Fat Myringoplasty Research Articles

Factors affecting fat myringoplasty in elderly patients with chronic otitis media: A case control study

BackgroundWe compared and analyzed the surgical results of fat myringoplasty between elderly and young adult patients with chronic otitis media. We also investigated whether underlying diseases and other factors impact the surgical outcome.MethodsWe retrospectively reviewed the data of 141 patients who underwent fat myringoplasty for chronic otitis media for five years. They were compared by age, sex, underlying disease, perforation size, pre- and postoperative pure tone audiometry, postoperative otorrhea, postoperative re-perforation, and cause of re-perforation.ResultPostoperative re-perforation was more common in the elderly group, albeit with no significant difference (p = 0.072). The factors affecting re-perforation were insufficient fat graft (44.4%), postoperative infection (33.3%), and nasal blowing (22.2%). Our findings revealed no significant association between preoperative perforation size and re-perforation (p = 0.391). Additionally, we found no significant relationship between hypertension and re-perforation (p > 0.99), nor between age group and postoperative infection (p = 0.488). Diabetes was also not significant (p = 0.640). Following surgery, both groups exhibited a significant improvement in hearing.ConclusionAlthough age and underlying conditions play significant roles in the healing process, our results suggest that external factors such as infection, nasal blowing, cough, and insufficient grafted fat tissue have a similarly significant impact on surgical outcomes in elderly patients with COM as they do in adults. In conclusion, the decision to perform surgery in elderly patients with COM should be based on a comprehensive assessment of the patient’s overall health status, hearing, use of hearing aids, and the indications for surgery.

Transcanal endoscopic myringoplasty with butterfly dermal allograft

ObjectiveTympanic membrane perforation (TMP) is a common cause of visits to the otolaryngology clinic. For decades, various surgical methods and various grafts have been used to treat TMP. This study aimed to compare the efficacy of butterfly dermal allograft (BDA) and fat myringoplasty for the treatment of TMP. Study designA retrospective case-control study. SettingTertiary referral center. MethodsWe retrospectively analyzed 40 patients who underwent BDA (n = 20) and fat myringoplasty (n = 20) for TMP performed by a single surgeon between January 2019 and December 2021. The hearing outcomes, graft success rate, complications, operation time, and hospital stay were recorded and compared between the two groups. Hearing outcomes were determined by pure-tone audiometry. ResultsThere was no significant difference between the BDA and fat groups regarding demographic characteristics. There was no significant difference in the pre and postoperative air conduction and bone conduction thresholds, or air-bone gap values between the two groups. A significant audiologic improvement was observed in both groups (p < 0.05), but there was no significant difference in the degree of hearing gain between the two groups. In terms of recurrence of tympanic membrane perforation, postoperative otorrhea, and discomfort symptoms; however, there was no significant difference between the groups (p > 0.05). The operation time and hospital stay were shorter in the BDA group than in the fat group (p < 0.05). ConclusionBDA myringoplasty is as safe and medically efficacious as fat myringoplasty and shortens the operation time and hospital stay.

Fat Myringoplasty for Small Central Perforation of Tympanic Membrane: A Prospective Study.

In fat myringoplasty, fat harvested from ear lobule is used as graft material for the closure of small size central perforation of tympanic membrane under local anaesthesia. This study was performed over a period of 5years (January 2016-December 2020) on 67 cases who underwent surgery and were willing to participate in the study at our tertiary hospital. Closure of perforation was found in 93% of cases within 2-3months of surgery. Hearing gain was 6.8dB on an average and morbidity was insignificant in successful cases. Fat myringoplasty is a successful yet simple procedure for repair of small size perforations. It is a day-care procedure under local anaesthesia requiring minimal tissue handling. It is also cost effective and has minimum post-operative morbidity. The likely cause of failure are ear infections and graft displacement due to respiratory tract infections. Results of the fat myringoplasty also depend upon the experience of the operating surgeon and cooperation of the patient.

Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.

Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant. Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.

