Evaluation of Tympanic Membrane Perforation Size Using Computer-Based Technology in Mucosal Chronic Otitis Media and Its Correlation with Hearing Loss

Background: Tympanic membrane perforation is a common manifestation of mucosal chronic otitis media and is frequently associated with conductive hearing loss. Accurate assessment of perforation size may help determine the severity of hearing impairment. Aim: To evaluate tympanic membrane perforation size using ImageJ computer-based image analysis and determine its correlation with conductive hearing loss in patients with inactive mucosal chronic otitis media. Materials and Methods: This hospital-based cross-sectional study included 90 patients (103 ears) with inactive mucosal chronic otitis media between January 2021 and May 2022. Tympanic membrane perforation size was measured using ImageJ software from otoendoscopic images and outpatient department drawings. Pure-tone audiometry was performed to assess hearing loss. Statistical analysis was conducted using SPSS version 25.0, with p<0.05 considered statistically significant. Results: Large perforations were observed in 58.3% of ears, followed by subtotal perforations (32.0%), small perforations (5.8%), and medium perforations (3.9%). The mean air–bone gap increased progressively with perforation size, measuring 12.49 dB, 21.24 dB, 27.49 dB, and 34.66 dB in small, medium, large, and subtotal perforations, respectively. A statistically significant weak positive correlation was observed between perforation size and hearing loss. A strong positive correlation was found between measurements obtained from otoendoscopic images and OPD drawings. No significant correlation was observed between the duration of ear discharge and perforation size (p=0.88). Conclusion: Tympanic membrane perforation size was positively associated with conductive hearing loss, with larger perforations producing greater hearing impairment. ImageJ software provided a practical method for objective assessment and documentation of perforation size in patients with mucosal chronic otitis media.