss in society. 1 According to a recent WHO study- CSOM prevalent in 6% of the world’s population with a higher incidence in countries with low socio-economic conditions. 2 Reduced effective surface area of TM in perforation leads to ineffective sound transmission. Difference of opinion exists regarding effect on hearing loss due to perforation in literature. Glasscock and Shambough found differential hearing losses in ears with similar size and location of perforation. 3 Zhang et al in their study on the effect of small tympanic membrane perforations in inferior quadrant on manubrium vibrations in guinea pig suggested that loss in vibration velocity of manubrium in perforations were dependent on the frequency of sound and more loss will be at a lower frequency. 4 Vaidya et al reported greater degree of hearing loss in posterior perforations. 5 Saliba et al concluded that conductive hearing loss resulting due to perforation of TM is frequency dependent; with the greatest loss occurring at the lowest sound frequencies. 6 Hearing loss in their study was not dependent on the location of perforation ABSTRACT Background: Tympanic membrane perforations are common cause of hearing loss. There are very few systematic studies that have evaluated the size and location of a perforation to the degree of hearing loss, this study correlates the size and location of tympanic membrane perforation to the pattern of hearing loss. Methods: The study design was based on cross sectional study. Ninety-six ears of dry tympanic membrane perforation of CSOM mucosal type were selected. Photographs of the tympanic membrane perforations were taken and size measured using the “Image J” software. The area of perforation was compared to hearing loss measured by pure tone audiometry. Results: Ninety-six patients, aged 15-60 years with perforated eardrums were studied. Size of tympanic membrane perforation showed moderate level of correlation with hearing loss (Pearson r value=0.463). The various locations of perforations were: posterior (23 ears with Mean hearing loss 28.6±7.7 dB), anterior (31 ears with Mean hearing loss 26.5±7.8dB), subtotal (42 ears with Mean hearing loss 34.2±8.2 dB). Conclusions: The hearing loss is frequency dependent, with maximum hearing loss at lower frequencies. Irrespective of size of perforation the hearing loss was the least for frequency of 2000Hz. Magnitude of hearing loss increases with increase in size of tympanic membrane perforation. Perforation posterior to handle of malleus resulted in more hearing loss than perforations involving anterior to the handle of malleus. Keywords: Hearing loss, Tympanic membrane perforation, CSOM Department of ENT, 1 AIIMS, Bhubaneswar, Odisha, 2 JIPMER, Pondicherry, India Received: 20 April 2018 Revised: 24 June 2018 Accepted: 25 June 2018 *Correspondence: Dr. Arun Alexander, E-mail: karthipriya010515@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20183693