Does the Location of a Small Tympanic Membrane Perforation Affect the Degree of Hearing Loss in Adult Patients with Inactive Mucosal Chronic Suppurative Otitis Media?

BACKGROUND: Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment. AIM OF THE STUDY: To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media. PATIENTS AND METHODS: A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation. RESULTS: The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168). CONCLUSION: In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.

Transcanal endoscopic myringoplasty with butterfly dermal allograft.

OBJECTIVE: Tympanic membrane perforation (TMP) is a common cause of visits to the otolaryngology clinic. For decades, various surgical methods and various grafts have been used to treat TMP. This study aimed to compare the efficacy of butterfly dermal allograft (BDA) and fat myringoplasty for the treatment of TMP. STUDY DESIGN: A retrospective case-control study. SETTING: Tertiary referral center. METHODS: We retrospectively analyzed 40 patients who underwent BDA (n = 20) and fat myringoplasty (n = 20) for TMP performed by a single surgeon between January 2019 and December 2021. The hearing outcomes, graft success rate, complications, operation time, and hospital stay were recorded and compared between the two groups. Hearing outcomes were determined by pure-tone audiometry. RESULTS: There was no significant difference between the BDA and fat groups regarding demographic characteristics. There was no significant difference in the pre and postoperative air conduction and bone conduction thresholds, or air-bone gap values between the two groups. A significant audiologic improvement was observed in both groups (p < 0.05), but there was no significant difference in the degree of hearing gain between the two groups. In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms; however, there was no significant difference between the groups (p > 0.05). The operation time and hospital stay were shorter in the BDA group than in the fat group (p < 0.05). CONCLUSION: BDA myringoplasty is as safe and medically efficacious as fat myringoplasty and shortens the operation time and hospital stay.

[Blast and explosion traumas-effects on the middle and inner ear based on the example of Bundeswehr foreign missions]. / Knall- und Explosionstraumata ­ Auswirkungen auf Mittel- und Innenohr am Beispiel von Auslandseinsätzen der Bundeswehr.

Despite all protective measures, blast and explosion traumas are a frequent pattern of injury in Bundeswehr missions abroad. Due to body protection measures, head injuries, particularly of the ears, are higher in number compared to injuries in other regions of the body. Perforations of the tympanic membrane are the most frequent lesions of the middle ear, acute sensorineural hearing loss is the most frequent lesion of the inner ear, often accompanied by tinnitus and dizziness. With a high spontaneous recovery rate, prompt specialist care for these injuries is provided according to medical standards comparable to those in the home country.

Comparison of long-term outcome of two endoscopic transtympanic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations.

OBJECTIVE: We compare the long-term efficacy of the cartilage-perichondrium modified over-underlay technique and transtympanic underlay alone technique using endoscopic myringoplasty without tympanomeatal flap elevating for repairing large chronic perforations. MATERIAL AND METHODS: Nine chronic large perforations with mucosal chronic otitis media were recruited and randomly allocated to endoscopic cartilage-perichondrium modified over-underlay myringoplasty (MOUM, n = 55) and endoscopic cartilage-perichondrium transtympanic underlay alone myringoplasty (TUAM, n = 54). The graft success rate, hearing gain, mean operation time and postoperative complications were compared between the groups at 6 and 24 months. RESULTS: In total, 99 patients were finally analysed. The graft success rates 6 months after surgery between MOUM and TUAM groups were not significantly different (100.0% vs 96.0%, p = 0.484). However, the MOUM group had a significantly higher success rate 24 months after surgery than the TUAM group (93.9% vs 76.0%, p = 0.028). In addition, postoperative ABG < 10 dB was 73.5% patients in the MOUM group and 76.0% in the TUAM group, the difference wasn't significant (p = 0.953). CT examination revealed well-pneumatised middle ears 24 months after surgery in both groups, and no middle ear cholesteatoma was observed. CONCLUSION: Endoscopic modified cartilage-perichondrium over-underlay myringoplasty without tympanomeatal flap elevating is reliable and effective for repairing large perforations. It improves the long-term graft success rate compared to the endoscopic cartilage-perichondrium transtympanic underlay alone technique. The risk for iatrogenic cholesteatoma is minimal.

Is no de-squamatization of the TM reliable for cartilage over-underlay myringoplasty without external auditory canal packing?

