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Quantitative analysis of tympanic membrane perforation: a simple and reliable method

  • T S Ibekwe (a1), A A Adeosun (a2) (a3) and O G Nwaorgu (a2) (a3)
  • DOI:
  • Published online: 22 October 2008

Accurate assessment of the features of tympanic membrane perforation, especially size, site, duration and aetiology, is important, as it enables optimum management.

Aim and objectives:

To describe a simple, cheap and effective method of quantitatively analysing tympanic membrane perforations.

Materials and methods:

The system described comprises a video-otoscope (capable of generating still and video images of the tympanic membrane), adapted via a universal serial bus box to a computer screen, with images analysed using the Image J geometrical analysis software package. The reproducibility of results and their correlation with conventional otoscopic methods of estimation were tested statistically with the paired t-test and correlational tests, using the Statistical Package for the Social Sciences version 11 software.


The following equation was generated: P/T × 100 per cent = percentage perforation, where P is the area (in pixels2) of the tympanic membrane perforation and T is the total area (in pixels2) for the entire tympanic membrane (including the perforation). Illustrations are shown. Comparison of blinded data on tympanic membrane perforation area obtained independently from assessments by two trained otologists, of comparative years of experience, using the video-otoscopy system described, showed similar findings, with strong correlations devoid of inter-observer error (p = 0.000, r = 1). Comparison with conventional otoscopic assessment also indicated significant correlation, comparing results for two trained otologists, but some inter-observer variation was present (p = 0.000, r = 0.896). Correlation between the two methods for each of the otologists was also highly significant (p = 0.000).


A computer-adapted video-otoscope, with images analysed by Image J software, represents a cheap, reliable, technology-driven, clinical method of quantitative analysis of tympanic membrane perforations and injuries.

Corresponding author
Address for correspondence: Dr Titus S Ibekwe, Division of ENT, Irrua Specialist Teaching Hospital, PMB 08, Irrua, Nigeria. E-mail:
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1TS Ibekwe , GT Ijaduola , OG Nwaorgu . Tympanic membrane perforation among adults in West Africa. Otol Neurotol 2007;28:348–52

3 RP Mehta , JJ Rosowski , SE Voss , E O'Neil , SN Merchant . Determinants of hearing loss in perforations of tympanic membrane. Otol Neurotol 2006;27:136–43

4SI Angeli , JL Kulak , J Guzman . Lateral tympanoplasty for total or near total perforation: prognostic factors. Laryngoscope 2006;116:1594–9

6S Schraff , N Dash , B Strasnick . ‘Window shade’ tympanoplasty for anterior marginal perforations. Laryngoscope 2005;115:1655–9

7CY Hsu , YS Chen , JH Hwang , TC Liu . A computer program to calculate the size of tympanic membrane perforations. Clin Otolaryngol Allied Sci 2004;29:340–2

11 Cool drives Sata USB and fire wire drives. 18 May 2005

12C Patricoski , J Kokesh , AS Ferguson , K Koller , G Zwack , E Provost Comparison of in-person examination and video otoscope imaging for tympanostomy tube follow-up. Telemed J E Health 2003;9:331–44

13S Hampal , N Padgham , S Bunt , A Wright . Errors in the assessment of tympanic membrane perforations. Clin Otolaryngol Allied Sci 1993;18:5862

15JA Fasunla , TS Ibekwe , PA Onakoya . Otomycosis in Western Nigeria. Mycoses 2008;51:6770

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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