Fat graft myringoplasty: A clinical study and review of literature

Objectives: There are numerous surgical techniques that have been demonstrated and utilized to repair small perforations in the tympanic membrane (TM) with various graft materials such as veins, perichondrium, periosteum, and others. In our study, fat was taken as the graft material and the main aim of the study was to evaluate the success rate of graft uptake, assessment of hearing improvement, and complications of the operative procedure. Material and Methods: In this single-center study, 46 patients underwent fat myringoplasty, 52 ears were operated from October 2016 to September 2017 for a period of 1 year. A detailed history, general physical, and a through ear, nose, and throat examination were done. Audiometric assessment was done using pure tone audiometry. Patients between the age group of 15 and 50 years were included in the study. Results: A total of 46 patients were included in the study who met the inclusion criteria. Six patients had bilateral perforations and 40 patients had unilateral perforation, a total of 52 perforations were operated. Forty-three (82.69%) patients had successful graft uptake and graft failure was seen in 9 (17.30%) patients. Maximum gain in hearing was seen in in patients with hearing loss between 20 and 30 dB, that is, 24 patients (46.1%). Conclusion: Fat myringoplasty is a methodized, precise, inexpensive, mini-invasive, and cosmetic outpatient procedure for small perforations of TM. It can be done under local anesthesia and has a good success rate if the patient selection is done appropriately.

Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, &lt;i&gt;p&lt;/i&gt;=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

Comparison of the Functional Success of Fat Myringoplasty and Perifascial Areolar Tympanoplasty in Transcanal Endoscopic Ear Surgery.

We compared the functional outcomes of fat myringoplasty and areolar tympanoplasty through a small postauricular incision in patients who underwent transcanal endoscopic ear surgery (TEES). The study included patients who underwent myringoplasty or type I tympanoplasty using TEES in our Department of Otolaryngology between April 2016 and May 2019. The patients were divided into 2 groups according to the type of graft material used, which was selected based on the available amount of subcutaneous fat and the surgeon's experience. In total, 63 patients received fat tissue grafts (group A) and 77 received areolar tissue grafts (group B). The median operative time was significantly longer in group B (132 minutes) than in group A (65 minutes); perforations were significantly larger in group B than in group A (61.0% vs 29.7% of the eardrum surface). The postoperative air conduction threshold, air-bone gap, and speech reception threshold values were significantly lower than the preoperative values in both groups. The graft success rate did not significantly differ between groups A (96.8%, 61/63) and B (96.1%, 74/77). In group A, the perforation was > 35% of the eardrum surface in 27.0% (17/63) of the patients; the graft success rate was 100% (17/17). In the remaining 46 patients (perforation > 35%), the graft success rate was 95.7% (44/46); this difference was not statistically significant. Transcanal endoscopic ear surgery increases the usefulness of fat myringoplasty for the repair of perforations > 35% of the eardrum surface. Postauricular fatty and areolar tissues are suitable for this simple and rapid technique, which yields excellent outcomes.

Results of cartilage shield tympanoplasty in revision cases of myringoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cartilage shield tympanoplasty (CST) is seen as a good option for revision surgery in cases of myringoplasty failure. Cartilage serves as rigid material which resists retraction. However, there have been concerns regarding hearing outcome and surveillance in follow up period.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted at our tertiary institute. 25 patients of either sex in age group of 18-50 years with one or more failed tympanoplasties underwent CST. Pre-operative and post-operative audiograms were obtained, and patients were regularly followed up to calculate graft uptake and hearing outcome. Quantitative data was analyzed by using Student t-test and for qualitative data chi square test was used. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean pre-operative pure tone air-bone gap was 25.09±8.10 dB while the mean postoperative pure tone air-bone gap was 13.47±5.18 dB, one case (4%) presented with failure as there was a residual perforation antero-inferiorly. Since it was a small residual perforation, it was planned for closure by fat myringoplasty. No complications were recorded. We obtained graft take rate of 96% and mean postoperative gain of 11.62±7.11 dB in PTA-ABG.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We recommend CST for revision cases of tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

The Efficiency of Endoscopic Fat Myringoplasty under Local Anesthesia

The Efficiency of Endoscopic Fat Myringoplasty under Local Anesthesia

Can Fat-plug Myringoplasty Be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-analysis.

