Impact of tympanic membrane perforation size and site on hearing

Abstract

Introduction: The correlation between the anatomical site of a tympanic membrane (TM) perforation and its cause or impact on hearing loss is unclear, with divergent opinions in the medical community. This study aimed to investigate the relationship between the site and size of TM perforations and the degree of hearing loss. Patients & Methods: A retrospective, cross-sectional study was conducted on 26 patients with ear discharge and hearing loss (excluding traumatic perforations). Data included pure-tone audiometry results and video otoscopy to classify perforation size (small, medium, large) and anatomical site (anterior-superior, anterior-inferior, posterior-superior, posterior-inferior quadrants). Results: Of the 26 patients, 61.5% had right-sided perforations. Size distribution was small (30.8%), medium (30.8%), and large (38.5%). The anterior-inferior quadrant was the most common location (44.0%). Hearing loss ranges were 0-28.3 dB HL for small, 0-43.3 dB HL for medium, and 0-40.0 dB HL for large perforations. Mean hearing loss by location ranged from 10.55±14.61 dB HL (PSQ) to 22.89±13.16 dB HL (AIQ). Spearman's correlation indicated a positive, though not strongly significant (p ≈ 0.2-0.3), relationship between perforation size and hearing loss, but no significant correlation was found for perforation site (p = 0.891). Conclusion: This study suggests that TM perforation size is a more influential factor in the degree of conductive hearing loss than its anatomical location. Larger perforations were associated with higher degrees of hearing loss, reinforcing the clinical importance of size in predicting auditory impairment and the need for timely intervention.