The Journal of Laryngology & Otology

Online Only Main Article

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

T S Ibekwea1 c1, A A Adeosuna2a3 and O G Nwaorgua2a3

a1 Division of ENT, Irrua Specialist Teaching Hospital, the Department of Surgery, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria

a2 Department of ORL, University College Hospital Ibadan, Nigeria

a3 Department of ORL, College of Medicine, University of Ibadan, Nigeria


Background: 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.

Results: 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).

Conclusion: 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.


c1 Address for correspondence: Dr Titus S Ibekwe, Division of ENT, Irrua Specialist Teaching Hospital, PMB 08, Irrua, Nigeria. E-mail:


Dr T S Ibekwe takes responsibility for the integrity of the content of the paper.

Competing interests: None declared