This study reviewed available literature to evaluate the success rate of fat myringoplasty compared with methods using other graft materials and suggests proper indications for this procedure. Studies reporting the success rate of fat myringoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2017. The following terms were used for the literature search: ("Fat" OR "Adipose") and ("Myringoplasty" OR "Tympanoplasty"). Eight case series reported the data of perforation size and audiologic results. The success rate varied according to the perforation size with a cutoff value of 3 to 5 mm in length or 30% of the total tympanic membrane area. The success rate in anterior perforation was lower than that in other sites, ranging from 76.7 and 85.2% to 84.5 and 91.7%, respectively. The meta-analysis was performed on 10 articles. The overall success rate in fat myringoplasty and paper patch technique was not significantly different, while the success rate of fat myringoplasty was lower than that for the conventional myringoplasty technique using fascia or perichondrium (OR 0.63, 95% CI 0.49-0.80). Hyaluronic acid showed a significantly higher success rate than fat myringoplasty (90.1% versus 69.9%) (OR 0.20, 95% CI 0.09-0.46). The success rate of fat myringoplasty may be associated with the perforation site and size. The success rate of fat myringoplasty was equivalent to that of the paper patch but inferior to a conventional method using perichondrium or fascia.

MYRINGOPLASTY OF CENTRAL TYMPANIC MEMBRANE PERFORATION WITH A FAT GRAFT FROM THE EAR LOBULE AND PLATELET RICH PLASMA.

ABSTRACT Background: Fat myringoplasty had been described over 50 years to be a safe and simple option for myringoplasty. Platelet rich plasma [PRP] is a simple and minimally invasive method to obtain a high concentrate of autologous growth factors that can facilitate wound healing. Objectives: To assess the effectiveness of using fat and PRP in myringoplasty. Patients and methods: Twenty patients with small to medium sized tympanic membrane perforations were enrolled in this study. Under local anesthesia, the margin of the perforation was freshened, then a single piece of ear lobule fat graft, approximately double the size of the perforation, was placed through the perforation, then the PRP was applied over the fat graft. Results: Successful TM perforation repair was achieved in 36 ears [85.7%]. 100% success rate was obtained in small peroration and 79.3%in medium sized perforation. There was significant postoperative improvement in the mean air bone gap [p = 0.0016]. Conclusion: Adding PRP to fat myringoplasty is a safe, effective, cost saving and minimally invasive procedure. It is suitable to repair small as well as moderate sized TM perforations. Keywords: Myringoplasty, platelet rich plasma, tympanic membrane. Ear lobule fat Corresponding author; Ahmed Roshdy Ebrahim.

Otoendoscopic management of small to medium sized tympanic membrane perforation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic suppurative otitis media (CSOM) is a wide spread disease of developing countries like India especially in rural areas. A perforated tympanic membrane results in loss of hearing due to decreased drum area and liability to recurrent infection of the middle ear mucosa. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted over a period of 18 months in the Department of ENT, HNS, Government Medical College, Srinagar with total of 36 patients were enrolled. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This study consists of male 12 and 24 females mean age 32 yrs hearing loss average 26 db. Management methods were grouped in group A, B, C and D fat myringoplasty, chemical cauterization (trichloroacetic acid), fat myringoplasty + chemical cauterization: and transcanal transtympanic myringoplasty using tragal perichondrium respectively with least success seen in group B 55% and 100% seen in group D. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Otoendoscopic management of small to medium sized TM perforations with different methods is a cost effective, less traumatic procedure, cosmetically better and functionally effective in terms of hearing improvement.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

A comparative study between fat myringoplasty and temporalis fascia tympanoplasty in moderate to large central perforation of pars tensa of tympanic membrane

