Indian J Otolaryngol Head Neck Surg

(JanuaryMarch 2012) 64(1):5962; DOI 10.1007/s12070-011-0251-5

ORIGINAL ARTICLE

Sensorineural Hearing Loss in Patients with Chronic Suppurative

Otitis Media
E. S. Kolo A. D. Salisu A. M. Yaro
O. G. B. Nwaorgu

Received: 17 June 2010 / Accepted: 16 March 2011 / Published online: 30 March 2011
Association of Otolaryngologists of India 2011

Abstract Even though there are other complications of

chronic suppurative otitis media, the aspect of hearing loss
is often studied. Nevertheless, the occurrence of sensorineural hearing loss in patients with this disease is still
controversial. This study aim (1) to assess the association
between sensorineural hearing loss and chronic suppurative
otitis media, (2) to investigate some clinical factors that
might affect the sensorineural component in patients with
this disease. This was a retrospective analysis of the clinical records and pure tone audiograms of patients with
chronic suppurative otitis media in a Nigerian Tertiary
Health Institution from January 2003 to December 2008.
Sixty-nine patients with a mean age of 28.93 years; standard deviation of 18.593 were studied. They had an age
range of 473 years. The duration of otorrhea ranged from
2 months to 20 years; with a mean of 6.11 years (standard
deviation of 6.393). The mean bone conduction threshold
in the diseased ear was 39.07 dB (standard deviation of
12.028), and 10.26 dB (standard deviation of 2.620) in the
control ear (P \ 0.05). The mean bone conduction
threshold differences between the diseased and control ears
range from 21.69 to 34.52 dB across the frequencies 0.5,
1.0, 2.0, and 4.0 kHz. These differences tended to increase
with increasing frequency and were all significant
(P \ 0.05). In the diseased ears, there were no significant
correlation between the age, duration of otorrhea, and the
degree of SNHL (r = 0.186, P [ 0.05; r = 0.190,
P [ 0.05 respectively). Patients with chronic suppurative
otitis media had a significant degree of sensorineural

E. S. Kolo (&)
A. D. Salisu
A. M. Yaro
O. G. B. Nwaorgu

Department of Otorhinolaryngology, Aminu Kano Teaching
Hospital, Kano, Nigeria
e-mail: [email protected]

hearing loss in this study. The higher frequencies were

more affected; however, the patients age and duration of
otorrhea seem not to have any correlation with the degree
of sensorineural hearing loss.
Keywords Chronic suppurative otitis media

Sensorineural hearing loss
Audiometry
Nigeria

Introduction
Chronic suppurative otitis media (CSOM) has assumed a
world-wide importance. For instance, the United States
government spends over 2 billion dollars yearly to treat
acute and chronic ear infections [1]. In the developing
countries, it has continued to constitute a heavy disease
burden, with the prevalence of chronic ear infections being
up to 72 cases per 1,000 inhabitants [2].
In spite of the fact that the complications of CSOM can
be fatal [3, 4], hearing impairment is regarded the main
health issue. Furthermore, the conductive hearing impairment resulting from this condition has been well
acknowledged in the literature [5]. However, the relationship between sensorineural hearing loss (SNHL) and
CSOM remains a controversial issue. For instance, some
workers have consistently reported the presence of SNHL
in patients with this condition [610]. On the contrary,
some investigators have reiterated the fact that little or no
such relationship exist [11, 12]. Ironically, though the
prevalence of this disease is still high in the developing
countries; there is a dearth of information on its effect on
hearing. The question is: what is the effect of this disease
on the cochlear function of our patients? An analysis of this
will help to bridge the gap in the current literature.

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Indian J Otolaryngol Head Neck Surg (JanuaryMarch 2012) 64(1):5962

Chronic suppurative otitis media is a persistent inflammation of the middle ear or mastoid cavity, and is characterised by recurrent or persistent ear discharge through a
perforation of the tympanic membrane [13]. The treatment
of this condition can be medical; with therapy directed at
eradicating pathogenic aerobic and anaerobic organisms
[14]. Those cases that are resistant to medical treatment
might need surgical intervention. The objectives of this
study were to assess the association between SNHL and
CSOM, and to investigate some clinical factors if any that
might affect the sensorineural component in patients with
this disease.

