Hyaluronic Acid Fat Graft Myringoplasty Research Articles

Cost of closure: Comparing success and spending of fat graft myringoplasties with and without hyaluronic acid

IntroductionMyringoplasties are common pediatric procedures used to surgically close a perforated tympanic membrane. While a wide variety of graft materials are available to surgeons, the cost effectiveness of these different techniques is not well studied. ObjectivesTo compare the cost effectiveness of the fat graft myringoplasty (FGM) with the hyaluronic acid fat graft myringoplasty (HAFGM). MethodsRetrospective chart review of patients ages 31 days to 18 years who had undergone either FGM or HAFGM from 2006 to 2016. ResultsWe identified 85 patients who had undergone FGM and 51 patients who had undergone HAFGM. The two groups were statistically similar in age (CI -0.51, 1.9; p = 0.23), sex (CI 0.3, 1.4; p = 0.27), and history of prior tympanostomy tube placement (CI -0.07, 0.07; p = 0.69). Both groups had a similar number of total comorbidities (40.0% of patients in the FGM group and 27.5% of patients in the HAFGM; CI -0.04, 0.29; p = 0.19). The FGM and the HAFGM procedure did not have statistically significant differences in perforation closure rates, 82.4% and 92.2% respectively (CI 0.81, 7.3; p = 0.13). In comparing the total surgeons’ cost of closing a tympanic membrane deficit, the FGM incurred a greater cost per perforation. The cost/tympanic membrane perforation closure for the FGM totaled $3011.88 per deficit, whereas the HAFGM totaled $2742.98. ConclusionAs financial stewardship becomes more important for medical decision making, it is imperative that providers consider cost and outcomes data together when comparing similar treatment options. The FGM and the HAFGM have statistically similar rates of success in closing tympanic membrane perforations. In this study, the FGM cohort consumed more health care dollars per perforation secondary to the need for revision surgeries. As such, this study offers that the additional use of a hyaluronic disc does not increase overall cost to the healthcare system when performing a fat graft myringoplasty over a large cohort of patients.

Implementation of the hyaluronic acid fat graft myringoplasty technique, pitfalls and lessons learned

Background: Myringoplasty is a common procedure in otorhinolaryngology. Many techniques with different complications and outcomes have been described, one of which is hyaluronic acid fat graft myringoplasty (HAFGM). This technique, as proposed by Saliba, uses fat tissue and hyaluronic acid discs. The technique is relatively fast with a high success rate and low complications. However, what outcomes can be expected when performed by other surgeons? In this paper, we report on the technique’s success in our own hands.Materials and methods: Based on Saliba’s protocol, we performed 86 HAFGMs by a transcanal approach between 2012 and August 2014. However, our 70% success rate was significantly different from Saliba’s 92% (p value 2.8e − 05). We visited Saliba’s clinic in order to identify critical differences between our approaches. We adapted the differences we found in our protocol and analysed another 50 HAFGMs performed afterwards, between October 2014 and December 2015.Results: The success rate increased to 86–89%, this percentage is not different compared to Saliba’s results (p value .25 and .54).Conclusion: HAFGM is a reproducible technique in the hands of other surgeons, but critical following of the surgical protocol is important.

In response to Growth factors expression in hyaluronic acid fat graft myringoplasty

In response to <i>Growth factors expression in hyaluronic acid fat graft myringoplasty</i>

Hyaluronic Acid Fat Graft Myringoplasty Versus Autologous Platelet Rich Plasma.

