Background: The large effective surface area of an intact and normally vibrating tympanic membrane plays a major role in middle ear transformer mechanism. Perforation of tympanic membrane can lead to varying degrees of hearing loss. Therefore accurate assessment of the perforation of tympanic membrane and its relationship with hearing loss is important for the clinician.

Methods: A prospective study was done on Patients attending the outpatient department in Tertiary care centre, Vizag during October 2016 to October 2018 who had a perforation in tympanic membrane. A sample size of 100 perforated ears from patients of safe CSOM were included in the study. Photographs of the perforated tympanic membrane were taken using otoendoscope. The site of perforation was noted anterior or posterior to handle of malleus. The images were analysed using ‘IMAGE J’ software, a free download software available on the internet. The size of the perforation and the total size of the tympanic membrane were measured in terms of pixels. The ratio of area of the perforation (P) to the area of the tympanic membrane(Q) was calculated as percentage using the formula P/Q×100

Results: The most commonly affected age group is between 20 to 35 years. The tubotympanic type of chronic otitis media is more common in females. Chronic otitis media is more common in low socioeconomic group due to lack of advanced medical care especially in rural areas. The present study showed a significant linear association between the degree of hearing loss and size of perforation of tympanic membrane, with p value 0.002.

Conclusion: The magnitude of hearing loss increased with increase in size of the perforation of tympanic membrane .There was no significant relationship between location of tympanic membrane perforation and degree of hearing loss.

Keywords: Transformer mechanism, Image J, Tubotympanic disease, Otoendoscope.

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2. Ediale J, Adobamen PROC, Ibekwe TS. Audiometric assessment of adolscents and adults with tympanic membrane perforation in Benin city. Int. J Otorhinolaryngol Head Neck Surg 2018; 4 : 901-6.
3. Alsarhan HW , Dawood MR , Jwery AK , Khammas AH, Hamad AK. Assessment of hearing loss in tympanic membrane perforation. Adv Arab Acad Audio-Vestibul J 2016; 3: 16-9.
4. Ibekwe TS, Nwaorgu OG , Adeosun AA , Kokong DD, Lawal HO, et al. Assessments of the size of tympanic membrane perforations: a comparision of clinical estimations with video-otoscopic calculations. Ear Nose Throat J .2008; 87(10):567-9.
5. Matsuda Y, Kurita T. Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on mile ear sound transmission. J Laryngol Otol. 2009; 123;31:81-89.
6. Sood AS, Pal P, Kumar A. Tympanic membrane perforation: correlation of hearing loss with its site and size. Int J Otorhinolaryngol Head Neck Surg 2018; 4 : 397-402.
7. Kumar UA, Bhat KV. Do the site and size of tympanic membrane perforation correlate with audiogram ? Asian journal of Ear, Nose and Throat 2007;4: 25-30
8. Hsu CY, Chen YS, Hwang. A computer programme to calculate the size of tympanic membrane perforations. Clin Otolaryngol All Sc 2004, 29:340-342.
9. Bhusal CL, Guragain RPS,Shrivastav RP. Size of tympanic membrane perforation and hearing loss. J Nep Med Assoc 2006;45:167-72
10. Maharajan M , Kafle P, Bista M , Shrestha S, KC Toran. Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. Kathmandu University Medical Journal. 2009;7(4): 397-401
11. 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.
12. Reberio FA, Gaudino VR, Pinheiro CD, Marcal GJ, Mitre EI. Objective comparision between perforation and hearing loss. Braz J Otorhinolaryngol. 2014;80:386.
13. Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol. 1989;103 (12):1150-3.
14. Anthony WP, Harrison CW. Tympanic membrane perforation. Arch Otolaryngol 1972;95:504-510.
15. Kulwant Kaur Pannu, Snyachadha, Dinesh Kumar, Preeti. Evaluation of hearing loss in tympanic membrane perforation. Indian J Otolaryngol Head Neck Surg. 2011;63(3): 208-213.
16. Ediale J, Adobamen PROC, Ibekwe TS. Audiometric assessment of adolscents and adults with tympanic membrane perforation in Benin city. Int. J Otorhinolaryngol Head Neck Surg 2018; 4 : 901-6.
17. Alsarhan HW , Dawood MR , Jwery AK , Khammas AH, Hamad AK. Assessment of hearing loss in tympanic membrane perforation. Adv Arab Acad Audio-Vestibul J 2016; 3: 16-9.
18. Ibekwe TS, Nwaorgu OG , Adeosun AA , Kokong DD, Lawal HO, et al. Assessments of the size of tympanic membrane perforations: a comparision of clinical estimations with video-otoscopic calculations. Ear Nose Throat J .2008; 87(10):567-9.
19. Matsuda Y, Kurita T. Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on mile ear sound transmission. J Laryngol Otol. 2009; 123;31:81-89.
20. Sood AS, Pal P, Kumar A. Tympanic membrane perforation: correlation of hearing loss with its site and size. Int J Otorhinolaryngol Head Neck Surg 2018; 4 : 397-402.
21. Kumar UA, Bhat KV. Do the site and size of tympanic membrane perforation correlate with audiogram ? Asian journal of Ear, Nose and Throat 2007;4: 25-30
22. Hsu CY, Chen YS, Hwang. A computer programme to calculate the size of tympanic membrane perforations. Clin Otolaryngol All Sc 2004, 29:340-342.
23. Bhusal CL, Guragain RPS,Shrivastav RP. Size of tympanic membrane perforation and hearing loss. J Nep Med Assoc 2006;45:167-72
24. Maharajan M , Kafle P, Bista M , Shrestha S, KC Toran. Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. Kathmandu University Medical Journal. 2009;7(4): 397-401
25. 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.
26. Reberio FA, Gaudino VR, Pinheiro CD, Marcal GJ, Mitre EI. Objective comparision between perforation and hearing loss. Braz J Otorhinolaryngol. 2014;80:386.
27. Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol. 1989;103 (12):1150-3.
28. Anthony WP, Harrison CW. Tympanic membrane perforation. Arch Otolaryngol 1972;95:504-510.

Phani Bhushan Ivaturi

Assistant Professor, Department of ENT, Government Medical College, Nalgonda