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Clinical and Experimental Otorhinolaryngology > Volume 9(4); 2016 > Article
Park, Hong, Kim, Han, Chung, Seo, Oh, Chang, and Lee: In Reply: Dominance of Ossicular Route in Sound Transmission
We reported that the degree of conductive hearing loss resulting from a tympanic membrane (TM) perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid, not location of perforation. This result was conflicted with previous study that revealed the influence of location of TM perforation on the severity of hearing loss in 1970 [1].
When the perforation size was relatively large, the sound transmission via acoustic route would became dominant and air-bone gap would increase more by phase cancelation at round window in posterior TM perforation rather than in anterior TM perforation [2, 3]. Unfortunately, most of patients who were included in our study had small perforation size within 30% of TM (n=34/44, 77%). The authors agree with your comments which we did not mention in the discussion.


No potential conflict of interest relevant to this article was reported.


1. Anthony WP, Harrison CW. Tympanic membrane perforation: effect on audiogram. Arch Otolaryngol. 1972 Jun;95(6):506-10.
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2. Voss SE, Rosowski JJ, Merchant SN, Peake WT. How do tympanic-membrane perforations affect human middle-ear sound transmission? Acta Otolaryngol. 2001 Jan;121(2):169-73.
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3. Voss SE, Rosowski JJ, Merchant SN, Peake WT. Non-ossicular signal transmission in human middle ears: experimental assessment of the “acoustic route” with perforated tympanic membranes. J Acoust Soc Am. 2007 Oct;122(4):2135-53.
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The Dominance of Ossicular Route in Sound Transmission  2016 September;9(3)
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