BackgroundHyaluronic acid fat graft myringoplasty (HAFGM) is an office-based technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aimed to compare HAFGM technique to a recently described topical use of autologous platelet rich plasma myringoplasty (PRPM) in the repair of TMP. We also aimed to assess the hearing level improvement postoperatively.MethodsWe conducted a prospective study in an adult tertiary care center between January 2015 and January 2016. Adult patients presenting with simple TMP were operated randomly using either HAFGM or PRPM under local anesthesia in an office-based setting. Perforations were classified into four grades. Success was considered when complete closure is achieved. Audiometric parameters were evaluated pre- and postoperatively.ResultsWe included 27 patients, of whom 16 were operated with HAFGM and 11 were operated with PRPM. Complete closure was achieved in 81.2% and 18.1%, respectively. Postoperatively, no worsening of bone conduction threshold was noted. The study was abandoned due to the low success rate in patients with PRPM. The pure tone audiometry was improved postoperatively in patients with closed tympanic membrane.ConclusionsThe study was aborted because of the unsatisfactory obtained results using PRPM. It confirms once again the beneficial effect of hyaluronic acid in the healing process when added to fat graft myringoplasty. Furthermore, it requires no hospitalization.

In response to: Hyaluronic acid fat graft myringoplasty vs. fat patch fat graft myringoplasty

In response to: Hyaluronic acid fat graft myringoplasty vs. fat patch fat graft myringoplasty

Growth factors expression in hyaluronic acid fat graft myringoplasty

To investigate the effect of hyaluronic acid (HA) associated to fat graft on growth factors expression during the healing process of tympanic membrane (TM) perforations in guinea pigs using the hyaluronic acid fat graft myringoplasty (HAFGM) technique. Prospective randomized animal study. Thirty guinea pigs were divided equally into three groups: group I (control group), group II (fat graft myringoplasty technique), and group III (HAFGM technique). TMs were perforated on day 1 and then sampled on days 0, 3, 8, and 21 and tested for the expression of: epidermal growth factor (EGF), insulin-like growth factor (IGF), tumor necrosis factor α (TNF α), vascular endothelial growth factor (VEGF), and keratinocyte growth factor (KGF). Five perforated TMs were taken at day 0 from group I to serve as a reference level. Group III showed an increased expression of all tested growth factors, except for KGF. EGF was highest in the early healing process; then IGF peaked at day 8 with statistically significant increase compared to groups I and II. TNF α in group III was significantly higher than group I throughout the study, with a peak level at day 21. VEGF was significantly higher in group III compared to group I at days 3 and 21. Neovascularization and scarless TM closure was obtained in group III, while spontaneous closure was associated with thin-layered and scarred TM in group I. HA association to fat graft in perforated TM increases the expression of the endogenous growth factors, suggesting that such an association is advantageous for healing. N/A.

Advantages of Hyaluronic Acid Fat Graft Myringoplasty Over Fat Graft Myringoplasty

To compare hyaluronic acid fat graft myringoplasty (HAFGM) with fat graft myringoplasty (FGM) on grade I tympanic membrane perforations (TMPs) (<25% of the tympanic membrane surface) and to assess 12-month postoperative hearing outcomes in a pediatric population. Prospective study. Tertiary care pediatric center. PATIENTS Ninety-two children with a TMP were included in the study and were operated on using either the HAFGM (n = 50) or FGM (n = 42) technique. Age at surgery ranged from 4 to 17 years (mean age, 11.52 years). Hyaluronic acid fat graft myringoplasty is a new technique for TMP repair in a pediatric population and is performed using local anesthesia at the outpatient office. Postoperative status of the tympanic membrane, hearing improvement, and incidence of complications. Successful closure of the tympanic membrane was achieved in 90% of the HAFGM group and in 57.1% of the FGM group (P = .004). The mean (SD) postoperative air-bone gap in the HAFGM (6.86 [8.52] dB) group was significantly lower than in the FGM (18.32 [13.44] dB) group (P < .002). The mean postoperative follow-up time was 31.5 and 34.7 months for HAFGM and FGM groups, respectively. No difference was observed between children 10 years or younger and children older than 10 years. In the 2 groups, no postoperative complications were observed. The location of the perforation was not found to be a factor indicative of failure. The success rate of HAFGM is superior to that of FGM alone. Hyaluronic acid fat graft myringoplasty can be performed as an office-based procedure using local anesthesia and requires no hospitalization. Because of its substantial advantages, HAFGM could be considered as the first choice for the reconstruction of a dry TMP in the pediatric population.

