Yusof, Asfa Najmi Mohamad
(2017)
The Effect of middle ear volume on hearing improvement post myringoplasty.
Masters thesis, Universiti Sains Malaysia.
Abstract
Tympanic membrane perforation (TMP) is one of the features of CSOM. It is
surgically corrected with myringoplasty. Successful myringoplasty referred to a
completely healed tympanic membrane and may resulted in hearing improvement
post operatively. Besides TMP, middle ear volume (MEV) is another factor that has
been shown quite recently to affect hearing loss and thus is thought to play a role in
hearing improvement post myringoplasty. This study aims to determine whether MEV
does have an important role in the hearing improvement post myringoplasty.
A total of 72 CSOM patients who underwent myringoplasty and resulted with healed
TM were evaluated. Audiometric tests were performed pre- and 3 months postoperatively.
Pure tone audiometry (PTA) was done to determine the level of hearing
improvement and improved hearing was recorded as average difference air bone gap
(ABG) pre and post-operatively. While tympanometry was done to determine the
MEV. The mean MEV was measured and divided into small and large groups.Perforated eardrums were examined and photographed through a system of
'endoscopic' or drawing. The size of TMP was recorded in percentage and then
divided into 3 groups; small <50%, moderate 50-75% and > 75%.
Data analysis showed hearing improvement post myringoplasty in all frequencies,
particularly at low frequencies. ABG pre-operative was 27.58 dB and post-operative
was 14.33 dB. The ABG difference showed hearing improvement of 13.25 dB. Mean
MEV in this study was 2.83 ml. MEV was found not to have any affect on the hearing
improvement post myringoplasty. Moreover, the size of perforated tympanic
membrane measured pre-operatively also did not affect hearing outcome post
myringoplasty. Lastly, there was no significant correlation between those 2 factors on
hearing improvement post myringoplasty.
Objective
To determine whether the middle ear volume affecting hearing improvement post
myringoplasty.
Study design
This is a prospective observational study in Otorhinolaryngology Clinic and Hospital
Universiti Sains Malaysia Hospital Raja Perempuan Zainab II.Methodology
xii
72 subjects of CSOM patients who fulfilled the criteria were selected to participate in
this study. Patients aged 15 years and above, conductive hearing loss and surgical
planning for myringoplasty were included in this study. However, we excluded
patients with hearing loss greater than 50 dB, mucopurulent ear discharge and
unhealed tympanic membrane after surgery. Written consent for this study were
obtained from the patient. All information regarding the patient’s detail, physical
examination and hearing tests were recorded. PTA was performed to determine the
level of hearing improvement and tympanometry to determine the MEV before and 3
months after surgery. Improved hearing recorded is the average difference ABG pre
and post-operatively in 250, 500, 1000, 2000 and 4000Hz frequencies. The mean
MEV divided the volume into small and large groups. A perforated eardrum
examined and photographed through a system of 'endoscopic' or drawing. Percentage
of size of TMP was recorded and divided into 3 groups; small <50%, moderate 50-
75% and > 75% were recorded.
Conclusion
Closure of TMP had resulted in significant hearing improvement in all frequencies.
However, both size of perforation and MEV showed no effect on hearing
improvement post myringoplasty. There is no correlation between them.
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