# Evaluating Hearing Impairment in Different Histopathological Grades of Oral Submucous Fibrosis: An Audiometric Analysis

## TL;DR

This study examines how hearing is affected in different stages of a chronic mouth condition called oral submucous fibrosis.

## Contribution

The study links clinical and histopathological grades of OSMF with audiometric and tympanometric findings for the first time.

## Key findings

- Clinical and histopathological grades of OSMF showed a statistically significant association.
- Middle ear dysfunction was more common on the left side, likely due to left-sided masala use.
- Audiometric differences between OSMF grades were not significant, but ear asymmetry was observed.

## Abstract

Background

Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant condition primarily linked to areca nut and masala chewing. The fibrotic process not only affects the oral mucosa but may extend to adjacent structures, including the palatal and paratubal muscles, resulting in Eustachian tube dysfunction and consequent auditory impairment. Most individuals habitually place the quid on the left buccal mucosa due to right-handed dominance, which may explain the greater degree of fibrosis and more frequent auditory changes observed on the left side.

Aim

The present study aimed to analyze the level of hearing impairment in different grades of OSMF patients through audiometric and tympanometric findings in both clinical and histopathological grades of the disease.

Materials and methods

A cross-sectional study was conducted on 60 participants, including clinically and histopathologically confirmed cases of OSMF (Grades I-IV) and healthy controls. All subjects underwent pure tone audiometry (PTA) and tympanometric analysis using a calibrated clinical audiometer. Statistical analysis was performed using SPSS version 17.0 (IBM Corp., Armonk, NY), applying chi-square and unpaired t-tests, with p < 0.05 considered significant.

Results

A statistically significant association (p ≤ 0.05) was observed between the clinical and histopathological grades of OSMF, indicating parallel disease progression. Tympanometric evaluation revealed significant middle ear dysfunction predominantly on the left side, consistent with higher fibrosis among left-sided masala users. Although audiometric differences between grades were not statistically significant, asymmetry between right and left ears was evident.

Conclusion

The findings suggest that progressive fibrosis in OSMF can particularly impair Eustachian tube function, leading to conductive hearing loss. Therefore, it is recommended to perform a routine audiological assessment using PTA and tympanometry for early detection and comprehensive management.