ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
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ORIGINAL RESEARCH

Effect of Small Tympanic Membrane Perforations on Hearing
Timpanik Membrandaki Küçük Perforasyonların İşitme Üzerine Etkisi
Received Date : 12 Feb 2019
Accepted Date : 12 Apr 2019
Doi: 10.24179/kbbbbc.2019-65479 - Makale Dili: EN
KBB ve BBC Dergisi 2019;27(1):22-6
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: The effects of perforations on middle-ear sound transmission are not well defined because of middle ears with TM perforations generally have additional pathological changes. The aim of the study is to compare the hearing loses in tympanic membrane perforation of quadrants with exclusion of the possible middle and inner ear pathologies that may have resulted any hearing loss. Material and Methods: Patients who attended Otorhinolaringology-Head Neck Surgery Department, and underwent type 1 tympanoplasty between 2011 January and 2014 December were retrospectively analyzed. Size of perforation had been described in millimeter and location was grouped as anteroinferior (AI), anterosuperior (AS), posteroinferior (PI), posterosuperior (PS). Results: Sixty-five patients (65 ears) with isolated TM perforations were included in the study. Twenty-seven (41.5%) perforations were in PI, 8 (12.3%) perforations PS, 25 (38.4%) perforations AI, and 5 (7.7%) perforations AS-localized. There were not statistically significant differences between 4 groups at each frequency (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz) for air-bone gap. Statistically significant decrease of bone conduction thresholds was observed in AI group when compared with other groups at higher frequencies (2 and 4 kHz, p<0.05) and between small and moderate perforation groups in all frequencies (500, 1000, 2000 ve 4000 Hz, p value: p0.025, p0.025, p0.037, p0.034 respectively). Conclusion: The results showed that the air-bone gap increases with increasing size of perforation. However, no statistically significant air-bone gap differences between tympanic membrane quadrants were determined.
ÖZET
Amaç: Timpanik membran perforasyonlarının orta kulaktan ses iletimi üzerine olan etkisi tam olarak bilinmemektedir. Çünkü, çoğu zaman diğer orta kulak patolojileri de timpanik membran perforasyonlarına eşlik etmektedir. Bu çalışmanın amacı işitme kaybına neden olabilecek olası orta ve iç kulak patolojilerin dışlanmış olduğu hastalarda timpanik membran perforasyonu ile işitme kaybı arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Ocak 2011 ile Aralık 2014 tarihleri arasında Başkent Üniversitesi Kulak Burun Boğaz ve Baş-Boyun Cerrahisi Ana Bilim Dalı’nda tip 1 timpanoplasti uygulanan hastalar retrospektif olarak incelendi. Perforasyon boyutu milimetre ile belirtildi. Hastalar perforasyonun lokalizasyonuna göre anteroinferior (AI), anterosüperior (AS), posteroinferior (PI), posterosüperior (PS) olarak 4 gruba ayrıldı. Bulgular: Çalışmaya basit kulak zarı perforasyonu olan 65 hasta (65 kulak) dahil edildi. Posteroinferior grupta 27 hasta (%41,5), posterosüperior grupta 8 hasta (%12,3) anteroinferior grupta 25 hasta (%38,4), anterosüperior grupta 5 hasta (%7,7) vardı. Her frekansta (0,5 kHz, 1 kHz, 2 kHz, 4kHz) 4 grup arasında hava-kemik aralığı açısından istatistiksel anlamlı farklılık saptanmadı. İki ve 4 kHz’te anteroinferior grupta diğer gruplar ile karşılaştırıldığında kemik yolu eşiklerinde istatistiksel olarak anlamlı düşüş tespit edildi (p<0,05). Orta ve küçük boy perforasyon grupları arasında havakemik aralığı açısından istatistiksel anlamlı fark tespit edildi (p<0,05). Sonuç: Sonuçlar, perforasyon boyutu arttıkça hava-kemik aralığının arttığını göstermektedir. Ancak, hava-kemik aralığı açısından timpanik membran kadranları arasında istatistiksel anlamlı farklılık saptanmadı.
