Study of Outcome of Tympanoplasties in Relation to Size and Site of Tympanic Membrane Perforation

Original Article


There are not many studies on the effect of the site and size of the perforation on the hearing loss. This study is set to investigate the relationship between the size and site of perforation and hearing loss. This study was carried out between September 2011 to September 2013, at a tertiary care centre during which 100 cases of chronic otitis media tubotympanic type having central perforation were selected. All patients underwent, tympanoplasty using temporalis fascia/cartilage graft, underlay technique with or without simple mastoidectomy/modified radical mastoidectomy and followed up for 3 months and evaluated for graft uptake and hearing improvement with respect to size and site of TM perforation. To measure the size of perforation intra-operatively, thin transparency sheet was used, on which a graph paper of 1 × 1 mm2 size was printed. Significant relationship was observed between size and site of tympanic membrane perforation with hearing loss. Perforations which were involving all four quadrants (AS + AI + PS + PI) are having maximum residual perforations after the surgery. In relation with size, subtotal perforation were having more residual perforations postoperatively, followed by medium sized perforations. An inherent relationship noted between ossicular involvement and hearing loss, maximum average hearing loss was observed in those cases, where all three ossicles (malleus, incus & stapes) were involved, also more hearing loss was noted in posterior perforations.


Tympanic membrane Tympanoplasty Ossiculoplasty 



Authors are thankful to Dr. V K Mahadik, Medical Director, R D Gardi Medical College for giving permission to publish this article and for his kind encouragement and constant support.


  1. 1.
    Maharjan M, Kafle P, Bista M, Shrestha S, Toran KC (2009) Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. KUMJ 7(28):397–401PubMedGoogle Scholar
  2. 2.
    Nepal A, Bhandary S, Mishra SC, Singh I, Kumar P (2007) Assessment of quantitative hearing loss in relation to the morphology of central tympanic membrane perforations. Nepal Med Coll J 9(4):239–244PubMedGoogle Scholar
  3. 3.
    Ibekwe TS, Nwaorgu OG, Ijaduola TG (2009) Correlating the site of tympanic membrane perforation with hearing loss. BMC Ear Nose Throat Disord 9(1):1PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Bhusal CL, Guragain RP, Shrivastav RP (2007) Frequency dependence of hearing loss with perforations. JNMA 46(168):180–184Google Scholar
  5. 5.
    Kumar N, Chilke D, Puttewar MP (2012) 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 64(1):5–12. doi: 10.1007/s12070-010-0114-5 PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Sakagami M, Maeda A, Node M, Sone M, Mishiro Y (2000) Long-term observation on hearing change in patients with chronic otitis media. Auris Nasus Larynx 27(2):117–120PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2014

Authors and Affiliations

  • Sudhakar Vaidya
    • 1
  • J. K. Sharma
    • 1
  • Gurchand Singh
    • 1
  1. 1.Department of OtolaryngologyRD Gardi Medical CollegeUjjainIndia

Personalised recommendations