Download rajiv gandhi university of health sciences, bangalroe, karnataka

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
M.S. ENT
Subject
4.
Date of Admission to
30-05-2012
Course
5.
Title of Topic
“A CLINICAL STUDY TO EVALUATE HEARING
LOSS IN PATIENTS WITH TYMPANIC
MEMBRANE PERFORATION.”
6.
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 20–30% 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 π 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 Water’s 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.
8.
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; 93:1091–1098.
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; 169–73.
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; 12:47–49.
6. Gulati SP, Sachdeva OP, Kumar P. Audiological profile in CSOM. Indian J
Otolaryngol. 2002; 8:24–28.
9.
SIGNATURE OF THE
CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME & DESIGNATION (IN
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.
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
11.6 SIGNATURE
12.
12.1 REMARKS OF THE
CHAIRMAN & PRINCIPAL
12.2 SIGNATURE
DR. SOMSUNDAR REDDY
PROF. & HOD,
DEPARTMENT OF ENT
MVJMC& RH HOSKOTE