OBJECTIVE: We evaluated the graft and hearing outcomes of patients with chronic perforations treated via the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and external auditory canal (EAC) packing. MATERIALS AND METHODS: Thirty-nine patients with chronic perforations and residual tympanic membranes around the perforation margins were treated using the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and EAC packing. Patients were followed-up for 6 months. RESULTS: For all 39 patients with unilateral perforations, the graft success rate was 100% (39/39) at 6 months after surgery. The mean air-bone gap significantly (P < 0.05) improved from 13.41 ± 8.34 dB preoperatively to 7.45 ± 3.81 dB postoperatively in patients with small and medium perforations; the mean air-bone gap significantly improved from 20.57 ± 9.41 dB preoperatively to 9.84 ± 2.41 dB postoperatively in patients with large perforations. The lateral perichondrium gradually became necrotic and crust at postoperative 2-3 months and migrated into the EAC in all patients. CONCLUSIONS: The cartilage-perichondrium over-underlay myringoplasty without de-squamatization of the TM and EAC packing is feasible, affording a high graft success rate and good hearing improvement. The lateral perichondrium may gradually become necrotic and crusted, and migrate along the EAC over time.

[Spontaneous course of traumatic tympanic membrane perforations]. / Spontaner Heilungsverlauf traumatischer Trommelfellperforationen.

BACKGROUND: Traumatic eardrum perforation is a common presentation in otorhinolaryngologic practices and emergency clinics. A consistent management strategy (active intervention vs. watchful waiting) is, however, still lacking. OBJECTIVE: In the following study, the outcome of watchful waiting is analyzed and presented. MATERIALS AND METHODS: A collective of 272 patients presenting at two different specialist ENT practices within days of traumatic tympanic membrane perforation from June 2002 to March 2019 were analyzed. Treatment was non-surgical, with prospective monitoring. Whereas antibiotics were not given at all in one practice, they were given only upon signs of infection in the other practice. The outcome was evaluated retrospectively on the basis of patient files. RESULTS: The collective consisted of 185 males and 87 females. Mean age was 30 years (range: 7 months to 82 years). The perforations were most commonly located in the upper anterior and lower posterior quadrants. According to Griffin grading, the size was grade I in 97%. The three most common causes were impact to the ear, barotrauma, and foreign bodies. Under a watchful waiting regimen, 95% of the patients presenting for follow-up checks showed complete closure. CONCLUSION: Watchful waiting can be assessed as appropriate in traumatic eardrum perforation, provided otorhinolaryngologic follow-up is ensured. An exception is blast injury, which is now much less common in Central Europe, as this is associated with a risk of secondary cholesteatomas. In these rare cases, active treatment with surgical exploration of the middle ear including relining the perforation is indicated.

[Hearing dynamics in acute traumatic perforation of the tympanic membrane after application of blood plasma enriched with platelet growth factors]. / Regeneratsiya barabannoi pereponki i otsenka dinamiki slukha pri ostroi travmaticheskoi perforatsii barabannoi pereponki posle applikatsii plazmy krovi, obogashchennoi trombotsitarnymi faktorami rosta.

OBJECTIVE: The article considers the possibility of treating patients with acute traumatic perforation of the eardrum with a single application of blood plasma enriched with platelet-derived growth factors in the perforation area. As a result of the studies, it was found that the acceleration of its closure and the restoration of hearing. MATERIAL AND METHODS: The study included 43 patients with unilateral acute PBP of various etiologies (Table 1). Patients were divided into 2 groups - the main - 24 patients (10 men and 14 women), the average age - 30±9.7 years and the control - 19 patients (9 men and 10 women), the average age - 26.5±6.37 years. The compared groups did not reliably differ in age, gender, frequency and severity of hearing impairment. RESULTS: Analyzing the results, we can confidently talk about the beneficial effect of blood plasma enriched in platelet-derived growth factors on the speed, completeness of closure of traumatic perforation of the eardrum and the dynamics of restoration of auditory function. The use of blood plasma enriched with platelet growth factors led to a regular reduction in the time and increase in the frequency of cases of early closure of perforated eardrum, as well as improvement and restoration of auditory function according to the results of tonal threshold audiometry and otoacoustic emission in dynamics. CONCLUSION: Being generally available even in outpatient practice, the method of a single application of blood plasma enriched with platelet growth factors in the area of perforation of the tympanic membrane can significantly accelerate the healing process of the tympanic membrane, while improving the quality of life of the patient.

