The effects of both size and location of tympanic membrane perforations on hearing loss were studied. Using only those cases in which the air-bone gap was closed by myringoplasty, the variable of ossicular chain defects was controlled. Definite trends appeared in averages of the groups which tend to confirm two generalizations: (1) Effectiveness of the tympanic membrane decreases with loss of total area and (2) loss of membrane contact with the manubrium of the malleus affects its abiliy to move. A useful formula for predicting hearing loss on the basis of size and location of perforation is impossible because of wide variations of individual cases within any particular group.
Anthony WP, Harrison CW. Tympanic Membrane Perforation: Effect on Audiogram. Arch Otolaryngol. 1972;95(6):506–510. doi:10.1001/archotol.1972.00770080796003
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