Central versus marginal tympanic membrane perforations: does it matter? An analysis of 792 patients.

BACKGROUND: There is a lack of studies concerning chronic otitis media without cholesteatoma. OBJECTIVES: To perform an analysis of tympanic membrane perforations (TMP), compare the parameters of central and marginal TMP, combining both the traditional and more recent technologies available. MATERIAL AND METHODS: 792 consecutive patients. The TMP subgroups were divided by central and marginal locations and compared based on signs suggestive of previous tympanic retraction, namely, medialized malleus, tympanic remnants over the promontory, tympanic remnants over the ossicular chain, and incus/stapes erosion. Analysis of the status of the contralateral ear (CLE). RESULTS: Central TMP was diagnosed in 79.8%. Compared with the central group, the marginal group had more reported hearing loss (95.6%), greater conductive hearing loss (pure tone average for air-conduction 43.3 dB and average air-bone gap of 28.7 dB), a larger perforated area (46.45%), more posteroinferior quadrant involvement, a greater number retraction signs prior to the TMP, and more changes in the CLE (71%). CONCLUSION: The differences between TMP subgroups are highlighted when we use all technologies available to compare them. Marginal TMPs have more altered parameters than central TMPs. SIGNIFICANCE: There is a great possibility to enhance the knowledge of TMPs and to improve the pathogenesis-based treatment.

Correlation between sensorineural hearing loss and chronic otorrhea.

Many studies have attempted to correlate chronic otorrhea in children and in adults with the sensorineural hearing loss in the affected ear, with contradictory results. This loss might be the result of the likely toxicity of the bacteria involved, effects of inflammatory cytokines, or constant use of ototoxic antibiotics. All studies evaluated to date compared the affected ear with the normal contralateral ear. From the digitized archive of otologic surgery files of the Department of Otorhinolaryngology at Santa Casa de São Paulo School of Medical Sciences, the ears of patients with chronic otorrhea were evaluated visually and compared with the normal contralateral ears. Ears with otorrhea were also compared with ears of other patients with dry tympanic perforation. Ears with suppuration were evaluated for cholesteatoma. The duration of otorrhea was considered. The sensorineural hearing threshold was evaluated for the frequencies of 500, 1,000, 2,000, and 4,000 Hz. A total of 98 patients with chronic otorrhea and 60 with dry tympanic membrane perforation were evaluated. A correlation between sensorineural hearing loss and chronic otorrhea was observed when compared with both contralateral normal ears and dry perforated ears of other patients. No relationship between hearing loss and the duration of suppuration or cholesteatoma was found. Sensorineural hearing loss occurs in ears with chronic otorrhea. The duration of otorrhea and the etiology of suppuration did not influence the hearing loss.

Otoscopic and audiological findings in different populations of 5-14 year-old schoolchildren in Colombia.

OBJECTIVE: To present the otoscopic and audiological findings of studies carried out in groups of 5-14 year old schoolchildren in diverse indigenous, White, and African descended communities in the Republic of Colombia. MATERIALS AND METHODS: The present study is descriptive and cross-sectional. We obtained a convenience sample for the analysis. We define acute otitis media (AOM), (bulging or redness); tympanic perforation (TP), (disruption of continuity in the tympanic membrane) and sequelea (scarring, myringosclerosis, retractions, secrections). Our results are described as frequencies in percentages. Audiometry was performed in every student. Readings were taken at 250, 500, 1000, 2000, 4000, and 8000 Hz for air-conduction and bone-conduction thresholds. Normal hearing is considered up to 20 dB, mild sensorineural hearing loss between 21 and 39 dB, moderate between 40 and 59 dB, severe between 60 and 89 dB and profound more than 90 dB. For conductive hearing loss the air-bone gap is measured. RESULTS: 3052 otoscopies were conducted in 1526 schoolchildren. Males predominated in each group except in the Wayuu group. Otoscopic abnormalities rates varied between 1.5% in Providencia group, up to 9.6% in the Amazon groups. No perforations were found in the Wayuu Indian schoolchildren and the highest frequency of Tympanic perforations (1.2%) and sequelaes (8.2)% in the Amazon groups. Audiometric findings were normal in 94-98% of cases. Conductive hearing loss (CHL) was found in 5.5% of Amazon groups and the lowest (1.4%) in the Wayuu groups. Slight to moderate Neurosensorial Hearing Loss (NHL) were found in 1.3% in the Arhuaca communities and moderate 0.9% in the Amazon groups. CONCLUSIONS: The present study is the first conducted in Colombia to evaluate the frequency of ear diseases and sequelae in populations of 5-14 year old children. High prevalences of sequelaes were found in the indigenous groups of the Amazon and the lowest in the Black schoolchildren on the island of Providencia. It is recommended that medical anthropological studies be conducted in these areas, and evaluation done on the probable connection between these types of diseases and processes of intercultural interaction.