Fetoplacental ratios in stillbirths and second trimester miscarriages.

An abnormal fetoplacental (F/P) ratio is a risk factor for poor pregnancy outcomes including fetal death, but studies of F/P ratio among stillbirths are limited. In the Wisconsin Stillbirth Service Program cohort of second and third trimester fetal deaths, 1,022 were at ≥24 weeks with data on fetal and placental weight. Comparison with data for viable infants of the same gestational ages (GAs) showed that the F/P ratio increases more rapidly with GA for stillbirths than for viable infants. While placentas of stillborn infants are small at all GA, weights of deceased fetuses are lowest early in the second trimester, becoming nearly normal by term. Excess high F/P ratios are noted at all GAs, increasing toward term, while low ratios are frequent at early gestation but rare near term. Analysis by cause of death shows that F/P ratios are markedly elevated for placental and maternal causes (about 50% above the 90th centile), somewhat elevated for cord accidents, non-hydropic fetal, and unknown causes (about 1/3 above the 90th centile), and variable with 40% below the 10th centile for hydropic stillbirths. Across all causes and GAs, placental weights are more abnormal than fetal weights, suggesting that diminished placental function may contribute to fetal demise even when non-placental causes (e.g., premature membrane rupture, cord accidents, and chromosomal disorders) are identified. About half of all stillbirths have abnormal F/P ratios, suggesting that improvements in prenatal assessment of placental size and function might aid in identifying pregnancies at risk for demise; unfortunately, therapeutic options for ongoing pregnancies with diminished placental function remain limited.

Assessment of hearing loss induced by tympanic membrane perforations under blast environment.

PURPOSES: This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model. METHODS: Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear-Nose-Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL. RESULTS: The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15-30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal-Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI). CONCLUSIONS: It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).

Middle-ear cholesteatoma co-existing with labyrinthine fistula and vestibular schwannoma.

BACKGROUND: Many conditions, among them vestibular schwannoma and middle ear cholesteatoma with lateral semicircular canal destruction, may be associated with asymmetrical sensorineural hearing loss (SNHL) and vertigo. However, the probability that these two distinct disease entities causing the same symptoms occur in a single patient is very low, approximately 1 per 28 billion per 1 year. METHODS: We present the case of a 40-year-old male admitted to our clinic because of chronic middle ear inflammation with concomitant tinnitus vertigo, and deafness in the right ear. The patient was diagnosed with lateral semicircular canal fistula caused by middle-ear cholesteatoma and concomitant vestibular schwannoma. Canal wall-down surgery was carried out to remove the cholesteatoma, followed by gamma knife radiosurgery for the vestibular schwannoma. RESULTS: Vertigo and tinnitus resolved within 3 days after the ear surgery, and gamma knife treatment resulted in the complete involution of the vestibular schwannoma. The patient presented with completely dry middle-ear cavity and no recurrence of the cholesteatoma was observed during a 3-year follow-up. CONCLUSION: As the hereby reported condition is very rare, the results cannot be compared with any similar report published previously. Nevertheless, based on the outcome, the treatment strategy seems to be both reasonable and effective.

Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium.

OBJECTIVES: This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium. METHODS: This was a retrospective comparative study of 53 patients (25 males and 28 females) with tympanic membrane perforation who underwent type I tympanoplasty in the department of otorhinolaryngology at a tertiary medical center from March 2011 to April 2017. The subjects were classified into two groups; transcanal endoscopic tympanoplasty with ADA (TET, n=26), conventional endaural microscopic tympanoplasty with autologous tragal perichondrium (EMT, n=27). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3months postoperatively, operation time, sequential postoperative pain scale, and postoperative graft failure rate were evaluated. RESULTS: The perforation size of the tympanic membrane in TET and EMT group was 22.3±10.9% and 23.5±9.7%, respectively (P=0.143). Mean operation time of EMT (92.3±16.5min) was longer than that of the TET (65.3±20.5min) with a statistical significance (P=0.004). Graft success rate in the TET and EMT group were 92.3% and 96.3%, respectively; the values were not significantly different (P=0.610). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Pain in the immediate postoperative and day 1 after surgery were significantly less in the TET group. CONCLUSION: With human cadaveric ADA, minimal invasive endoscopic tympanoplasty can be achieved with similar postoperative results and less pain.