0.5, 1.0, 2.0, and 4.0 kHz were considered for this study. In
order to increase the sensitivity of the study, we defined
SNHL as an intensity of 30 dB or more for the BC
thresholds in two or more frequencies (those with significant cochlear damage) [6]. The main outcome measures
were the BC threshold averages for the frequencies 0.5,
1.0, 2.0, and 4.0 kHz; and with comparison between the
control and diseased ears. The chi-square test was used to
compare proportions and the differences between the diseased and control ears BC thresholds were analyzed with
the Wilcoxon test. The association between age, duration
of otorrhea, and degree of SNHL were tested by the
Pearson correlation test. A P-value of \0.05 was considered statistically significant.

Methods
This was a retrospective analysis of the clinical records of
patients with CSOM who attended the Otolaryngologic
clinics of Aminu Kano Teaching Hospital (Northern
Nigeria), over a 5-year period; from January 2003 to
December 2008. The study was approved by the Institutional Review Board of the hospital.
The case notes of all patients with diagnosis of CSOM
seen in the ENT out patient clinic were retrieved using
their registration numbers in the ENT clinic register. Their
respective pure tone audiograms were then retrieved. The
Pure Tone Audiometry (PTA) was performed on dry ears in
a sound proof booth by a trained and experienced audiologist; and with the same audiometer (calibrated Kamplex
AD 229 with TDH 39P headphones). A 5 dB step procedure was employed, and a narrow band noise was used for
masking.
Patients were recruited into the study if they met the
following inclusion criteria: unilateral continuous otorrhea
through a perforated tympanic membrane for at least
2 months, normal tympanic membrane in the contralateral
ear based on otoscopy, no history of head trauma or
meningitis, no previous tympanomastoid surgery, no systemic ototoxic drug therapy, no family history of congenital or acquired SNHL, and no post-traumatic tympanic
membrane perforation. They were excluded if their clinical
records were incomplete, or if they had no audiograms. The
age, gender, duration of ear disease, and PTA results were
all recorded.

Results
A total of 106 CSOM patients clinical notes were
retrieved; however only 69 met the inclusion criteria and
were analyzed. The clinical and demographic characteristics of these 69 patients are shown in Table 1.
The mean BC thresholds of the disease and control ears
across the frequencies (0.5, 1, 2, and 4 kHz) are shown in
Table 2.
The mean BC threshold in the diseased ear was
39.07 dB (SD = 12.028), and 10.26 dB (SD = 2.620) in
the control ear (P \ 0.05).
Table 3 shows the mean BC threshold differences
between the diseased and control ears range from 21.69 to
34.52 dB across the four frequencies. These differences
tended to increase with increasing frequency and were all
significant (P \ 0.05).

Table 1 Clinical and demographic characteristics of the study

population
Characteristics

Number (n)

Percentage (%)

Sex
Male

39a

56.52

30b

43.48

Female
Age (years)
Range

473

Mean

28.93 (SD = 18.593)

Duration of otorrhea

Data Analysis
All the data obtained were entered into a specialized form
designed for this study. They were analyzed using the
Statistical Package for Social Sciences software version 13
(SPSS 13). The contralateral ear (paired) acted as a control.
Bone conduction (BC) thresholds for the frequencies of

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Range

2 months20 years

Mean

6.11 years (SD = 6.393)

Affected ear
Right

42

60.87

Left

27

39.13

a,b

No significant difference

SD standard deviation

Indian J Otolaryngol Head Neck Surg (JanuaryMarch 2012) 64(1):5962

Table 2 Comparison of mean bone conduction thresholds in the
disease and control ears
Frequency (kHz)

Mean BC in disease ear

Mean BC control ear

0.5

32.46 (14.587)a

10.14 (4.470)

36.06 (14.140)

10.14 (5.208)

42.18 (15.183)

9.97 (4.585)

