title: Functional correlations of tympanic membrane perforation size.
abstract: OBJECTIVE
  The correlation between tympanic membrane perforations and hearing loss was studied.
  
  
  METHODS
  Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included.
  
  
  METHODS
  All patients underwent primary myringoplasty.
  
  
  METHODS
  Preoperative conductive hearing loss due to eardrum perforations.
  
  
  RESULTS
  Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p < 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an 'inverted V shape' of the air-bone gap is a consistent finding. If the air-bone gap exceeds the 'inverted V-shape' pattern, additional pathology behind the eardrum must be assumed and addressed.
  
  
  CONCLUSIONS
  We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An "inverted V-shape" pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the air-bone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint Jan Brugge-Oostende AV, campus Brugge, Bruges, West-Vlaanderen, Belgium. bob.lerut@azbrugge.be
authors.forename: Bob
authors.initials: B
authors.lastname: Lerut
authors.forename: Alain
authors.initials: A
authors.lastname: Pfammatter
authors.forename: Johnny
authors.initials: J
authors.lastname: Moons
authors.forename: Thomas
authors.initials: T
authors.lastname: Linder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001299:Audiometry; D002648:Child; D004429:Ear Ossicles / Q000473:pathology; D004432:Ear, Middle / Q000473:pathology; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009225:Myringoplasty; D010033:Otitis Media / Q000601:surgery; D013506:Otologic Surgical Procedures; D011446:Prospective Studies; D013701:Temporal Bone / Q000473:pathology; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000473:pathology* / Q000601:surgery; D055815:Young Adult