Correlation of Tympanic Membrane Perforation with Hearing Loss and Its Parameters in Chronic Otitis Media: An Analytical Study


Chronic otitis media is one of the commonest illnesses in otorhinolaryngological practice which requires medical attention. Intact tympanic membrane acts as a shield for round window niche to create a phase difference in sound wave conduction. 700 patients of age 10–70 years with inactive mucosal chronic otitis media were included in the study. Condition of tympanic membrane and site of tympanic membrane perforation was noted and audiometric analysis was performed. 338 (48.28%) were males and 362 (51.71%) were females. In 1400 membranes examined, 769 (54.85%) presented with perforation. 631 (82.03%) had unilateral perforation and 69 (17.97%) had bilateral perforations. In unilateral cases, 289 (37.50%) had right ear perforation and 342 (44.53%) left ear perforation. Single quadrant perforations were present in 168 (21.74%) membranes and 419 (54.55%) involved two quadrants. Three quadrant perforations were seen in 62 (8.09%) and 120 (15.63%) perforations involved all four quadrants. In 171 (22.26%) ears, perforation was present anterior to handle of malleus and in 243 (31.53%) it was present only posterior to handle. In 355 (46.21%) perforations, handle of malleus was involved. Perforations involving posterior half of tympanic membranes showed greater loss than those involving anterior or inferior half of membrane statistically. Maximum loss (51.56 ± 5.1 dB) was seen in perforation involving all four quadrants. In 631 unilateral cases, conductive loss was seen in 424 (67.10%), 101 (16.10%) showed sensorineural and 74 (11.80%) showed mixed loss. Out of 769 perforated ears having hearing loss, 251 (37.69%) had complaints for 5–10 years with mean loss of 51.15 ± 7.8 dB, 172 (25.68%) had COM for 1–5 years with loss of 39.26 ± 5.1 dB. A mean hearing loss of 52.18 ± 4.2 dB was seen in 110 (16.52%) patients suffering from COM for more than 10 years. 134 (20.12%) patients having disease less than 1 year reported hearing loss of 36.46 ± 8.2 dB. The effects of perforation of tympanic membranes on transmission of sound and its dynamics are not easy to correlate because of additional pathological changes in middle ear.

This is a preview of subscription content, access via your institution.


  1. 1.

    Rathbun TA, Mallin R (1977) Middle ear disease in a prehistoric Iranian population. Bull NY Acad Med 53:901–905

    CAS  Google Scholar 

  2. 2.

    Proceedings of the 10th international symposium on recent advances in COM New Orleans, Louisiana USA. 2011;

  3. 3.

    Browning GG, Gatehouse S, Caalder IT (1988) Medical management of active chronic otitis media: a controlled study. J Laryngol Otol 102(6):491–495

    CAS  Article  Google Scholar 

  4. 4.

    World Health Organization (2004) Chronic suppurative otitis media Burden of Illness and Management Options [Internet]. Geneva, Switzerland: 14. Available from:

  5. 5.

    Singh R, Srivastava A, Mohan C (2016) Comparative evaluation of hearing in different tympanic membrane perforations. Indian J Otol 22:258–261

    Article  Google Scholar 

  6. 6.

    Sood AS, Pal P, Kumar A (2018) Tympanic membrane perforation: correlation of hearing loss with its site and size. Int J Otorhinolaryngol Head Neck Surg 4(2):397–402

    Article  Google Scholar 

  7. 7.

    Sade J (1982) Prologue. In: Kugler SJ (eds) Proceedings of the second international conference of cholesteatoma and mastoid surgery, vol 1. Amsterdam

  8. 8.

    Ediale J, Adobamen PROC, Ibekwe TS (2018) Audiometric assessment of adolescents and adults with tympanic membrane perforation in Benin City. Int J Otorhinolaryngol Head Neck Surg 4(4):901–906

    Article  Google Scholar 

  9. 9.

    Pannu KK, Chadha S, Kumar D, Preeti (2011) Evaluation of hearing loss in tympanic membrane perforation. Indian J Otolaryngol Head Neck Surg 63(3):208–213

    Article  Google Scholar 

  10. 10.

    Voss SE, Rosowski JJ, Merchant SN, Peake WT (2001) How do tympanic membrane perforations affects human middle ear sund transmission. Acta Otolaryngol (Stockh) 121:169–173

    CAS  Article  Google Scholar 

  11. 11.