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To compare the efficacy between fat graft (FG) and temporalis fascia (TF) graft in tympanic membrane perforations larger than 4mm size or involvement of &amp;gt;25% of tympanic membrane.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was carried out during December 2015 to January 2016, for a period of 13months at our Otolaryngology Department. All study patients, who fit into inclusion and exclusion criteria, were divided into two groups according to the type of graft material taken. In group- 1temporalis fascia (TF) graft was taken while in group- 2 fat graft (FG) was taken. An evaluation of hearing was done with full Audiometric and Eustaschian tube function testing. All laboratory preoperative testing was done. Postoperative follow up was done at 2&lt;sup&gt;nd&lt;/sup&gt;, 3&lt;sup&gt;rd&lt;/sup&gt; and 5&lt;sup&gt;th&lt;/sup&gt; month’s period and sos, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded and compared with preoperative PTA records in both groups. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In TF group total 24 (80%) patients had graft uptake, 4 (13.3%) patients had residual perforation and 2 (6.6%) patients had graft failure due to postoperative infection. In FG group total 16 (53.3%) patients had graft uptake, 6 (20%) patients had graft medialised and necrosed, 6 (20%) patients had residual perforation and 2 (6.6%) patient had graft rejection due to postoperative infection. Graft uptake rate in group 1 was 80% while in group 2 was 53.3%. Mean preoperative ABG in TF group was 25±17 dB and mean postoperative ABG was 10±02 dB, in fat graft technique mean preoperative ABG was 25±13 dB and mean postoperative ABG was 16±15 dB. Fat graft technique is simple, quick and minimally invasive. It doesn’t require middle ear manipulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is no ideal material for tympanic membrane repair but for moderate to large perforation temporalis fascia graft is better than fat graft in terms of healing and hearing outcomes but considering morbidity fat gives less morbidity. &lt;/p&gt;

One hundred twenty-five fat myringoplasties: Does marginal perforation matter?

Objective to evaluate if calcified plaques adjacent to the perforation and marginal perforations are real contraindications to the fat graft myringoplasty. Study Design prospective study. Methods This study was conducted, from 1st January 2008 to 31 December 2015 at our Otolaryngology Department of S.G. Moscati Hospital. The investigation included 125 patients, 60 males and 65 females, affected by COM who have undergone fat graft myringoplasty between 01/01/2008 to 31/12/2011. The average age of patients was 46 years (ranged 18 – 80).The patients were selected consecutively. For all the procedures the last otomicroscopic control was performed in 2015. Follow-up studies were done at 3 days, 7 days, 1 month, 3 months, 6 months and then once a year(mean follow-up 5.5 years, range 4-7 years). Informed consent was obtained after discussion of the alternative solutions. The consent of our institutional ethic committee was obtained. The inclusion criteria were the following: none previously ear surgery, dry ear at the time of surgery, persistent perforation for at least 6 months, absence of granulomatous tissue and cholesteatoma, perforation size of up to 35% of the eardrum surface, absence of ossicular chain damage. All patients who met inclusion criteria were enrolled. All patients included in the study accepted to be controlled for the entire follow-up. On the basis of tympanic membrane characteristics the study group was divided into 3 groups and 4 sub-groups: Group A (n=67) the fat myringoplasty was performed following the traditional indications, Group B(n=31) marginal perforations in which one side of the perforation is the fibrous annulus, was divided in 2 sub-groups B1(n=16) without calcified plaques adjacent to perforation and B2 (n=15) with plaques, Group C (n=27), marginal perforations in which one side is the bone annulus, was divided in 2 subgroups C1(n=15) without plaques and C2 (n=12) with plaques. The Fisher exact test (FET) was used to compare results in the described groups(sub-groups B1 with group A, sub-groups B2 with group A, subgroups C1 with group A and subgroups C2 with group A). A p<0.05 was considered significant. The surgical success is obtained with a complete closure of the tympanic membrane perforation. 0 dB. The mean pre-operative air bone gap (ABG) was 18,2 dB. Calculation of hearing results was in accordance with the American Academy of Otolaryngology Head and Neck Surgery 1995 guidelines for reporting conductive hearing loss 7 . This article is protected by copyright. All rights reserved.

