RA1IV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUB1ECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND
ADDRESS
DR. VIDYA 1ANAKI. R.
PG IN ENT,
KARNATAKA INSTITUTE OF MEDICAL
SCIENCES,
HUBLI - 580 022.
2. NAME OF THE INSTITUTION KARNATAKA INSTITUTE OF MEDICAL
SCIENCES, HUBLI-22.
3. COURSE OF THE STUDY AND
SUB1ECT
M.S. IN ENT.
4. DATE OF ADMISSION TO THE
COURSE
10-06-2008.
5. TITLE OF THE TOPIC CORRELATION OF SITE AND
SIZE OF TYMPANIC MEMBRANE
PERFORATION WITH PURE TONE
AUDIOGRAM.
6. BRIEF RESUME OF INTENDED WORK:
6.1 NEED FOR THE STUDY:
Chronic suppurative otitis media(CSOM) is a wide spread disease oI the
developing countries like India especially in the rural areas. It is one oI the
commonest causes oI hearing loss that mainly results due to a tympanic membrane
perIoration.
The large eIIective surIace area oI an intact and normally vibrating
tympanic membrane plays a major role in the middle ear transIormer mechanism.
PerIoration oI the tympanic membrane is a common cause Ior hearing loss due to loss
oI eIIective area oI vibration. PerIorations can result Irom various reasons including
middle ear disease, trauma.
It has been generally believed that the degree oI hearing loss increases with
the size oI the perIoration. Many prior clinical studies have shown that hearing loss
associated with perIoration was more at low Irequencies than at high Irequencies and
it increases with the size oI perIoration.
Correlation oI the site oI perIoration to hearing loss is not very clearly
established though a Iew studies have shown no signiIicance oI site oI perIoration.
Another showed postero inIerior perIoration caused more hearing loss than others.
Accurate assessment oI the TM PerIoration and its relationship with hearing
loss is important as it enables the clinician to optimally assess the condition and oIIer
an appropriate solution. Hence the need Ior the study.
6.2 REVIEW OF LITERATURE:
1. In 1979, Ahmad.S.W and Ramani G. V studied 70 patients with dry central
perIorations to assess the hearing loss and concluded that hearing loss was greater
at the lower Irequencies and increases with the size oI the perIoration. They
also Iound that posteroinIerior quadrant perIorations caused more hearing loss
than antero inIerior ones, the diIIerence being greater at lower than at higher
Irequencies.
1
2. In 2006, Ritvik P Mehta, Rosowski J John et al conducted a study on 56 patients
with isolated TM PerIorations and showed that hearing loss is Irequency dependant
and the greatest loss occurred at the lowest Irequencies, hearing loss increased with
increase in size oI perIoration, varied inversely with middle ear volume and does
not vary substantially with location oI the perIoration.
2
3. In 2003, Bhusal C L et al studied IiIty patients with CSOM Tubo tympanic
type undergoing myringoplasty and showed that hearing loss was more at lower
Irequencies and less as Irequencies increase and hearing loss increased with the size
oI perIoration.
3
4. In 2001 ,Voss S E, Rosowski JJ et al measured acoustic transmission beIore and
aIter making controlled perIorations in cadaver ears and showed that perIorations
caused Irequency dependent loss that was largest at low Irequencies ,increased as
the size oI perIoration increased and did not depend on perIoration location.
4
5. In 1972, Walter P et al studied the eIIects oI both size and location oI tympanic
membrane perIorations on hearing loss in 103 patients who had undergone
myringoplasty and concluded that eIIectiveness oI the TM decreased with loss oI
total area.
5
6.3 AIMS OF THE STUDY:
1. To record the site and size oI tympanic membrane perIorations.
2. To correlate the site and size oI the perIoration with pure tone audiogram in such
patients who IulIilled the study criteria..
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
Patients attending ENT OPD in KIMS, Hubli in the study period Irom January 2009 to
December 2009 who have a tympanic membrane perIoration.
7.2 METHODS OF COLLECTION OF DATA:
A cross sectional, correlative study is planned.
Every consecutive eligible patient will be recruited into the study and divided into two
to three groups depending on the size oI the perIoration. The site oI perIoration will
also be recorded and a pure tone audiogram will be perIormed on the patient. The data
obtained will be analyzed using an appropriate statistical test.
INCLUSION CRITERIA:
1. Subject should have central TM perIoration due to trauma or CSOM.
2. All subjects should have dry ears ( duration 3 months )
3. Patients with intact ossicular chain- conIirmed by patch test.
4. Age between 10 to 60 years.
EXCLUSION CRITERIA:
1. Patients with Attico- antral disease- presence oI cholesteatoma or granulation
tissue.
2. Active CSOM.
3. Patients with ossicular chain pathology.
4. Patients who cannot give a valid and consistent PTA response.
5. Patients with sensorineural hearing loss.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS
TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR
ANIMALS? IF
SO, PLEASE DESCRIBE BRIEFLY.
~Yes
Pure tone audiometry and patch test.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION
IN CASE OF 7.3?
Yes, Ethical clearance has been obtained Irom ethical committee oI KIMS, Hubli.
8. LIST OF REFERENCES:
1. Ahmad S W and Ramani G V 'Hearing loss in perIorations oI the tympanic
membrane. The Journal oI Laryngology and Otology 1979;93;1091-1098.
2. Ritvik P Mehta et al 'Determinants oI hearing loss in perIorations oI the tympanic
membrane. Otology and Neurology 2006;27;136-143.
3. Bhusal et al 'Size oI tympanic membrane perIoration and hearing loss. JNMA J
Nepal Med Assoc. 2006;45(161);167-172.
4. Voss S E et al 'How do tympanic membrane perIorations aIIect human middle ear
sound transmission?Acta otolaryngol. 2001 jan;121(2):169-73.
5. Walter P Anthony et al 'Tympanic membrane perIoration Archives oI
otolaryngology 1972;vol 95 :504-510.
6. Ajith kumar U and Vikram Bhat K. 'Do the site and size oI tympanic membrane
perIoration correlate with audiogram?Asian journal oI Ear,Nose and Throat
2000;4;25-30.
7. Vikram J Jaisinghani et al 'quantitative analysis oI tympanic membrane disease
using video otoscopy The Laryngoscope 2000 oct:110:1726-1730.
8. Ibeweke TS et al 'quantitative analysis oI tympanic membrane perIoration:a
simple and reliable method. The journal oI laryngology and otology 2008 oct 22:1-
4 .
9. Ibeweke TS et al 'assessments oI the size oI tympanic membrane perIorations:a
comparison oI clinical estimations with video otoscopic calculations. Ear Nose and
Throat Journal. 2008 oct:87(10):567-569.
10. Payne M C and Glither F J 1951 archives oI otolaryngology, 54 666-674.
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11. 11.1 NAME AND DESIGNATION OF
THE GUIDE
DR. VIKRAM K BHAT MS, DNB, Phd.
ASSOCIATE PROFESSOR OF ENT
DEPARTMENT OF ENT,
KIMS, HUBLI.
11.2 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
DR. UMESH S NAGALOTIMATHMS,DNB
PROFESSOR & HEAD,
DEPARTMENT OF ENT,
KIMS, HUBLI.
11.6 SIGNATURE
12 12.1 REMARKS OF THE
CHAIRMAN AND THE
PRINCIPAL
12.2 SIGNATURE