Rana Amit Kumar, Upadhyay Deepak, Yadav Akanksha, Prasad Surendra
Department of Otorhinolaryngology and Head Neck Surgery, SRMS Institute of Medical Sciences, Bareilly, UP India.
Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly, UP India.
Indian J Otolaryngol Head Neck Surg. 2020 Jun;72(2):187-193. doi: 10.1007/s12070-019-01740-9. Epub 2019 Oct 12.
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.
慢性中耳炎是耳鼻咽喉科临床最常见的疾病之一，需要医疗关注。完整的鼓膜充当圆窗龛的屏障，在声波传导中产生相位差。本研究纳入了700例年龄在10至70岁之间的静止期黏膜慢性中耳炎患者。记录鼓膜状况和鼓膜穿孔部位，并进行听力分析。男性338例（48.28%），女性362例（51.71%）。在检查的1400个鼓膜中，769个（54.85%）存在穿孔。631个（82.03%）为单侧穿孔，69个（17.97%）为双侧穿孔。在单侧病例中，289个（37.50%）为右耳穿孔，342个（44.53%）为左耳穿孔。168个（21.74%）鼓膜为单象限穿孔，419个（54.55%）涉及两个象限。62个（8.09%）为三象限穿孔，120个（15.63%）穿孔累及所有四个象限。171个（22.26%）耳的穿孔位于锤骨柄前方，243个（31.53%）仅位于锤骨柄后方。355个（46.21%）穿孔累及锤骨柄。统计学上，累及鼓膜后半部的穿孔听力损失比累及鼓膜前半部或下半部的穿孔更大。累及所有四个象限的穿孔听力损失最大（51.56±5.1dB）。在631例单侧病例中，424例（67.10%）出现传导性听力损失，101例（16.10%）为感音神经性听力损失，74例（11.80%）为混合性听力损失。在769例有听力损失的穿孔耳中，251例（37.69%）有5至10年的听力损失主诉，平均损失为51.15±7.8dB，172例（25.68%）有1至5年的慢性中耳炎病史，听力损失为39.26±5.1dB。110例（16.52%）患慢性中耳炎超过10年的患者平均听力损失为52.18±4.2dB。134例（20.12%）患病时间少于1年的患者报告听力损失为36.46±8.2dB。由于中耳存在额外的病理变化，鼓膜穿孔对声音传播及其动力学的影响不易关联。
