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

Abstract

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.

Chinese abstract

背景：缺乏关于无胆脂瘤慢性中耳炎的研究。

目的：结合传统技术和最新技术, 进行鼓膜穿孔（TMP）的分析, 比较中心和边缘TMP的参数。

材料和方法：792例连续患者。 按中心和边缘位置来划分TMP亚组, 并根据鼓膜曾回缩的体征进行比较, 即踝关节内侧、岬骨上鼓膜残留、听骨链上鼓膜残留、砧骨/镫骨侵蚀。分析对侧耳朵（CLE）的状态。

结果：79.8％的患者被诊断为中心TMP。与中心组相比, 边缘组报告的听力损失更多（95.6％）, 传导性听力损失更大（空气传导的纯音平均值为43.3 dB, 平均气骨间隙为28.7 dB）, 穿孔面积更大（46.45％）, 更多后下象限受累, TMP之前有更多的缩回征象以及更多CLE的变化（71％）。

结论：当我们使用所有技术来进行比较时, TMP各亚组之间的差异显得突出。边缘TMP比中心TMP具有更多更改的参数。

意义：增进对TMP的了解并改善基于病因的治疗, 可能性是很大的。

Keywords:

• Tympanic membrane perforation
• central
• marginal
• videotoscopy
• perforation size
• contralateral ear

Disclosure statement

No potential conflict of interest was reported by the author(s).