Assessment of Hearing in Patients with Tympanosclerosis with Intact Tympanic Membrane

Background: Tympanosclerosis is a chronic sequela of middle ear inflammation characterized by hyalinization and calcification of connective tissue within the tympanic membrane and middle ear structures. Although tympanosclerotic plaques may remain asymptomatic, extensive involvement can impair the mobility of the tympanic membrane and ossicular chain, resulting in conductive hearing loss. The present study was conducted to assess hearing status in patients with tympanosclerosis involving an intact tympanic membrane and to evaluate the relationship between the site of tympanosclerotic plaques and audiological findings. Material and Methods: A cross-sectional study was conducted in the Department of ENT, Santosh Medical College & Hospital, Ghaziabad, from May 2024 to September 2025. A total of 90 patients with tympanosclerosis and an intact tympanic membrane were included. All patients underwent detailed otorhinolaryngological examination, otoendoscopy, tuning fork tests, pure tone audiometry (PTA), and impedance audiometry. The anatomical site of tympanosclerotic patches was documented and correlated with audiological findings. Results: The mean age of patients was 36.36 ± 9.23 years, with maximum patients belonging to the 41–50 years age group (36.67%). Female predominance was observed (58.89% females and 41.11% males). Unilateral involvement was present in 81.11% of patients, whereas bilateral involvement was observed in 18.89%. Hearing loss was the commonest presenting symptom, reported in 84.44% of patients. On otoendoscopy, posterosuperior involvement was the most frequent site in unilateral cases (24.66%), while circumferential involvement was predominant in bilateral cases (41.18%). Pure tone audiometry revealed mild conductive hearing loss in 56.16% of unilateral cases and 52.94% of bilateral ears. Type As tympanogram was the most common impedance finding, observed in 53.42% of unilateral and 52.94% of bilateral ears. A significant association was observed between the site of tympanosclerotic patch and PTA findings in unilateral (p=0.004) and bilateral involvement (p=0.001). Significant correlation was also observed between tympanosclerotic site and impedance audiometry findings (p=0.001 and p<0.001, respectively). Conclusion: Tympanosclerosis with an intact tympanic membrane is frequently associated with conductive hearing impairment, although some cases may remain asymptomatic. Posterosuperior and circumferential tympanosclerotic involvement showed greater association with hearing abnormalities. Otoendoscopy combined with pure tone audiometry and impedance audiometry provides valuable assessment of functional impairment and helps in appropriate management planning.

Keywords: Tympanosclerosis; Intact tympanic membrane; Conductive hearing loss; Pure tone audiometry; Impedance audiometry; Otoendoscopy; Tympanometry.