Measurement of hearing loss due to perforated tympanic membrane using image processing techniques
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Abstract:
The tympanic membrane (ear drum) is a thin tissue film that is stretched between the outer and middle ear. Sound waves travel from outside the ear, and strike the tympanic membrane resulting in its vibration. These vibrations amplify the sound waves and transmit them to the ossicles (auditory bones). The magnitude of amplification is directly proportional to vibrating area of tympanic membrane. Hence a perforation in this membrane would result in hearing loss. Pure-tone audiometry is the traditional procedure used to detect the amount of hearing loss in a patient. However, it is lengthy and less efficient, as it largely depends on the response of the patient to sound intensity and frequency of pure-tones. We present a relatively more efficient approach to determine hearing loss due to perforated tympanic membrane using image processing techniques. We describe an algorithm that uses unsharp masking to sharpen images of the perforations as well as the tympanic membrane. Then, it converts the image into a binary image using thresholding. A median filter is applied to get rid of the noise component in the image. The ratio of the area of perforation and total area of tympanic membrane will define the percentage of hearing loss. Our approach will eliminate the error introduced due to patient dependency as in the traditional method.Keywords:
Malleus
Tympanum (architecture)
Tympanic Membrane Perforation
Ossicles
Pure tone audiometry
Perforation
The present author, by the method of measuring human tympanic membrane by molding with alginate impression material, studied the detailed morphological changes of drum at normal pressure and-30mm Hg of the tympanum in 7 normal ears.1. The present experiment was performed on 7 ears of 7 adults, 1655 years old, whose heasing acuity was normal and who had no abnormal findings in the tympanic membrane.2. Average size of the tympanic membrane. Projecting on a flat surface the vertical diameter was 9.85mm, the diameter along the malleus 7.51mm and the horizontal diameter 7.55mm. In true lengths, the vertical diameter was 11.19mm, the diameter along the malleus 8.81mm and the horizontal diameter 8.77mm. The projection resulted in a shortening to about 14%.3. The radius of the tympanic membrane from the umbo was shortest antero-inferiorly (3.63mm). The postero-inferior radius was next (4.39mm, and 4.42mm to the short process) and the postero-superior radius was longest (5.15mm). The average diameter of the pars flaccida was, along the vertical line, 2.37mm.4. By negative pressure the tympanic memdrane was distended on the diameter along the malleus by 0.22mm (2.5%) and on the horizontal diameter by 0.17mm (1.97%). Centering the umbo the distention was 0.12mm (2.73%) on the postero-inferior radius, 0.09mm (2.48%) on the antero-inferior radius, 0.10mm (2.26%) along the malleus, and 0.08mm (1.55%) on the postero-superior radius. The distention was largest in the pars flaccida (0.22mm, 9.28%).5. The average distance of the infundibulum to the imaginal surface of the tympanic membrane was 2.04mm, which was displaced 0.21mm medially by negative pressure. The height of the short process was 0.06mm. By negative pressure the process was displaced 0.18mm medially. The height of the basis of the pars flaccida was 0.49mm. The basis was retracted by negative pressure 0.35mm more. Namely, comparing to the degree of retraction of the umbo, that of the short process was smaller by 14.4% and that in the pars flaccida was larger by 67%.6. The retraction in the pars tensa by negative pressure was most extreme in the posterosuperior part (0.26mm). This was larger than the retraction of the umbo by 24%. The retraction of the antero-inferior part was 0.18mm, that near the handle of the malleus 0.16mm, and that in the postero-inferior part was 0.13mm, which was slightest, and furthermore, smaller than the retraction of the umbo by 38%.7. Otoscopically, the radius centering the umbo was 4.59mm in the antero-superior part, 3.11mm in the antero-inferior part, 3.16mm in the postero-inferior part, and 1.46mm in the postero-superior part. The radius was lengthened by negative pressure 0.32mm and 0.36mm in the antero-inferior and postero-inferior parts respectively, while it was shortened 0.01mm and 0.34mm in the antero-superior and postero-superior parts respectively. Namely, the umbo was displaced 0.35mm in the postero-superior direction and gave a criterion of measurement of the degree of retraction.8. The average width of the posterior fold of the tympanic membrane, observed with an otoscope, was 0.75mm. By negative pressure it decreased by 0.36mm to a half. Thus it formed a sharp border by an extreme retraction of the posterior part of the tympanic membrane and accentuated the degre of the retraction.
