**3. Results**

Seventy patients were found to have traumatic tympanic membrane perforation. However 6 individuals were excluded because of incomplete data. Thus only 64 patients' records were analyzed and formed the basis for this study. Age range of the patients was between 6 months to 50 yrs with a mean age of 29.2yrs and modal age of 35 years. About 5 (7.9%) of them were ≤5years and majority of the patients were between 35 and 50years of age (Table 1).

There were 46 (71.9%) males and 18 (28.1%) females with a male to female ratio of 2.5:1. Males were affected in most of the aetiologies except in "fall" where no male patient was recorded (table 2).

The commonest aetiology for trauma was from slaps, followed by road traffic injury (RTI) in 35.9% and 23.5% patients, respectively (Table 3).

Majority of the slap injury were from fights, security agents, senior students and cultist synonymous with Gangsterism (group of criminals especially those who are armed and use guns or group of students acting as terrorists within the school system.)at schools in 30.5%, 17.4% and 17.4% respectively. (Table 4)

Traumatic tympanic membrane perforation affected 36 left ears and 28 right ears. Majority of the patients (95%) had associated sudden hearing loss. Tinnitus was present in 52% while 24 (37.5%) of the patients had progression to chronic suppurative otitis media (Table 5). It was observed that majority of the patients failed to follow up clinical visits once the symptoms of bleeding and pain had subsided. An average of three follow up visits per patient was recorded. Out of the few %that came for follow up check ups, only 7.8% had neo-membrane formation.


Table 1. Age distribution of patients with traumatic TM perforations.

Conductive Hearing Loss Due to Trauma 167

associated loss of inner ear and facial nerve function (Ologe FE 2002, Toner JG & Kerr AG 1997, Okafor BC 1983, Ijaduola GTA 1986, Bhattia PL 1987, Ladapo AA 1979, Ijaduola GTA and Okeowo PA 1986). Previous studies have shown that trauma to the tympanic membrane and the middle ear can be caused by overpressure (slap, fight, assault from security agents and road traffic injury (RTI)), thermal or caustic burns, blunt or penetrating injuries such as instruments and barotraumas (Mitchell K. S 2003, da Lilly-Tariah OB and Somefun OA 2007). Overpressure is by far the most common mechanism of trauma to the tympanic membrane (Mitchell K. S 2003) in our environment. Traumatic perforation of the tympanic membrane may be caused by direct impact of fluids and

The tympanic membrane (TM) is an important component of sound conduction as its vibratory characteristic is necessary for sound transmission in human beings (Richard R. G

Traumatic tympanic membrane perforation findings from our study are similar to findings elsewhere from the world (Ologe FE 2002, Mitchell K. S 2003, da Lilly-Tariah OB and Somefun OA 2007). Male to female ratio was found to be 2.5:1 with high predominance among males (72%). This is expected, as trauma is more common in this group of patients similar to other reported series (Ologe FE 2002, da Lilly-Tariah OB and Somefun OA 2007, Richard R. G and Mark R.G 2003). Our study of injury site indicated that the left ear is at a higher risk than the right ear in the ratio of 1.0:1.3 right to left which could be associated with the fact that most assailants were right handed, Thus it is likely that most of the acts of trauma such as slap occurred with the assailant and victims were facing each other making the left ear to be predominantly affected compared to the right side. Some of the causes of overpressure include slap injuries and blast injuries. Slap injuries are extremely common and can be result of either a hand or water slap and these injuries usually result in a triangular or linear tear of the TM (Mitchell K. S 2003). These slap injuries could be a product of fight or armed robbery attack. However, in our study it was found to be more common among the youth. In more than 50%of cases reviewed and those in the adult these cases were due to attack by the armed robbers or security agents. This was the highest cause of traumatic tympanic membrane perforation in our study as compared to a similar study in other regions of Nigeria where fight with spouse was the commonest aetiology recorded (da Lilly-Tariah OB and Somefun OA 2007). In contrast this type of injury made the least

Slaps were the commonest type of violence seen between individuals, mostly between security agents and the offender followed by those among students. However, another study found tympanic membrane perforation resulting from slap from marital conflict between wife and husband (Mitchell K. S 2003). There is a need to educate the students and security agents on other punitive measure as there is predisposition to conductive hearing loss or an imminent chronic suppurative otitis media if not properly managed. Slap was commoner among males than in females similar to another study (Mitchell K. S 2003). Trauma to the temporal bone with fracture and leakage of cerebrospinal fluid into the middle ear causing conductive hearing losses was second common in this study and this was found to be secondary to road traffic injury. The management protocol for skull base fracture with TM perforation/CSF leakage does not require any intervention based on

direct pressure from outside.

and Mark R.G 2003)

contribution in our study.


Table 2. Predisposition and sex of patients.


Table 3. Aetiological profile of TM perforations.


Table 4. Sources of Slaps.