[Diagnosis and treatment of Eustachian tube dysfunction]. / Diagnostik und Therapie von Funktionsstörungen der Tuba auditiva.

The Eustachian tube protects against secretion, germs and sound pressure from the nasopharynx, it acts as a drain, and serves pressure equalization in both directions so that the ear drum and sound-conducting apparatus can vibrate optimally. The incidence of Eustachian tube dysfunction in adults is about 1%, in children almost 40%. Symptoms are often unspecific. For diagnosis, the Eustachian tube score (ETS-5) can be used in patients with a perforated ear drum, and the ETS-7 score in patients with intact ear drum. Adenoid hypertrophy is a frequent cause of obstructive tube dysfunction in children. Treatment of obstructive dysfunction includes steroid nasal sprays and regular performance of the Valsalva maneuver, as well as tube dilation with the Bielefelder balloon catheter. The patulous Eustachian tube is treated with saline nasal irrigation, estrogen-nasal ointment, and craniocervical manual therapy; causal treatments are evaluated.

Tympanoplasty surgery: a retrospective audit of surgical outcomes at a regional hospital.

BACKGROUND: Chronic Suppurative Otitis Media (CSOM) is a common condition in our setting, resulting in tympanoplasty surgery being one of the common surgical procedures performed. Little is published regarding outcomes of tympanoplasty surgery in patients living with Human Immunodeficiency Virus (HIV), which has a high prevalence in South Africa. METHODS: A retrospective review of all tympanoplasty surgeries performed at our institute. Outcomes of surgery according to patient demographics, documented HIV status, seniority of surgeon, type and techniques of graft placement and hearing outcomes were reviewed. RESULTS: Successful closure of perforations was 84.4%. Closure rates in the 10 patients known to be HIV positive were 100%. The number of patients meeting the criteria for The Belfast Rule of Thumb (BROT) increased from 26.3% (n = 20) preoperatively to 68.4% (n = 52) postoperatively. CONCLUSION: The results are comparable to both the results obtained at a tertiary hospital and those published internationally. Successful outcomes are obtainable in patients infected with HIV; however, as to the optimal timing of this surgery, this would require further investigation.

Retrospective Analysis of 24 Cases of Forensic Medical Identification on Traumatic Tympanic Membrane Perforations.

OBJECTIVES: To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations. METHODS: Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated. RESULTS: For the traumatic tympanic membrane perforations, the study showed that the small size of perforation （<1/2 quadrant） with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%. CONCLUSIONS: In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification.

[The application of contrast-enhanced X-ray salpingography for the evaluation of the effectiveness of catheterization of the acoustic tube with the use of the Eustachian catheters]. / Rentgenokontrastnaia sal'pingografiia v otsenke éffektivnosti kateterizatsii slukhovoi truby ushnymi kateterami.

The objective of the present study was to evaluate the effectiveness of the administration of a medication into the middle ear structures during catheterization of the acoustic tube (AT) in the course of the contrast-enhanced X-ray salpingographic investigation. The study included 18 patients (18 ears) presenting with chronic otitis media and the perforated tympanic membrane without the disturbances of the ventilation function of the auditory tube. All the patients were allocated to two groups depending on the type of the Eustachian catheters being used. Group 1 was comprised of 9 patients treated with the use of traditional Giyot's catheter, group 2 was composed of another nine patients who were treated with the use of the Eustachian catheters having an original shape with a specific configuration of its distal part. The X-ray studies were carried out before and after catheterization of the acoustic tube with the administration of 1 ml of the hypaque contrast medium. The study has demonstrated that the X-ray contrast agent did not penetrate into the inner structures of the middle ear of the patients comprising group 1 whereas in the patients of the second group the contrast medium reached as far as the bony portion of the acoustic tube.

Otoscopic examinations reveal high prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa.