    Bhusal CL, Gurugain RPS, Shrivastav RP (2006) Size of tympanic membrane perforation and hearing loss. J Nepal Med Assoc 45:167–172

    CAS  Google Scholar 

  12. 12.

    Kamal N, Joarder AH, Chowdhury AA, Khan AW (2004) Prevalence of chronic suppurative otitis media among the children living in two selected slums of Dhaka city. Bangladesh Med Res Counc Bull 30(3):95–104

    CAS  PubMed  Google Scholar 

  13. 13.

    Shrikrishna BH, Jyothi AC, Sanjay G, Samson SG (2013) Age and gender differences in the incidence eof non-cholesteatomatous chronic suppurative otitis media. Int J Res Pharma Biomed Sci 4(4):1172–1174

    Google Scholar 

  14. 14.

    Ibekwe TS, Nwaorgu OG, Ijaduola TG (2009) Correlating the site of tympanic membrane perforation with hearing loss. BMC Ear Nose Throat Disord 9:1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Kaur K, Sonkhya N, Bapna AS (2003) Chronic suppurative otitis media and sensorineural hearing loss: Is there a correlation? Indian J Otolaryngol Head Neck Surg 55(1):21–24

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Maharajan M, Kafle P, Bista M, Shrestha S, Toran KC (2009) Observation of hearing loss in patients with chronic suppurative otitis media tubotympanic type. Kathmandu Univ Med 7(28):397–401

    Google Scholar 

  17. 17.

    Mohammed SI, Rafiqul I, Mohammad ARB, Shazibur R, Datta PG (2010) Pattern and degree of hearing loss in chronic suppurative otitis media. Bangladesh J Otorhinolaryngol 16(2):96–105

    Google Scholar 

  18. 18.

    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 tubes function, and three flap tympanoplasty. Indian J Otolaryngol Head Neck Surg 64(1):5–12

    Article  Google Scholar 

  19. 19.

    Kabdwal N, Vashney S, Bist SS, Bhagat S, Mishra S (2013) Pre and post-operative evaluation of hearing in chronic suppurative otitis media. Indian J Otol 19(4):164–168

    Article  Google Scholar 

  20. 20.

    Muftah S, Mackenzie I, Faragher B, Brabin B (2015) Prevalence of chronic suppurative otitis media (CSOM) and associated hearing impairment among school-aged children in Yemen. Oman Med J 30(5):358–365

    Article  Google Scholar 

  21. 21.

    Darad H, Sinha M (2017) Comparative assessment of hearing in various tympanic membrane perforations in patients at Bhuj, Kutch Gujarat, India: a cross sectional study. Int J Otorhinolaryngol Head Neck Surg 3(2):273–275

    Article  Google Scholar 

  22. 22.

    Berger G (1989) Nature of spontaneous tympanic membrane perforations in acute otitis media in children. J Laryngol Otol 103(12):1150–1153

    CAS  Article  Google Scholar 

  23. 23.

    Nepal A, Bhandary S, Mishra SC, Singh I, Kumar P (2008) The morphology of central tympanic membrane perforations. Nepal Med Coll J 9:239–244

    Google Scholar 

  24. 24.

    Mehta RP, Rosowski JJ, Voss SE, O’Neil E, Merchant SN (2006) Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol 27(2):136–143

    Article  Google Scholar 

  25. 25.

    Cusimano F, Cocita VC, Damico A (1989) Sensorineural hearing loss in chronic otitis media. J Laryngol Otol 103(2):158–163

    CAS  Article  Google Scholar 

  26. 26.

    Hussona AA, Haidar H (2012) Sensorineural hearing loss in chronic suppurative otitis media. Thi Qar Med J 6(1):163–168

    Google Scholar 

Download references


No funding was received for this project from any person or institution.

Author information



Corresponding author

Correspondence to Deepak Upadhyay.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethical clearance committee vide letter no IEC/28/2014 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rana, A.K., Upadhyay, D., Yadav, A. et al. Correlation of Tympanic Membrane Perforation with Hearing Loss and Its Parameters in Chronic Otitis Media: An Analytical Study. Indian J Otolaryngol Head Neck Surg 72, 187–193 (2020).

Download citation


  • Perforation
  • Position
  • Duration
  • Hearing loss
  • Quadrants