[Objective comparison between perforation and hearing loss]. / Comparação objetiva entre perfuração timpânica e perda auditiva.

INTRODUCTION: There appears to be no relationship between the size of tympanic perforations and hearing loss. Some studies in the literature have assessed this connection, with conflicting data and without proper methodology, especially concerning the measurement of the size of the perforation, which was performed in a subjective manner. OBJECTIVE: To evaluate the size of tympanic perforations and to relate them to hearing loss in four different sound frequencies through the use of an objective method. METHODS: Transversal retrospective study. The present study evaluated 187 perforations through digital imaging, calculated the percentages of the tympanic membrane that was perforated using ImageScope software version 11.1.2.760 and correlated perforations' size with hearing loss at four frequencies. RESULTS: Data were statistically analyzed using Pearson's correlation test. CONCLUSION: There was no significant relationship between the size of tympanic perforations and hearing loss in the four analyzed frequencies.

Objective comparison between perforation and hearing loss / Comparação objetiva entre perfuração timpânica e perda auditiva

INTRODUCTION: There appears to be no relationship between the size of tympanic perforations and hearing loss. Some studies in the literature have assessed this connection, with conflicting data and without proper methodology, especially concerning the measurement of the size of the perforation, which was performed in a subjective manner. OBJECTIVE: To evaluate the size of tympanic perforations and to relate them to hearing loss in four different sound frequencies through the use of an objective method. METHODS: Transversal retrospective study. The present study evaluated 187 perforations through digital imaging, calculated the percentages of the tympanic membrane that was perforated using ImageScope software version 11.1.2.760 and correlated perforations size with hearing loss at four frequencies. RESULTS: Data were statistically analyzed using Pearson's correlation test. CONCLUSION: There was no significant relationship between the size of tympanic perforations and hearing loss in the four analyzed frequencies. .

INTRODUÇÃO: Parece não haver relação entre o tamanho das perfurações timpânicas e a perda auditiva. Alguns trabalhos na literatura estudaram esta relação, com dados conflitantes e sem uso adequado da metodologia empregada, principalmente quanto à medição do tamanho da perfuração que se faz de modo subjetivo. OBJETIVO: Analisar através de um método objetivo o tamanho dessas perfurações e relacioná-las com perdas auditivas em quatro frequências sonoras. MÉTODO: Estudo retrospectivo de corte transversal. Foram avaliadas 187 perfurações timpânicas através de digitalização de imagem, medidas porcentualmente com o uso do software ImageScope Version 11.1.2.760 e correlacionadas com os limiares auditivos em quatro frequências. RESULTADOS: Os dados foram avaliados estatisticamente pelo teste de correlação de Pearson, que não demonstrou correlação entre o tamanho da perfuração timpânica e o grau de perda auditiva. CONCLUSÃO: Não há relação significativa entre o tamanho das perfurações timpânicas e as quatro frequências estudadas. .

Fístula perilinfática traumática: entidad otorrinolaringológica poco frecuente / Traumatic perilymphatic fistula: a rare otorhinolaryngological entity

La fístula perilinfática corresponde a una patología infrecuente en la práctica otorrinolaringológica diaria. Esta puede tener un origen congénito, de aparición espontánea o más frecuentemente postraumática, presentando habitualmente la triada clínica de hipoacusia, tinnitus y vértigo. A continuación se presenta el caso clínico de una paciente de 50 años atendida en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile, ingresada por un cuadro con clínica compatible, de inicio súbito luego de una perforación timpánica traumática autoinferida.

Perilymphatic fistula is an infrequent pathology in standard otorhinolaryngological practice. Fistulas of this sort may be of congenital, spontaneous or, more frequently post traumatic origin, normally presenting with the clinical triad of hearing loss, tinnitus and vertigo. The case of a 50 year old patient presenting with clinically compatible symptoms of sudden appearance after a self-infringed traumatic tympanic perforation is discussed.

Perfuração timpânica: causas e o que fazer / Tympanic perforation: causes and what to make

Os autores fazem uma revisão bibliográfica sobre as principais causas de perfuração da membrana timpânica, sua sintomatologia, complicações relacionadas e condutas a serem adotadas na prática médica.