The efficacy of fat myringoplasty in small central perforation of pars tensa

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In the present study, an attempt was made to study the effectiveness of fat graft material and the improvement in hearing following fat myringoplasty in small central perforations of pars tensa.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was carried out in our tertiary centre between October 2014 to October 2015 in 38 patients selected randomly who attended our ENT OPD. Patients with tubotympanic type of chronic suppurative otitis media CSOM (TT), with dry small central perforation involving less than 25% of tympanic membrane (TM) were included. Patients with ossicular fixation or disruption with air bone gap (ABG) &amp;gt;40dB were excluded. All procedures were performed under local anesthesia (LA). Fat graft was harvested from ear lobule and was placed through endomeatal microscopic approach after freshening perforation margin. All patients were followed up to 5months postoperative period and graft status and audiological assessment was made. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In 86.8% cases (33 patients) graft was taken up while in 13.2% cases (5 patients) graft was not taken up. Mean pre-operative air conduction in right/left ear was 28.5±7.6/27.1±8.5 and post-operative was 24.9±5.3/23.4±6.9 dB respectively. Similarly, it was seen that mean pre-operative air bone gap in right/left ear was 17.6±7.2/17.0±7.4 and post-operative was 14.0±5.3/13.2±6 dB respectively.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It is a very safe, simpler procedure and in this we don’t disturb the annulus so the chance of lateralization or medialization of graft is nil. During fat myringoplasty the angle of tympanic membrane and anterior recess is maintained in natural position and we don’t disturb acoustics, so fat myringoplasty is an excellent option especially for small perforation.

Traumatic tympanic membrane perforations: an overview in tertiary care hospital

This hospital-based prospective study was conducted in the Department of Ear Nose Throat, Head and Neck Surgery, Government Medical College Srinagar, Jammu and Kashmir, for a period of 1 year from June 2013 to June 2014 with the aim of studying the aetiological factors, clinical presentation and management options for traumatic tympanic membrane perforations. A total of 50 patients with traumatic perforations of the tympanic membrane were enrolled in the study, comprising of 34 males and 16 females patients. Age of the patients ranged from 12 to 56 years, with a mean age of 32 years. The results showed that the most common mode of trauma was slaps (56%); sudden hearing loss and tinnitus were the two most common presentations (92%). Audiometry shows that the larger the tympanic membrane perforation, the larger the air–bone gap. Hearing loss was highest at the lowest frequencies and generally decreased as the frequency increased. The differences in air–bone gaps between small and large perforations were significant at all frequencies (P<0.05, Student’s t-test). Overall, 72% of patients responded to conservative management, whereas 28% needed fat myringoplasty and/or chemical cauterization.

Fat Myringoplasty and its Impact on the Hearing Mechanism of Middle Ear

ABSTRACT Objectives To address the fat grafting to tympanic membrane perforations—fat myringoplasty type I—and its impact over the hearing mechanism of the middle ear for both small (&lt; 25% of the tympanic membrane) and large perforation (&gt; 75 % of the TM). How to cite this article Al-qahtani B, Al Tuwaijri M, Al Mokhatrish M. Fat Myringoplasty and its Impact on the Hearing Mechanism of Middle Ear. Int J Otorhinolaryngol Clin 2015;7(3):138-140.