45.51 (15.384)

10.99 (3.930)

Standard deviation

Table 3 Mean bone conduction threshold differences between the

disease and control ears
kHz
dB
a

0.5

21.69 (14.676)a 25.66 (15.183) 32.28 (16.309) 34.63 (15.144)

Standard deviation

Table 4 Mean air-bone gap in the diseased ears

Frequency (kHz)

Mean air-bone gap (dB)

0.5

40.48 (26.311)a

36.43 (19.567)

27.25 (18.671)

28.50 (17.925)

Standard deviation

Table 4 shows the mean air-bone gap across the test

frequencies in the diseased ears. These differences in mean
were not statistically significant (P [ 0.05).
In the diseased ears, there were no significant correlations between the age, duration of otorrhea, and the degree
of SNHL (r = 0.186, P [ 0.05; r = 0.190, P [ 0.05
respectively). Also, there were no significant correlations
between the air-bone gap and the degree of SNHL across
the test frequencies in the diseased ears (r = -0.279,
P [ 0.05; r = -0.078, P [ 0.05; r = 0.074, P [ 0.05 and
r = -0.038, P [ 0.05 for the frequencies 0.5, 1, 2 and
4 kHz respectively).

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However, it is pertinent to note that the higher BC

thresholds found in our study could possibly be because
only patients with substantial cochlear damage (30 dB and
above) were included in the analysis. In contrast, de
Azevedo et al. [6] found no strong evidence of the effect of
the disease on BC thresholds at any frequency.
This study found in the diseased ears, and across the test
frequencies, that there were no significant differences in the
mean air-bone gap. Also, there were no significant correlations between the air-bone gap and the degree of SNHL.
On the contrary, though the Carharts effect is most commonly found in otosclerosis, it has been well demonstrated
in chronic otitis media among other middle ear conditions
[16]. Therefore, it might be expected that there might be a
worsening in the bone-conduction, and possibly a significantly decreased air-bone gap at 1 or 2 kHz.
Furthermore, this study found no significant correlation
in the diseased ears between the degree of SNHL and the
duration of otorrhea. Likewise, previous authors had also
arrived at the same conclusion [6, 7]. Moreover, when we
analyzed the effect of the patients age on the degree of
SNHL in the diseased ears, there was still no significant
correlation. On the contrary, other workers had found that
increasing age was a risk factor in the evolution of SNHL
in patients with CSOM [6, 15]. The discrepancies in the
study populations with respect to the patients ages could
possibly be responsible for the differences in our findings.
Therefore, the findings from this study lend credence to
the theory that cochlear damage in patients with CSOM
might be due to bacterial toxins that diffuse through the
round window membrane. Subsequently, these toxins
might cause damage to the hair cells especially those at the
cochlear base; where the hair cells are sensitive to high
frequency sounds [17, 18]. However, we acknowledge that
this study lack control for the possible effect of a confounding factorthe use of topical antibiotics. This was a
limitation as almost all our patients had admitted to have
used such medications. But quite interestingly, some
investigators have found little or no evidence that topical
antibiotics can cause significant SNHL in humans [19].

Discussion
Conclusion
Although numerous studies have documented the association between SNHL and CSOM, opinions still differ
regarding the significance of this concept. In this study, we
found a significant degree of SNHL amongst patients with
CSOMthe mean BC thresholds across the speech frequencies were significantly higher in the diseased ears
compared to the control ears. Also, the higher frequencies
tend to be more affected. This is in support of the findings
of MacAndie [7] and Redaelli et al. [15] in a similar study.

A significant degree of SNHL in patients with CSOM was

noted in this study. The higher frequencies were more
affected, and there were no correlations between the degree
of SNHL and the patients age and duration of otorrhea.
Acknowledgments We wish to thank the entire staff of ENT
department of Aminu Kano Teaching Hospital for their assistance
during the course of this work. We also thank the departmental secretary Mr. Abdullahi for helping in typing the manuscripts.

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Indian J Otolaryngol Head Neck Surg (JanuaryMarch 2012) 64(1):5962

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