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Background: The aim of the surgical procedure of tympanoplasty is to strive to achieve an intact neo tympanum with normal hearing acuity. Widening of the external auditory canal, called canalplasty, helps in better visualization and hence better placement of the tympanic membrane graft. Aim of this study was to compare effect of canalplasty on the outcome of results of type I tympanoplasty.
Methods: 50 cases of patients diagnosed with chronic otitis media mucosal disease with a central dry perforation involving two or more quadrants of the tympanic membrane were included in the study. One group of 25 cases underwent tympanoplasty with canalplasty and was grouped under Group I while the other group of 25 cases underwent tympanoplasty without canalplasty and was called group II.
Results: Analysis was done for graft uptake, hearing improvement and time taken for the surgery. Group I achieved a success rate of 92% graft uptake as compared to group II, which achieved 84%. There was statistically significant improvement in post-operative hearing in cases with canalplasty. Time taken was between the two groups were not statistically significant.
Conclusion: Anatomical and technical factors diversely affect the functional outcome of tympanoplasties. Canalplasty helps in better visualization and placement of the graft. Time spent on drilling in canalplasty is compensated by the time gained in grafting of the neo tympanum. The procedure prevents lateralization of the graft due to the accurate exposure of the annulus. Post operative care is also easier in cases of tympanoplasty with canalplasty.
Tympanum (architecture)
Tympanic Membrane Perforation
Perforation
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Infrared Tympanic Thermometer (ITT) is one of the most useful instruments for accurately measuring temperature. The effects of ear pathologies on ITT measurement remain unclear. The purpose of this study is to determine if tympanic membrane perforation (TMP) affects ITT measurements in adult patients.A total of 90 adult patients with monaural central TMP were enrolled in this study. Patients were categorized into three subgroups according to perforation size (1-3 mm, 4-7 mm, and 8-10 mm). The tympanic temperatures of the affected and unaffected sites, and subgroups were compared with each other.This study contained 54 (60%) males and 36 (40%) females ranging from 20 to 58 years of age (mean age: 30.74 ± 9.61 years). The mean tympanic temperature of the side affected with TMP was 36.34oC ± 0.61oC. The mean tympanic temperature of the unaffected side with healthy and intact tympanic membrane was 36.33oC ± 0.6oC. The Pearson correlation score for the tympanic temperatures and the size of TMP was 0.22 which was not significant (r=-0.12).TMP and perforation size do not affect ITT measurements in adult patients.
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Tympanic Membrane Perforation
Perforation
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Infrared thermometer
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To present the experiences of tympanoplasty in patients with large perforation of tympanic membrane in pars tensa.Of 147 patients who underwent surgery for chronic otitis media with large perforation of tympanic membrane in pars tensa,101 patients without mastoid problem underwent tympanoplasty, 46 patients who had evidence of middle ear, antral/epitympanic, or mastoid disease underwent tympanoplasty with mastoidectomy.The tympanic membrane graft take rate for the entire group of 147 patients was 96.6% (142 grafts succeed). The average postoperative pure tone air-bone gap was (16.6 +/- 10.9) dBHL after 3 months of the operation.To patients with chronic supperative otitis media and large perforation of tympanic membrane, the CT scan before operation and detailed exploration of tympanum are necessary. The drainage of Eustachian tube, attic and antrum must be enough. The cartilage-perichondrium composite is an ideal material for reconstruction of the drum, the attic and the posterior tympanum.