KAYNAKLAR
  1. Vossa SE, Rosowski JJ, Merchant SN, Peake WT. Non-ossicular signal transmission in human middle ears: experimental assessment of the "acoustic route" with perforated tympanic membranes. J Acoust Soc Am. 2007;122(4):2135-53. [Crossref]  [PubMed]  [PMC] 
  2. Roosli C, Sim JH, Chatzimichalis M, Huber AM. How does closure of tympanic membrane perforations affect hearing and middle ear mechanics? An evaluation in a patient cohort and temporal bone models. Otol Neurotol. 2012;33(3):371-8. [Crossref]  [PubMed] 
  3. Voss SE, Rosowski JJ, Merchant SN, Peake WT. Middle-ear function with tympanic membrane perforations: I. Measurements and mechanisms. J Acoust Soc Am. 2001;110(3 Pt 1):1432-44. [Crossref] 
  4. Voss SE, Rosowski JJ, Merchant SN, Peake WT. Middle-ear function with tympanic- membrane perforations: II. A simple model. J Acoust Soc Am. 2001;110(3 Pt 1):1444-52. [Crossref] 
  5. Anthony WP, Harrison CW. Tympanic membrane perforation. Effect on audiogram. Arch Otolaryngol. 1972;95(6):506-10. [Crossref] 
  6. Mehta RP, Rosowski JJ, Voss SE, O'Neil E, Merchant SN. Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol. 2006;27(2):136-43. [Crossref]  [PubMed]  [PMC] 
  7. Ahmad SW, Ramani GV. Hearing loss in perforations of the tympanic membrane. J Laryngol Otol. 1979;93(11):1091-8. [Crossref] 
  8. Malik S, Ashrafi K, Sohail Z, Afaq S, Nawaz A. Determinants of variable hearing loss in patients with chronic suppurative otitis media. Pak J Otolaryngol. 2012;28:45-7.
  9. Voss SE, Rosowski JJ, Merchant SN, Peake WT. How do tympanic-membrane perforations affect human middle-ear sound transmission? Acta Otolaryngol. 2001;121(2):169-73. [Crossref]  [PubMed] 
  10. Kumar N, Chilke D, PuttewarMP. Clinical profile of tubotympanic CSOM and its management with special reference to site and size of tympanic membrane perforation, eustachian tube function and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2012;64(1):5-12. [Crossref]  [PubMed]  [PMC] 
  11. Pannu KK, Chadha S, Kumar D, Preeti. Evaluation of hearing loss in tympanic membrane perforation. Indian J Otolaryngol Head Neck Surg. 2011;63(3):208-13. [Crossref]  [PubMed]  [PMC] 
  12. Merchant SN, Ravicz ME, Voss SE, Peake WT, Rosowski JJ. Tonybee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears. J Laryngol Otol. 1998;112(8):715-31. [Crossref]  [PubMed] 
  13. Goode RL, Ball G, Nishihara S, Nakamura K. Laser doppler vibrometer (LDV): a new clinical tool for the otologist. Am J Otol. 1996;17(6): 813-22.
  14. Puria S, Peake WT, Rosowski JJ. Soundpressure measurements in the cochlear vestibule of human-cadaver ears. J Acoust Soc Am. 1997;101(5 Pt 1):2754-70. [Crossref] 
  15. Ribeiro Fde A, Gaudino VR, Pinheiro CD, Marcal GJ, Mitre EI. [Objective comparison between perforation and hearing loss]. Braz J Otorhinolaryngol. 2014;80(5):386-9. [Crossref]  [PubMed] 
  16. Nepal A, Bhandary S, Mishra SC, Singh I, Kumar P. The morphology of central tympanic membrane perforations. Nepal Med Coll J. 2007;9(4):239-44.
  17. Voss SE, Rosowski JJ, Merchant SN, Peake WT. How do tympanic-membrane perforations affect human middle-ear sound transmission? Acta Otolaryngol. 2001;121(2):196-73. [Crossref] 
  18. Ibekwe TS, Nwaorgu OG, Ijaduola TG. Correlating the site of tympanic membrane perforation with Hearing loss. BMC Ear Nose Throat Disord. 2009;9:1. [Crossref]  [PubMed]  [PMC]