Hearing loss increases with size but not site of tympanic membrane perforation in Aboriginal Australian children in remote locations

Objective: To investigate the effect of size, site, and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children. Design: Observational study. Methodology: Children aged 5–18 years who identified as ATSI at seven Anangu community schools within the Anangu Pitjantjatjara Yankunytjatjara Lands and Maralinga Lands of South Australia underwent 4-frequency pure-tone audiometry (0.5, 1, 2, and 4 kHz) and video-otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25%–50%, 50%–75%, or 75%–100%). Results: Five hundred seventy-five VO files with matching audiological data were obtained. Active perforations (35 dBHL; 28–44 IQR) demonstrated greater HL than inactive perforations (31 dBHL; 29–39 IQR) p =.0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p <.0001) whereas for active perforations the significance changed to between <25% (p <.0001) and 25%–50% (p <.05) when compared to larger perforations. When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses, findings did not change when individual frequencies were compared to 4-frequency pure-tone average dBHL. Conclusion: In ATSI children from remote communities, HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL. Level of evidence: Level 4.