Mastoidectomy
Tympanic Membrane Perforation
Tympanum (architecture)
Perichondrium
Eustachian tube
Perforation
Myringoplasty
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ABSTRACT Chronic tympanic membrane perforations (TMP) can be a source of significant morbidity from hearing loss, recurrent middle ear infections, changes in lifestyle, and risk of cholesteatoma formation. Laboratory experiments of TMP have been fraught by the rapid and high rate of spontaneous healing observed in animal models. There is controversy on the minimal time that perforations in animal models must have in order to be considered chronic TMP and thus have clinical relevance, with authors suggesting time periods of perforation patency of 8–12 weeks. In this article, we sought to create a clinically significant experimental model that could yield a high rate of perforation patency for at least 8 weeks. Animals undergoing acute TMP were exposed to three different experimental situations to delay the healing of the perforation: fractionated radiation, topical lipopolysaccharide application, and a combined dexamethasone and mitomycin C (DXM/MC) solution. In our study, the use of DXM/MC reliably produced TMP lasting at least 8 weeks in 86.48% of the cases without the need to reopen the perforation, infolding the edges of the membrane, or using physical barriers to prevent TMP closure. Histologically, the resulting perforated tympanum showed hyaline changes of the remnant tympanum and hyperkeratosis of the squamous epithelia of the external auditory canal. We believe that this model is reproducible and has potential use in experiments of delayed healing of TMP. Anat Rec, 303:619–625, 2020. © 2019 American Association for Anatomy
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The most common etiologies of tympanic membrane perforation are infections and trauma.The objective of the present study was to assess the healing of traumatic tympanic membrane perforation in rats.The tympanic membrane from male Wistar rats was perforated in the anterior and posterior portions to the handle of the malleus. Five tympanic membranes were evaluated 3 days after tympanic perforation; 5 after 5 days; 5 after 7 days; 3 after 10 days; and 4 after 14 days. The tympanic membranes were submitted to histopathological evaluation after hematoxylin-eosin staining.Tympanic membrane closure occurred at about 7-10 days after injury and the healing process was complete by day 14. The proliferative activity of the outer epithelial layer was present close to the handle of the malleus and to the tympanic annulus.The spontaneous healing process of the tympanic membrane starts from the outer epithelial layer, with later healing of the lamina propria and the mucosal layer.
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Perforation
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Objective To investigate the therapeutic effect of microsurgery with epithelial flaps of tympanic membrane.Methods Forty five ears with simple tympanum perforation were adopted.Epithelial flaps of tympanic membrane were used for the perforation repair and the conditions of tympanum repair and hearing improvement were followed up for 3 to 6 months.Results Two weeks after surgery,pure tone auditory(0.5,1,2,4 kHz) showed that the average air conduct threshold was 17.9 dB HL,improved by 10 dB HL compared to the hearing level before surgery.Both the original perforation and the wound created by epithelial flap of tympanic membrane were completely repaired.Conclusions Myringoplasty with epithelial flap of tympanic membrane was an effective method to repair small simple tympanum perforation.It was a microsurgery without getting materials from the other place of the body.
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Myringoplasty
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Tympanic Membrane Perforation
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Perforation
Tympanic Membrane Perforation
Mitomycin C
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Abstract Objective To perform quantitative analysis of pathological changes in the tympanic membrane using video‐otoscopic images. Study Design Prospective case‐control study. Methods Forty‐two ears of children with chronic otitis media with effusion (OME) and 15 ears of normal children were included in this study. Tympanic membrane images were captured and digitized using a Welch‐Allyn (Skaneatales Falls, NY) VDX‐300 Illumination and Imaging system with S‐VHS input to a MIRO DC 30 (Pinnacle Systems, Mountain View, CA) visual board in a Power PC–based computer. These images were visualized and recorded during static and pneumatic pressure changes. Quantitative analysis of tympanic membrane disease was performed using Image Pro Plus Imaging software (Media Cybernetics, Del Mar, CA). The measurements included area of the tympanic membrane and its quadrants, area of tympanic membrane involved by disease, angle formed at the umbo, and length of the malleus versus vertical length of the tympanic membrane. Results Tympanosclerosis was present in 57% of ears and occurred most frequently in the anteroinferior quadrant, but the ma‐imum area of involvement was in the posteroinferior quadrant. The ratio of the angles formed at the umbo was significantly greater ( P = .01) for the OME group compared with the control group. The ratio of the length of the umbo and the vertical length of the tympanic membrane was almost identical for the OME and the control groups ( P = .4). Conclusions Video‐otoscopic images can be used for quantitative analysis of tympanic membrane disease. The ratio of the posterior angle to the anterior angle formed at the umbo seems to be a more reliable indicator of post otitis media than is a reduced length of the long process of malleus.
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Tympanic Membrane Perforation
Quadrant (abdomen)
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Conductive hearing loss
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