OBJECTIVE: To determine the prevalence of outer and middle ear pathologies in paediatrics in Limpopo, South Africa. DESIGN: Cross-sectional retrospective review of otoscopy results obtained during a school health screening campaign conducted between March and June 2015. Descriptive statistics through percentages and frequency tables were used to analyse the data. Logistic regression was used to determine associations between age, gender and pathologies observed. STUDY SAMPLE: Medical folders of 1089 pupils. RESULTS: Forty-nine percent had normal otoscopy results. A significant 36% (n = 392) had impacted cerumen. Furthermore, 45% of those with impacted cerumen were bilaterally impacted. Additionally, 4% presented with foreign bodies and a further 8% had otitis externa and otitis media. The remaining 3% had tympanic membrane perforations. The odds of developing outer and middle ear pathologies were higher in pupils below 6 years of age (p = 0.046). CONCLUSION: This study highlights a high prevalence of outer and middle ear pathologies in paediatrics in Limpopo and therefore recommends comprehensive baseline and periodic screenings; to identify children with outer and middle ear pathologies and need further management, and consequently prevent the complications of these pathologies. Additionally, this report highlights a rising need for large-scale research to provide comprehensive analysis of these pathologies.

The Effect of PRP-enriched Gelfoam on Chronic Tympanic Membrane Perforation: A Double-blind Randomized Clinical Trial.

OBJECTIVE: To evaluate the effect of PRP-enriched gelfoam on the healing of chronic TM perforation in comparison with gelfoam alone. METHODS: In this double-blind randomized clinical trial Patients with chronic tympanic membrane were randomly allocated to two groups; intervention group underwent tympanoplasty with platelet rich plasma (PRP)- enriched gel foams and control group underwent operation with conventional gel foams alone. Patients information was recorded 4 and 12 months after surgery. RESULTS: Eventually 24 patients (12 males and 12 females) with a mean age of 43.33 ± 12.34 years in intervention and 41.33 ± 10.02 years in control group underwent analysis (p = 0.667). Complete TM healing was seen in 8 (66.67%) patients in intervention group and 3 (25%) patients in control group three months after intervention (p = 0.031, OR = 5.98). CONCLUSION: Addition of PRP to conventional gelfoams used in TM perforation repair increases the complete healing rate of TM perforation with less morbidity and complications.

Conditions of the external and middle ear: an overview of presentation, management and associated complications.

Ear, nose and throat (ENT) presentations to primary care are common and frequently affect military patients. Many patients can be managed in primary care with appropriate treatment, but some presentations require appropriate, timely, and occasionally emergency onward referral for hospital management. This paper discusses the management of common otological presentations including otitis externa (OE), acute otitis media, chronic suppurative otitis media (including cholesteatoma), tympanic membrane (TM) perforations and pinna haematoma.

The contralateral ear in cholesteatoma.

Middle ear cholesteatoma has been extensively studied. Theories of cholesteatoma pathogenesis involving previous tympanic membrane retraction are the most widely accepted, but the contralateral ear in patients with cholesteatoma remains unstudied. This study aimed to investigate the contralateral ear in patients with cholesteatoma, and to determine whether the characteristics of it differ according to patient age and cholesteatoma growth patterns. This study was cross sectional. We evaluated 356 patients with middle ear cholesteatoma in at least one ear, and no history of surgery, between August 2000 and March 2013. Otoendoscopy was conducted on both the affected and the contralateral ear. They were classified as normal, tympanic membrane perforation, moderate to severe tympanic membrane retraction and cholesteatoma. The mean age of the patients was 32.77 years, and 53.1 % of the cohort were female. Only 34.8 % of the contralateral ears were normal. The most common abnormality was moderate to severe tympanic membrane retraction (41.6 %). Cholesteatoma was identified in 16 %. Children exhibited a greater frequency of tympanic membrane retractions, whereas adults exhibited a greater frequency of cholesteatoma. All of the contralateral ears in the anterior epitympanic group were normal, but otherwise there were no differences in the contralateral ear when we compared the cholesteatoma growth patterns. We conclude that patients diagnosed with acquired cholesteatoma of one ear are significantly more likely to exhibit abnormalities of the contralateral ear.

Tympanic Membrane Perforation Caused by Thunderbolt Strike.

Thunderbolt strike is a life-threatening entity. In the patients presenting with thunderbolt strike, the central nervous system and the cardiovascular system should be primarily evaluated, followed by tympanic membrane lesions. The most important symptom connected with ear is the loss of hearing. In this report, a 43-year-old male patient with unilateral tympanic membrane perforation, tinnitus, and bilateral sensorineural hearing loss caused by thunderbolt strike is presented through a review of the literature.