RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALROE, KARNATAKA

ANNEXURE II
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

Name of the candidate and Address (In Block Letters)

Dr. ANKUR KUMAR S/O RAMENDRA NATH 11B/2 KIRTI BASH MUKHERJEE ROAD KOLKATA-700067 WEST BENGAL

2.

Name of the Institute

MVJ MEDICAL COLLEGE AND RESEARCH HOSPITAL, HOSKOTE BANGALORE

3.

Course of Study and Subject

M.S. ENT

4.

Date of Admission to Course

30-05-2012

5.

Title of Topic

A CLINICAL STUDY TO EVALUATE HEARING

LOSS IN PATIENTS WITH TYMPANIC MEMBRANE PERFORATION.

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BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY
Tympanic membrane is a membranous partition separating the external auditory meatus from the tympanic cavity, measuring 9-10 mm vertically and 89 mm horizontally. It plays a major role in middle ear transformer mechanism. Tympanic membrane perforation is caused by variety of causes, the most common being Infection and trauma. Infections (Acute otitis media, chronic otitis media, TB) Trauma (self inflicted, Iatrogenic). Tympanic membrane perforation leads to varying degree of conductive hearing loss. Loss of hearing is a national health problem with significant physical and psychosocial disability to the patient. So it is important to diagnose and treat tympanic membrane perforation as early as possible as untreated tympanic membrane perforation leads to ongoing destructive changes in the middle ear, thus adding to further hearing loss[1]. The incidence of otitis media and tympanic membrane perforation is high in this region ; so I have undertaken this study.

6.2 REVIEW OF LITERATURE:

Ahmad and Ramani stated that the hydraulic action arising from the difference in area of TM and of the stapedial footplate is the most important factor in impedance matching. When the surface area is decreased due to perforation, there will be decrease in amplification and hearing loss will be proportionate to size of perforation. They also found greater hearing loss in malleolar perforation[2]. Voss. studied that hearing loss increased as the perforation size increases[3]. Shambaugh in a study of 42 ears with tympanic membrane perforation classified group C

perforation (size 2030% of surface area of TM) into anterior and posterior groups and found that there was no statistically significant difference between two means at any frequency[4]. Shah in his study observed that malleolar perforations had significantly greater hearing loss than non-malleolar perforations[5]. Gulati in a study of 21 patients with otitis media(mucosal disease) reported a linear relation between size of perforation and amount of hearing loss[6].

6.3 OBJECTIVES OF STUDY:

1. To assess the effect of size and site of tympanic membrane perforation, on degree of hearing loss. 2. To evaluate the effect of duration of tympanic membrane perforation on hearing.

7.

MATERIAL AND METHODS. 7.1(a) SOURCE OF DATA

For the study, patients of either sex and of age 18 years and above presenting with dry perforations of tympanic membrane unilateral or bilateral, presenting in MVJMC&RH ENT opd in between November 2012 to October 2014 will be selected.

(b) STUDY DESIGN Non-randomized, prospective cohort study.

(c) INCLUSION CRITERIA

All patients above 18 yrs of age with a tympanic membrane perforation (dry ear, both unilateral and bilateral) will be included in the study irrespective of the sex and

cause of the perforation. Patients having active ear discharge will be treated so as to make the ear dry and will be taken up for the study subsequently.

(d) EXCLUSION CRITERIA 1. Patients with other associated ear pathology like otomycosis, acute and chronic otitis externa, etc. 2. Patients with sensorineural hearing loss or mixed hearing loss.

(e) SAMPLE SIZE:

A minimum of 50 cases of patients with tympanic membrane perforation will be taken up during the course of study.

7.2 METHODS OF COLLECTION OF DATA

A thorough history will be taken in each case, followed by detailed examination including tuning fork tests and other laboratory investigations. Then, the evaluation of hearing loss will be done in each case of dry tympanic membrane perforation with no active middle ear disease at the time of presentation, depending on the size, site and duration of perforation. Diameter of perforation will be measured by a 1 mm thin wire hook . Readings will be taken under microscope. Two diameters is taken for each perforation, one maximum vertical and the other maximum horizontal. Area calculated will be:

where is the 3.14159 constant, R1 is the radius along the vertical axis, R2 is the radius along the horizontal axis.

The site of the perforation will be determined with help of otoscope and microscope.

7.3 Does the study require any investigation or intervention to be conducted on patients, other humans or animals? If so please describe briefly?
Yes 1. Examination under microscope. 2. Hb, TC, DC. 3. Random Blood Sugar. 4. Urine routine 5. X-Ray Paranasal sinus Waters view. 6. B/L X-Ray mastoid lateral oblique view to know the mastoid status. 7. Pure Tone Audiometry.

After informing the patients and obtaining prior written consent, the patient will be subjected to investigations, as indicated and their hearing status is assessed. No animal study is required.

7.4

Has ethical clearances been obtained from your institution in case of 7.3
YES.

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1. LIST OF REFERENCES
1. Kulwant Kaur, Pannu, Snya Chadha, Dinesh Kumar, Preeti. Evaluation of hearing loss in tympanic membrane perforation. Indian Journal of Otolaryngology and Head & Neck Surgery. 2011; July-Sep.63:3:208-213.

2. Ahmad SW, Ramani GV. Hearing loss in perforation of tympanic membrane. J Laryngol Otol. 1979; 93:10911098.

3. Voss SE, Rosowski JJ, Merchant SN, Peake WT. How do tympanic membrane perforations affect middle ear sound transmission. Acta Otolaryngol. 2001; 121(2):169 173.

4. Hamilton, BC Decker. Conductive hearing loss. Shambaugh surgery of Ear, 5th edition. 2003; 16973.

5. Shah S, Bhat V, Gupta D, Sinha V. A study of correlation of site and size of perforation with deafness. Indian J Otology. 2006; 12:4749.

6. Gulati SP, Sachdeva OP, Kumar P. Audiological profile in CSOM. Indian J Otolaryngol. 2002; 8:2428.

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SIGNATURE OF THE CANDIDATE

10.

REMARKS OF THE GUIDE

This topic will be an interesting study to conduct as we get many cases of CSOM with different types of perforation and varying degree of hearing loss. All the equipments needed for the study are available in the hospital and there is no extra burden of the cost on patients.

11.

NAME & DESIGNATION (IN BLOCK LETTERS) 11.1 GUIDE DR. SOMSUNDAR REDDY PROFESSOR DEPT.OF ENT MVJ MC & RH. HOSKOTE

11.2 SIGNATURE 11.3 CO-GUIDE (IF ANY) 11.4 SIGNATURE 11.5 HEAD OF THE DEPARTMENT DR. SOMSUNDAR REDDY PROF. & HOD, DEPARTMENT OF ENT MVJMC& RH HOSKOTE

11.6 SIGNATURE

12.

12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL 12.2 SIGNATURE