Hyaluronic Acid Fat Graft Myringoplasty: An Office-Based Technique Adapted to Children

Hyaluronic Acid Fat Graft Myringoplasty: An Office-Based Technique Adapted to Children

Hyaluronic Acid Fat Graft Myringoplasty&lt;subtitle&gt;An Office-Based Technique Adapted to Children&lt;/subtitle&gt;

To evaluate hyaluronic acid fat graft myringoplasty (HAFGM) for different tympanic membrane perforation (TMP) sizes and to compare its success rate with that of the underlay and overlay techniques. Prospective study. Tertiary care pediatric center. Two hundred eight children aged 4 to 16 years (mean age, 11.84 years) with TMPs. The HAFGM is a new technique for TMP repair in an outpatient pediatric population using local anesthesia. All the patients in groups 1 (underlay) and 2 (overlay) were operated on using general anesthesia, whereas group 3 (HAFGM) was operated on at the outpatient office using local anesthesia. Postoperative status of the eardrum, hearing improvement, and incidence of complications. Patients with TMP were divided into 3 groups: group 1 had 75 patients; group 2, 65; and group 3, 73. The global success rate was 87% in group 3, with no difference with the remaining 2 groups. Successful closure of different TMP sizes was the same for the 3 groups. Postoperatively, air-bone gap improvement was better for group 3. No bone conduction threshold worsening was noted. The mean duration of the operative procedure was 65, 74, and 18 minutes for groups 1, 2, and 3, respectively (P=.02). Mean postoperative follow-up was 20.7, 17.5, and 14.6 months for groups 1, 2, and 3, respectively. Identification of the anterior perforation rim is mandatory to perform HAFGM. The HAFGM did not require hospitalization for pediatric patients. It had the advantage of being feasible in children using local anesthesia. Its success rate was comparable with that of conventional techniques.

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

Hyaluronic acid fat graft myringoplasty (HAFGM) is a new technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aim to evaluate the HAFGM on different TMP sizes, to compare the success rate of HAFGM with the underlay and overlay techniques, and to assess the hearing improvement at one year postoperatively. Prospective study. Patients were divided into three groups depending on the patient's choice of technique: HAFGM (group I), underlay technique (group II), and overlay technique (group III). Perforations were classified into four grades. Postoperatively, the status of the eardrum, the improvement of hearing, and the incidence of complications were the main criteria for measuring outcome. Distribution of TMP was 131, 63, and 52 in group I, II, and III, respectively. Global successful rate and successful closure of the grade I, II, III, and IV were the same for the three groups. Postoperatively, no worsening of bone conduction threshold was noted. Air-bone gap (ABG) was statistically similar for the three groups. No complications were noted for group I. The mean duration of the operative procedures was 16, 65, and 74 minutes for group I, II, and III, respectively (P = .02). The mean postoperative follow-up was 18.7, 20.6, and 15.5 months for groups I, II, and III, respectively. HAFGM success rate is comparable to that of the underlay and overlay techniques. Furthermore, it requires no hospitalization and avoids the difficulty of overlay and underlay tympanoplasty.

Hyaluronic acid fat graft myringoplasty: how we do it

Dear Editor, Tympanic membrane (TM) perforation is most commonly a result of infection, trauma, or the sequelae of tympanostomy tube insertion. Although 88% of traumatic perforations of any size heal without intervention, the remainders become chronic and require treatment.1 Without closure, morbidity may include hearing loss, chronic otorrhea and cholesteatoma formation.2 These tympanic membrane perforations can be repaired surgically; however, doing so requires a general anesthesia which is often protracted and/or hypotensive, and which can represent an unacceptable risk in older patients.3 Day-stay surgery has become an integral part of modern otolaryngology. Myringoplasty under local anesthesia is a short, simple, cost-effective and minimally invasive technique compared with traditional myringoplasty.4 The purpose of this prospective clinical trial was to evaluate the success rate of the Hyaluronic Acid Fat Graft Myringoplasty (HAFGM) performed under local anesthesia as an outpatient clinic procedure and to discuss the utilities and advantages of this new procedure described by the author.