Fat Myringoplasty: Better Patient Selection for Better Results

Objectives: (1) Evaluate the outcome of fat myringoplasty in relation to the perforation size. (2) Compare the outcome in relation to 2 fat sources (ear lobule and abdominal wall). Methods: This study was conducted between May 2012 and April 2013 in the ENT department, University of Alexandria, Egypt. It was carried out on 30 patients with tympanic membrane perforations &lt;30% of its surface (20 patients with perforations equal or less than 2 mm and 10 patients with perforations exceeding 2 mm in diameter), and with a maximum air bone gap of 20 dB. There were 2 randomized groups. Group A: 15 patients who had myringoplasty with ear lobule fat. Group B: 15 patients operated on using abdominal wall fat. Patients were followed for 6 months postoperatively. Results: Among the 20 patients with a perforation size ≤2 mm, 18 patients (90%) succeeded and 2 (10%) failed. Among the 10 patients with a perforation exceeding 2 mm, 5 patients (50%) succeeded and 5 (50%) failed. There was a significant statistical difference between perforation size and success rate. In group A, 12 patients (80%) had successful operations and 3 patients (20%) failed. In group B, 11 patients (73.3%) were successful and 4 patients (26.7%) failed. There were no significant differences between the 2 groups with regard to the success rate and hence its relation to the fat source ( P &gt; .05). Conclusions: Fat myringoplasty can be performed safely in cases with small perforations, especially up to 2 mm in diameter and small air bone gap. Ear lobule constitutes a convenient source of fat.

COMPARATIVE STUDY BETWEEN FAT AND PERICHONDRIUM GRAFT MYRINGOPLASTY

Introduction: Longstanding tympanic membrane perforation may cause hearing loss and middle ear infection even if they are small in size. The purpose of myringoplasty is to repair such perforations and thus to improve hearing and eliminate the susceptibility to middle ear infection. Methodology: This study was included 40 patients with dry central tympanic membrane perforation, not associated with ossicular pathology, retraction pocket or cholesteatoma showing conductive hearing loss with an air bone gab not exceeding 30 dBHL in the studied ear. Patients were divided into 2 groups (group I and group II) 20 patients who have undergone fat myringoplasty and 20 patients who have undergone perichondrium tympanoplasty. Each group was subdivided into 2 subgroups (A and B) according to size of perforation. Audiological evaluation was done pre and postoperative. Results: In fat myringoplasty, the success rate was 50% with success rate of 80% in group I A ( 4 mm). In perichondrium tympanoplasty, the overall success rate was about 80% with only 4 failed cases from 20 cases. It was found that there was improvement of hearing in group IA ranging from 7.5-10dB with a mean of 9±1 while in group IIA; there was improvement of hearing ranging from 5-20 dB with a mean of 10±6.5. There was no significant difference as regards improvement of hearing (P=0.67). While in group IB, the 2 successful cases showed improvement of hearing ranging of about 10 dB while in group IIB; there was improvement of hearing ranging from 7.5-20 dB with a mean of 12± 5dB. So, in large perforation, there was no significant difference between the studies groups (P=0.6). Conclusion: Fat graft myringoplasty is a reliable technique with shorter duration less operative care. Success rate is higher for perichondrium graft. Hearing improvement is not significantly different between both groups. Key words: fat graft- Perichondrium tympanoplast.

Comparison of Myringoplasty for the Chronic Small Tympanic Membrane Perforations: Fat versus Perichondrium

Received February 26, 2011 Revised April 4, 2011 Accepted April 12, 2011 Address for correspondence Jong Dae Lee, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Soonchunhyang University School of Medicine, 1174 Jung-dong, Wonmi-gu, Bucheon 420-767, Korea Tel +82-32-621-5441 Fax +82-32-621-5440 E-mail ljdent@schmc.ac.kr Background and ObjectivesZZThere are several techniques to perform myringoplasty for tympanic membrane perforations as an outpatient procedure. The aim of this study is to compare the results of fat and perichondrium myringoplasty for the treatment of chronic small tympanic membrane perforations. Subjects and MethodZZThis investigation included 46 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 2 main groups according to surgical procedures. The patients underwent fat, or perichondrium myringoplasty without skin incision via transcanal approach under local anesthesia. The healing results of perforation and hearing improvement were investigated. ResultsZZClosure rates of the perforations in the fat, perichondrium myringoplasty groups were all the same as 87% (20/23). There were no significant differences between techniques in tympanic membrane closure rates with regard to size and location and in hearing improvement. However, the recovery time was a little faster in perichondrium myringoplasty during follow up. ConclusionZZConservative myringoplasty using fat and perichondrium is a feasible procedure that can be perfomed on outpatient basis for chronic small tympanic membrane perforations. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:329-33